In Ukraine, with a population of about 44 million, there are more than 1.3 million patients with cancer.
Approximately 160,000 new cases of cancer are diagnosed each year.1 In almost every region, there are local cancer centers; specialized oncologic centers are located in large cities. In Kyiv, highly specialized care for patients with cancer is provided by the National Cancer Institute, the Kyiv City Cancer Center, and several other centers.
Patients with cancer traditionally had access to all modern diagnostic methods, including biopsy, molecular genetics, and imaging modalities, such as positron-emission tomography–computed tomography. Patients had access to all types of cancer treatment: surgery, chemotherapy, immunotherapy, radiation therapy, and hematopoietic cell transplantation.
Sergey Kozhukhov, MD, PhD
Moreover, in recent years, cardio-oncology has rapidly developed in European countries and Ukraine.2 In 2016, the first cardio-oncology unit in Ukraine was formed at the M.D. Strazhesko Institute of Cardiology in Kyiv.3 Educational programs have been held among oncologists, hematologists, cardiologists, general practitioners, and pharmacists.4 Recommendations and standards of treatment for cardiovascular complications during antitumor therapy and in long-term follow-up were developed and implemented.5 Thus, a well-established system of medical care for oncologic patients was organized.
Dramatic Disruption in Cancer Care
This all changed dramatically on February 24, 2022, when a full-scale armed conflict began in the territory of Ukraine. What followed was a mass movement of the population to the safer, mainly Western regions of Ukraine. Part of the population rushed to the nearby located countries of Western Europe. As of March 16, 2022, it is estimated that approximately 4.2 million people have left for neighboring countries, and an additional 6.5 million people have been displaced within Ukraine.6
Simultaneously, our well-organized medical care system for patients with cancer was disrupted. In areas of active hostilities, care completely stopped.7 Several hospitals that provide cancer care were damaged, destroyed, or even closed. Extreme, life-threatening pressure exists for health-care professionals and patients. Warehouses of medicine were partially destroyed. A lack of medication and medical products exists, especially in the Eastern and the Southern regions of Ukraine.
At the beginning of March 2022 in Kyiv, according to the data of the National Cancer Institute and the Kyiv Cancer City Center, only short courses of chemotherapy were possible. In mid-March, many types of cancer treatment were restored, including some surgical interventions, given the critical need for life-saving cancer care.8
In the cancer centers located in Western Ukraine, medical care is still being provided. However, difficulties exist owing to the large number of displaced people; chemotherapy and radiation therapy are still provided on a limited basis. Some patients have crossed the border and receive care in neighboring countries. For example, children with cancer have been moved largely to Poland to receive their care.
ECO and ASCO Collaborate
On March 10, 2022, the European Cancer Organization (ECO) and ASCO held an important online meeting— the ECO-ASCO Special Meeting: Impact of the War in Ukraine on Cancer—with more than 200 participants. The ECO-ASCO Special Network on the Impact of War in Ukraine8 serves to accomplish the following goals:
Goals and Challenges for Community Organizations and Neighboring Countries
At the meeting, information was provided on the state of oncologic care in Ukraine, emphasizing that specific intelligence about cancer care needs to be continuously obtained to properly plan and mobilize resources. The representatives from Ukraine expressed their gratitude to all countries aiding Ukrainian patients. Here, we summarize the efforts, goals, and challenges that were discussed at the meeting by the various community organizations and neighboring countries.
Unfortunately, providing cardio-oncologic care has faded into the background.... Patients with cancer have limited access to diagnostic methods and biomarkers.— Sergey Kozhukhov, MD, PhD, and colleagues
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WHO Europe is convening partners and assisting on the ground in Ukraine. It is important to identify patients with cancer among refugees through questionnaires and pamphlets written in Ukrainian to inform them about the next steps regarding their cancer care. The EU and WHO are working together to transport people from Ukraine to receive care. The WHO is also working to help ensure that displaced patients do not bear the burden of treatment cost.
The European Commission’s Directorate General for Health and Food Safety expressed solidarity with all front-line health-care professionals working through this crisis. Coordinating efforts is key to maximize impact. Unity is needed from the entire EU for both sanctions and support. The European Commission is working to meet requests from Ukraine for aid: medicines, medical equipment, ambulances, and so forth. Three hubs have been created for the distribution of aid in neighboring countries. The Directorate General for Health and Food Safety and the Directorate General for European Civil Protection and Humanitarian Aid Operations are working together to coordinate the evacuation of patients in need of treatment, including children.
The European Society for Medical Oncology (ESMO) is seeking to support Ukrainian patients with cancer in its role as a professional organization for medical oncologists in Europe. This includes helping to place health-care professionals in touch with experts who can help in the provision of care and treatment for Ukrainians with cancer. ESMO also seeks to assist in the development of strategies to improve access to needed medicines, including collaborations with foundations and industry to meet Ukrainians’ needs.
The Ministry of Health in Romania is seeking to help with medical supplies to Ukraine. A hub has been created in North-East Romania to facilitate logistics and transportation. New legislation is being put in place to enable Ukrainian people arriving in Romania to benefit from medical assistance, including for cancer treatment.
For the Institutul Oncologic din Cluj-Napoca, a key issue is that many Ukrainian patients with cancer leaving the country do not have access to their medical records for the recipient country’s care providers to review. Romania expects increasing numbers of Ukrainian patients with cancer to arrive. The health system in Romania will require increasing support to meet this need. Support is also needed to provide accommodation and travel for these people, often women and their children.
After the end of active hostilities, it will be necessary to study the impact of military conflict on cancer-associated risk, morbidity, and mortality on the population that survived the war.— Sergey Kozhukhov, MD, PhD, and colleagues
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The Polish Cancer League has recommended a European database, with institutions offering treatment to Ukrainian patients with cancer. Such patients also need accommodation and resources to travel. Information to patients is a significant issue. Call centers in Poland are now operating with Ukrainian-speaking operators. Recommendations were made to have printed materials placed on the website of all relevant key nongovernmental organizations. Transportation of medicines to Ukraine faces legal problems, as some medications cannot be exported without specific arrangements.
The Fundacja Onkologiczna, based in Warsaw, started the OncoUkraine campaign, with a website collecting information in the Ukrainian language. E-mail addresses are provided to support patients in need. More than 1,000 users and 100 Ukrainian patients with cancer have asked for help via e-mail. A significant part of the need has been in women with breast or other gynecologic cancers. There is also a critical need for care for families of patients with cancer. Displaced women are often the only caregiver for their accompanying children. Treatment strategies are also different between Ukraine and Poland. Guidance is needed for Polish doctors in such cases.
From the Czech Republic
The Masaryk Memorial Cancer Institute noted that redistribution of refugees to other countries may be required, especially for highly specialized cancer care. They believed it is important to build a website for provision of cancer care to Ukrainian refugees across the EU, where key information can be found in a single place. In the Czech Republic, there is a contact point for refugees to ask for help and then to be sent to cancer centers, with a Ukrainian interpreter’s support. Again, a frequent problem is the lack of information on medical records and history.
For the Slovak League Against Cancer, key problems are in the identification of patients in need of urgent care and lack of access to patients’ medical records.
Provision of health care in Slovakia for arriving Ukrainians is currently free of charge. However, after 30 days, co-payments risk impact. Nongovernmental organizations such as the Slovak League Against Cancer are working on the ground to coordinate actions, but limited capacity in the Slovak health system exists. Transfer arrangements for patients to receive care in other countries may need more consideration.
For the National Institute of Oncology, documentation is a big issue, and there is also a lack of translators. Hungary has established a central interpreter line for oncology care providers to use in case of need. Capacity issues, for now, are in order. However, further intergovernmental efforts should be invested in the evacuation of patients with cancer from Ukraine.
Efforts From Other Organizations
This is only part of the information that was presented on the forum. With the assistance of various nongovernmental organizations, including those from the United States, and governments of countries that aid oncologic patients from Ukraine, a specific plan is being developed, starting with the formation of call centers to the provision of highly specialized oncologic care. Additional supplies of medical equipment and medicines are carried out with the assistance of commercial enterprises and charitable foundations. There are many ongoing issues that need to be addressed.
Other organizations have joined the ECO-ASCO Special Network on the Impact of War in Ukraine. On March 18, 2022, more than 300 organizations from around the world participated in the second meeting. Many agreed on the need for better, more efficient data collection from cancer centers in impacted countries. There is also a need for the community of oncologists, pharmacists, nurses, and patient organizations to share the intelligence they are receiving on the front line.
International support will be required for the reconstruction of Ukraine.— Sergey Kozhukhov, MD, PhD, and colleagues
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The organization Onco-Help.org was presented.9 This resource indexes informative materials and links within sections for Ukraine, Poland, Romania, Moldova, and Hungary, with translation to the Ukrainian language. Among the several issues and pressing needs emerging from the war in Ukraine, the Special Network has identified mental health and psychosocial support as important priorities for patients with cancer who are still in Ukraine or have migrated to neighboring countries. As a result, a consulting group aimed at providing psychological assistance to patients with cancer was created at the National Cancer Institute in Kyiv.
From Inside Ukraine
Many citizens have moved to Western Ukraine and are not going to leave the country. It is important to properly organize the provision of cardiovascular and oncologic care on site, especially in Western Ukraine. The websites of the Ministry of Health of Ukraine and the National Health Service of Ukraine regularly update information about cancer centers, including contact details. The logistics of the supply of medicines and medical products have been disrupted, but the Ukrainian government has simplified the procedures for the import of essential medical supplies. Ongoing work is focused on establishing contacts with cancer centers located in Western Europe.
Unfortunately, providing cardio-oncologic care has faded into the background, and patients receive consultations mostly online. Patients with cancer have limited access to diagnostic methods and biomarkers.
What do we need to do? In our view, we need to do the following:
The world is faced with a global problem. Armed conflict in Ukraine has led to the formation of a new front—the organization of necessary medical care for patients with cancer in a large-scale war. Restoration of an oncologic service in a country with a devastated economy will be directly associated with reconstruction of the entire public health system. After the end of active hostilities, it will be necessary to study the impact of military conflict on cancer-associated risk, morbidity, and mortality on the population that survived the war.
Through the evaluation of the experiences of countries that have gone through military conflicts, it seems that one important task to reduce oncologic morbidity and mortality in the country is the development of state programs for the prevention, screening, and early diagnosis of cancer. The unified efforts of all countries, their government and public organizations, charitable foundations, patient organizations, and commercial enterprises, are necessary to achieve this. The post-war period in our country may last for many years, and, undoubtedly, international support will be required for the reconstruction of Ukraine. The long-term medical and scientific impact will be studied in the years to come.10
Every patient has the right to live, and every patient has the right to medical care.
This perspective was originally printed in Kozhukhov S, Dovganych N, Smolanka I, et al: Cancer and war in Ukraine: How the world can help win this battle. JACC CardioOncol. April 25, 2022 (early release online).
Dr. Kozhukhov is Head of Clinical Pharmacology, Department & CardioOncology Center, National Scientific Center, “M.D. Strazhesko Institute of Cardiology,” Kyiv, Ukraine, and President of the International Cardio-Oncology Society (ICOS) Ukraine Chapter. Dr. Dovganych, Dr. Smolanka, and Dr. Kriachok are members of the Executive Board of the ICOS Ukraine Chapter. Dr. Kovalyov is a member of the Cardio-Oncology WG Ukrainian Association of Cardiology.
DISCLOSURE: The authors reported no conflicts of interest.
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10. Biondi-Zoccai G, Pirlamarla P, Sabouret P, et al: Cardiovascular scholarly challenges following the Russian invasion of Ukraine. Minerva Cardiol Angiol. March 28, 2022 (early release online).