A report on the ECO-ASCO webinar by Rachael Babin, Editor-in-Chief
We are now used to seeing young Ukrainian men on our screens, bestubbled with their suits swapped for khaki green. Dr Andriy Hrynkiv, a young Surgical Oncologist from the Lviv Cancer Center, appeared thus and delivered a detailed update in a style we have become accustomed to seeing from President Zelenskiy. Starkly contrasting his inset headshot taken in happier times, with tired eyes and a hastily draped Ukrainian flag in the background, Andriy gave us an avalanche of devastating facts in his medical update.
Notably, he informed us to his knowledge six doctors have been killed, paramedics have been taken prisoner by the Russian forces and the Mariupol Maternity and Children’s Hospital was deliberately attacked on orders direct from the Kremlin.
Mariupol is the most damaged city – the Mayor reports 90% of buildings have been destroyed. Andriy said it is now “the Aleppo of the Ukraine”. Over one thousand people – mostly women, children and the elderly – were sheltering in the Mariupol theatre which has been flattened by Russian shelling.
Iodine was now impossible to find in Ukrainian pharmacies due to fears of an imminent nuclear attack. This has impacted the treatment of thyroid cancer patients.
Fifty-five Ukrainian children become refugees in every minute of the conflict.
The Oncology Hospital in Kharkiv has been completely destroyed.
Healthcare professionals are working under extreme psychological pressure; they regularly experience threats to their lives.
Routine oncology care has essentially stopped throughout the country. Patients from the east have done their best to make it to the west – consults at the Lviv Cancer Center have increased dramatically.
Supplies are very scarce and logistical problems persist in most places.
Cancer in The Ukraine: Numbers at a glance*
From the IARC WHO Ukrainian Fact Sheet
Julie Gralow from ASCO, who chaired the webinar, thanked him for his report. Professor Richard Sullivan, Director of the Institute of Cancer Policy at King’s College London, UK, and member of the WHO Emergency Committee, then gave us a refugee update.
He reported that this is the biggest and fastest-moving refugee crisis Europe has ever experienced. The flood of refugees across the borders to neighbouring countries amounted to an “astronomical” 5% increase in their populations.
“The therapeutic geography of cancer care is very challenging” said Professor Sullivan, WHO Emergency Committee.
In Poland, there are 30 manned refugee centres and eight border crossing points. Richard confirmed that triage at the border crossings was basic, focused on helping traumatised children and the confused elderly.
Refugees are making their way out of the country in different ways. Some have driven to seek refuge with friends in other countries. Others are more vulnerable and crossing the border alone and on foot.
Currently, cancer care services in bordering countries were not overwhelmed however Richard expects this to increase exponentially once cancer patients have resolved more pressing social needs such as housing and employment as “refugees rarely present their cancer symptoms”.
He shared the sobering estimate that even “if the war ended today, it would take one to one-and-a-half years to recover cancer care in the Ukraine.” He reported that data from oncology clinics was very sparse and improving data collection needs to be prioritised to facilitate the correct allocation of funds. He reiterated that oncology is in no way a priority for the UNHRC and that specialty societies need to step up to fill this gap and provide treatments, navigation pathways and data. He wrapped up by pressing for progressive universal access to healthcare and oncology services so that no refugees are left behind.
We then heard specific updates on the situation in Romania and Poland. Dr Nicoleta Antone, a Medical Oncologist at the Cancer Institute Ion Chircuta in Romania, reported that 80% of cancer patients in Romania are treated at her centre which is close to the Ukrainian border. They received 11 patients from the Ukraine in the first week of the conflict – fresher data was not available but it was reported that these numbers have increased a lot in the subsequent weeks. Julie Gralow said these numbers were “the beginning of the trickle”. The patients received had a mix of malignancies across many tumour types and required both systemic treatment and radiotherapy.
Dr Antone described Herculean volunteer efforts especially highlighting translation services and the creation of the ‘Onco-Line’ phone support system for Ukrainian patients to call for help.
Number of New Cancer Cases in The Ukraine, 2020*
From the IARC WHO Ukrainian Fact Sheet
Professor Jacek Jassem, Professor of Oncology and Radiotherapy at the Medical University of Gdansk in Poland spoke next. He confirmed over two million refugees were currently in Poland and that cancer patients were most likely to seek refuge in Poland due to the similarity of the languages.
Of those 2 million people “many have or will have cancer.” He reported a shortage of anti-cancer drugs in the Ukraine and the stark reality that if medications can not be brought to the Ukraine, then patients will need to be relocated.
Once refugees’ immediate needs were addressed, that it was likely Polish cancer care services would exceed capacity. He reiterated the impossibility of flying out of Ukraine and noted that patients were being transported across the border and then flown to specialist centres around Europe.
Dr Laura Makaroff, Senior Vice President of Prevention and Early Detection at the American Cancer Society, presented an update on volunteer efforts and resources.
“We are honoured to provide support in any way we can,” said Dr Makaroff, American Cancer Society.
She detailed the many different resources being made available and reported that 11 calls to their dedicated phone service had been received, nine of which were from Ukraine. Twenty-one emails had also been received in the first week of launch with many more expected once refugees reach a place of settlement.
The Clinician Volunteer Corps was operating well with 123 active volunteers and many more expressions of interest being reviewed. She particularly highlighted the need for clinicians who speak Eastern European languages. ASCO and the American Cancer Society were working closely together on the Clinician Volunteer Corps and on the translation of resources.
“Your efforts are heroic and they give us hope”, Julie Gralow, ASCO.
The webinar concluded with final thoughts from Julie Gralow. She detailed ASCO’s official statement on the conflict and the resources ASCO have made available.
She asked everyone to “please stay engaged. We want to hear your comments, your questions and your suggestions.
“Volunteer, visit our resources and spread the word of this tragedy. Bring us all together.”
Julie concluded by thanking the speakers – “your efforts are heroic and they give us hope”.
The full webinar is 1 hour long and is available on demand at:www.asco.org/news-initiatives/current-initiatives/info-patient-dr-ukraine.
Reference: IARC WHO Ukrainian Fact Sheet. Access online here.
