Ukraine NCI’s Oleksandr Stakhovskyi: “We are fighting for the truth”

Oleksandr Stakhovskyi, a urologist and oncologic surgeon at Ukraine’s National Cancer Institute, is staying in Kyiv to treat cancer patients as the Russian invasion continues.

“We still have many patients inside Kyiv who need some oncological help. It’ll be either consultations, telemedicine, or chemotherapy that we currently provide at the National Cancer Institute—but we don’t know what will happen tomorrow,” Stakhovskyi said to The Cancer Letter. “If tomorrow it’s going to be bombing of Kyiv, and some bombs fall next to our institution, we will not be able to proceed with chemo.”

Men between the ages of 18 and 60 have been banned from leaving Ukraine, leaving behind a team that consists predominantly of male oncologists. They are doing their best to support cancer patients while anticipating the day when their medical skills will be needed for front-line wartime care. 

“A majority of doctors will stay within Kyiv, waiting for the moment their help will be needed, but praying that this help will never be needed,” Stakhovskyi said. 

Most patients have been discharged from Stakhovskyi’s institution, but a handful of them aren’t able to leave because their homes have been bombed, or because they’re from eastern Ukraine, which is facing more violence at this time. Stakhovskyi said he and his colleagues have been sleeping at NCI. 

“It’s sometimes safer to stay in hospital with your colleagues than back home by yourself,” Stakhovskyi said. 

Basic medical supplies and drugs are available, mostly thanks to coordinated humanitarian aid efforts, especially between Ukraine and Poland. But at Ukraine’s NCI, oncology care has been pared down to immediately necessary treatments and online consultations. 

“Basically, we are not able to give them any care,” Stakhovskyi said. “For the last couple of days, we started in Kyiv in National Cancer Institute chemotherapy, for patients who can come in, receive chemo, and go back home. We consult them online. The majority of our doctors are currently consulting patients via social media or phone number, email—online consultations.”

Cancer care is, at the moment, very location-dependent, Stakhovskyi said. Priorities look a lot different in eastern Ukraine than in cities further west. 

“It depends, first of all, on the primary risks. So, if your city is under fire, nobody’s caring about oncology,” Stakhovskyi said. “At this moment, we’re trying to move patients to more safe places. 

“So, to move them more western, and to Kyiv, over this line, which you can draw through Ukraine by the Dnieper river, which is basically dividing Ukraine into two parts. According to this river, we have the eastern part and western part. We know right now that all the western cities, they are more safe, so more oncological patients will find help there.”

Some patients, including NCI’s entire pediatric oncology ward, have been evacuated across the border into Poland. 

“People are putting everything on the table,” Stakhovskyi said. “Whatever they will do, they try to volunteer, they try to help—if not with weapons in their hands, at least with a car, with food, with petroleum, sending money to the army. It’s great to see how the nation united against one opponent, against Russia.

“We are optimistic. We are fighting for the truth. So, they’re not going to succeed.”

Stakhovskyi spoke with Alice Tracey, a reporter with The Cancer Letter on March 3. 

Alice Tracey: How is the conflict in Ukraine affecting cancer care and oncologists? 

Oleksandr Stakhovskyi: NCI is a leading structure and we are working close together with other regional oncological centers. 

So, in Ukraine, it’s a little bit separated. Oncology patients are receiving their oncological care in oncological centers, and those are in every Ukrainian region. Basically, you have the region around three, four million people and you have an oncological center in the middle, which is related to the big city.

In Kyiv, there are two—there is a local Kyiv one, and our facility, which is called National Cancer Institute. And as I know, from today, or even for the last seven days, basically there was not routine work done within these facilities.

I would say most likely a couple of western oncological centers, they probably did have some surgeries, but in Kyiv or in major big cities where this war is happening now, there is nothing with oncological patients. Basically, we are not able to give them any care. 

For the last couple of days, we started in Kyiv in National Cancer Institute chemotherapy, for patients who can come in, receive chemo, and go back home. We consult them online. The majority of our doctors are currently consulting patients via social media or phone number, email—online consultations.

But if we talk about surgeries, for example, and I’m a surgeon, first of all—it is basically on pause right now. It’s impossible to do because we are in a city where they bomb us every day and our OR theaters are usually on the upper floors. So, it’s quite dangerous to do any kind of surgeries. And usually oncological surgeries are not that urgent. 

So, we can pause, we can see what will happen in the next couple of days, and then figure out who will need surgery now, who may wait for their surgery due to specific location, like prostate cancer may be delayed, for sure, or we can send somebody west to those centers which are not under that kind of attack and where it can be done more safely.

It’s very hard to calculate the number of people affected because, I mean, I’m sure in Kharkiv, nobody’s going to work right now at all—the whole city’s bombed for the last three days and we are seeing this bombing during the daytime. So, I’m sure nobody’s caring about oncology at the moment.

It sounds like it’s very much on a city-by-city basis and also on a patient-by-patient basis, just doing what you can. You said that you’re communicating with people via social media and doing telemedicine—has the internet connection been good? Have you been able to stay in touch with people?

OS: I mean, yes. Luckily, for the last seven days, we are still with internet and with all our communication programs, like WhatsApp, Viber, Telegram, they’re still working. 

That’s basically that’s how we get our information. Basically nobody’s watching TV right now. Everything is done through telephones, through iPhone. For doctors, for sure. So, doctors usually do that. We are chatting through our institution, that’s how we’re communicating with each other.

I’m interested also—you said things are very different depending on the city you’re in? That some cities are in a lot more danger?

OS: It depends, first of all, on the primary risks. So, if your city is under fire, nobody’s caring about oncology, obviously in Kyiv it’s a different situation. 

We know we are kind of a goal, we know that Russians would like to take Kyiv, but since the majority of doctors who are in the city—I mean, obviously we have lots of female doctors, but let’s face the truth, that females may travel with kids away since we’re in this war status of Ukraine. 

Males from 18 to 60 are prohibited from leaving the country. So, you have a major number of oncologists, and they are majorly male. Unfortunately, we have lots of males, so they’re not able to leave the country. 

So, then if you go down to the specialists, and if you will try to get into his head, I mean, he was studying to be a doctor for a long, long time, and now he’s an oncologist, a surgeon, or chemo, radio.

There are definitely numbers of people who are taking weapons and going to this territory military units, and basically working as soldiers. We have those. In the National Cancer Institute, we are super specialized in every field—like urology for me, like Andrew [Andriy Beznosenko, chief medical officer, NCI Ukraine; president of Ukrainian Society of Medical Oncology] who was talking to you before, he’s in pathology, we have all these gynecology guys, and very specific specialists, highly trained by fields. 

So, they prefer to stick to medical facilities. Luckily, there are not currently any battles within the city, so there is not a huge number of injured or killed people in care. So, there is no work for us being, for example, a surgeon or even a medical doctor or medical personnel, within these military medical facilities which are organized within the city.

So, we can go to work, but at work, we are discharging patients [who] were in clinic. They’re postsurgical—we discharge almost everybody. We still have two or three patients, maybe up to 10, who are not able to leave [for] home because their home is destroyed. Those guys stay with us—or somebody will be from the eastern part of Ukraine, like from Luhansk, where basically they started the conflict. 

Those guys literally are not able to go back home, because they’re stuck in our institution and we are not able to kick them out. So, we are working as a hospital. That’s also a difficult situation.

But what I’m trying to say to you is that a majority of doctors will stay within Kyiv, waiting for the moment their help will be needed, but praying that this help will never be needed, that this conflict will not touch Ukraine.

Then you go to the eastern parts, where all these affected cities, like Kharkiv, for example, which is bombed for the last three days, and we have all these awful videos from that city—I’m sure that nobody’s caring about oncology at all. I don’t know the status of our oncological colleagues from there, but I believe they are trying to escape Kharkiv, to move to Kyiv or to other western cities.

At this moment, we’re trying to move patients to more safe places. So, to move them more western, and to Kyiv, over this line, which you can draw through Ukraine by the Dnieper river, which is basically dividing Ukraine into two parts. 

According to this river, we have the eastern part and western part. We know right now that all the western cities, they are more safe, so more oncological patients will find help there.

In terms of Kyiv, it’s a big city, it’s usually around four or five million people. So, we still have many patients inside Kyiv who need some oncological help. It’ll be either consultations, telemedicine, or chemotherapy that we currently provide at the National Cancer Institute—but we don’t know what will happen tomorrow.

If tomorrow it’s going to be bombing of Kyiv, and some bombs fall next to our institution, we will not be able to proceed with chemo. Doctors majorly stay in the hospital. 

With my colleagues here for the last five days, we can go home, but when you go back to hospital, it’s sometimes safer to stay in hospital with your colleagues than back home by yourself. It’s kind of frustrating to stay in a flat when your city is under attack.

I imagine that the travel part could be dangerous, too.

OS: Yes, we are not supposed to travel at night at all. I don’t know how to say it in English, but yes, you usually have limited traveling time during the night.

How are supplies—drugs, medical supplies? Are they limited?

OS: I can tell you officially, and I can tell you unofficially. So, we have a pediatric oncology department, and we were able to evacuate all of them to Poland, because Polish hospitals were able to accept our oncological patients—children patients. 

We were happy to do that a couple days ago. Yesterday, the last portion of kids were traveling to western Ukraine and from there to Poland, and this is good. So, we are not keeping kids right now, in terms of supplies.

I mean, we have basic supplies in Ukraine right now. We have lots of volunteers. I personally have a number of professors from Canada, the States, from Germany, from France. The guys I was talking to before I was taught by, and everybody’s sending us emails, do we need need any help?

And a number of businessmen from Ukraine, they created a hub somewhere in Poland where you can just send your medications, any help, to the hub, and that hub will accept, and then send it exactly to the point in Ukraine where it’s needed the most.

Pharmacies are working to midday, the first half of the day. So, still some basic medicines can be bought in Kyiv—definitely Kharkiv, those bombed cities, need more medications, but within Ukraine we are able to bring it there.

Lots of volunteers, you can’t even imagine how many volunteers are united right now. They are trying to send medications, trying to fulfill those gaps when something is needed and somebody is eager to give it. They are using their own cars and bring the medical supplies where they will be needed.

In Kyiv, it’s okay right now, because we are not having these big air strikes, but we believe if this continues and Kyiv becomes a battlefield, it will be needed here from the other side. I know all my friends, or friends of friends, who are sending humanitarian help to Ukraine. That’s how my friends say, who know this situation from eight years ago, when Ukraine was receiving lots of help from the outside, because of war at Donetsk.

We received lots of humanitarian aid, which was really close to expiring. Imagine you are a hospital somewhere in Europe or whatever, and you have a number of medications that are close to expiring, but not yet. And for you, it’s a very good thing to do to participate in humanitarian help—you’re getting rid of your close-to-expired medications.

We still have two or three patients, maybe up to 10, who are not able to leave [for] home because their home is destroyed. Those guys stay with us.

Sometimes they need it. Sometimes it’s not the stuff you really need on the battlefield, because it’s really specific what you need on the battlefield. You need gauze, you need stuff to stop the bleeding, but you sometimes don’t need other pharmacy stuff like anti-hypertensives for those with diabetes, because those guys are not in the field with weapons. 

I mean, Ukraine is currently receiving lots of help, because the world would like to help, and it’s really touching. But sometimes, the logistics are really tough—nobody was prepared for this.

I imagine it takes so much coordination.

OS: Yes, it’s not easy, but people are putting everything on the table. Whatever they will do, they try to volunteer, they try to help—if not with weapons in their hands, at least with a car, with food, with petroleum, sending money to the army. 

It’s great to see how the nation is united against one opponent, against Russia. It’s really nice, but it’s tough.

Well, thank you for making the time to talk to me, I know that you’re incredibly busy. I really do appreciate it and I hope that you and your family are safe.

OS: Lots of people send their families away while staying here. That’s how, at least, we can focus on what the problem is, because, you know, it’s very hard to keep your families next to you and then to deal with patients and organize hospital care for the injured. It’s very hard to combine the two. 

So, the guys who I know who are still stuck in the hospitals usually send their families to western Ukraine, or even Poland. At least we are not worrying about that part and we can focus on our work.

Well, thank you. We’ll hope everything will be good. I mean, we are very positive we’ll stay on our land. We are optimistic. 

We are fighting for the truth. So, they’re not going to succeed.