After ferrying her son to safety across the Hungarian border, Nataliia Verovkina has returned to Kyiv to resume treating cancer patients.
When she last talked with The Cancer Letter two weeks ago, Verovkina, a medical oncologist and research fellow at Ukraine’s National Cancer Institute, was in Vinnytsia, a city four hours southwest of Kyiv, on her journey west (The Cancer Letter, March 4, 2022).
“My son now is with his grandpa and grandma in Munich,” Verovkina said March 17, calling at 5 p.m. local time from the cancer hospital after completing her clinical duties for the day.
“I returned to Kyiv by train. I really know that my son is in safety,” she said. “I feel much better when I return to my work, feeling useful for the people helps to cope with this constant stress.”
In Kyiv, the NCI continues to be operational, with no damage to its facilities, and oncologists are able to provide chemotherapy. Medical supply lines, although prone to interruption, also appear to remain viable at this writing.
That could change anytime, said Verovkina, who also serves as an ambassador for the European School of Oncology.
“It’s really hard to cope with this, because there are many air raids in the day, at night, so you’re constantly under distress; but maybe we get used to them, unfortunately,” she said.
If the crisis in Kyiv worsens, aid networks for cancer patients will need to play a central role in providing relief and essential supplies—Verovkina’s department sees between 40 to 60 patients daily, and some cancer patients do not have evacuation options.
There are immediate unmet needs: many Ukrainians seeking health care in neighboring countries may not have clinical documentation, and require a lifeline to physicians in Ukraine who have access to their medical histories.
The recently launched Special Network for Ukrainian cancer patients—led by the European Cancer Organisation, the American Society of Clinical Oncology, and the World Health Organization—can help facilitate this (The Cancer Letter, March 11, 2022).
“I think that communication and direct communication will be very helpful, and building some networks on a regular, constant basis in consultation, maybe building some closer relationships, something like this, I think it will be good with American and European colleagues,” Verovkina said. “But what will happen later on? We don’t know.
“Maybe we will really require some humanitarian help,” she said. “So, we will see how the situation will develop.”
A video of this conversation is posted here.
Verovkina spoke with Matthew Ong, associate editor of The Cancer Letter.
Matthew Ong: Thank you so much for speaking with me again, Dr. Verovkina. How are you doing?
Nataliia Verovkina: Hi Matt. I’m fine, thank you. At least I’m doing my job. I’m returning home, I see my husband and I really know that my son is in safety. So, I think I feel that I can control this situation better than three weeks ago.
That’s right, that was three weeks ago when we spoke. How is your son? And what about the rest of your extended family?
NV: My son now is with his grandpa and grandma in Munich. They stayed here for a while and we’ll see what happens later.
Now, he’s attending online school lessons. These lessons are provided by his college here, from Ukraine, so he’s constantly attending his online lessons, and staying with grandpa and grandma.
So, I’m quite happy to hear that he is continuing learning and he’s quite happy. But he’s missing me and daddy.
I’m just so glad to hear that he’s safe and that at least you have that peace of mind; right?
NV: Yes.
I’m amazed and really awestruck, honestly, that you drove your son to safety in Western Ukraine, and then you drove back to Kyiv. Is that what you did?
NV: Yes. It may be quite strange, but as you know, due to the military state, the men are not allowed to leave Ukrainian borders. And I feel much better when I return to my work, feeling useful for the people helps to cope with this constant stress.
Yes, we realized the stress and the danger of constant air raids, and we realized that we are living under the constant threat, but personally, maybe mentally, it’s easier to cope with all these terrible situations when you are helping people, when you are doing what you can do best. So, I think now I feel better.
I feel that I can control my life, maybe I can help more vulnerable people, such as our oncology patients, because many of our patients left Kyiv, but many patients stay here, because they have relatives that they cannot leave—for example, disabled people who cannot move, older people.
There are many reasons why people stay at their home. Simply to leave their home is the tragedy for many people, and these people have to continue their vital treatment of oncology. So, they’re doubly hit by oncology diagnoses and by this war. So, we try to help them.
What we can do? Currently we can help them to provide chemotherapy and we are trying to help and do our best every day. So, now we have daily clinical routines, we’re seeing 40, 50, sometimes 60 patients.
Me and my colleagues, because many of my colleagues—doctors, nurses—come in every day to provide oncology services that are possible in this condition. And currently we are providing almost all chemotherapy that we can do.
What is the state of your hospital, the NCI? Is anything damaged?
NV: Fortunately, no. Our hospital is not damaged and hopefully won’t be damaged. So, it works. Our managers are doing their best—we have light, heating, we’re supplied with essential medication.
From time to time, we have interruption for some medication, but then, we’re receiving it. So, situation differs from day to day, but we have almost all we need to provide chemotherapy; almost all. So, many volunteers, many pharma, and we also had medication in our stock, so now we can provide patients with essential chemotherapy.
All of us abroad, we’re watching the situation in Kyiv on TV; we’re watching the situation in Mariupol, which is horrendous. But can you tell us what’s what it is like in Kyiv right now?
NV: In general, for the first time, Kyiv is relatively safe. Yes, you can see long queue to the pharmacy, or for example, for some supermarkets—not all are working—but you have access to products.
So, we have water, we have heating, electricity in our homes, except the homes that were hit by air raids or something like that. But the majority of buildings in Kyiv are in good conditions. So, we see many people.
Of course, here is much emptier than in the normal situation, but you can work. But we’re allowed to leave our homes only from 7 a.m. to 8 p.m., for example. From time to time, for example, like yesterday, we were not allowed to leave our homes.
So, we have to stay at home or in a shelter in case of air raids, and it’s really hard to cope with this, because there are many air raids in the day, at night, so you’re constantly under distress; but maybe we get used to them, unfortunately.
Do you have a shelter that you go to during air raids, or does your home have a compartment that is underground that is safe?
NV: My home has parking, and we can go here and stay here, or sometimes we decided to stay only in the corridor, because we have two walls, because it’s too hard—I live on 18th floor, so it’s too hard to go up and down, so we have chosen to stay for whole night in the shelter or stay at home and just go to the corridor.
For the first five days, we slept in [the] parking [facility], and then we decided not to do this, because it’s really exhausting.
It’s cold!
NV: That’s why we decided to go to the corridor. So, I think some people live in a subway, in the shelter for weeks, because they feel much safer there, for example. It’s dependent on each individual’s situation.
I see. And you mentioned that you see 50, 60 patients or more a day; right?
NV: Not personally me, but all my colleagues, because I’m not only one medical colleague who works. Almost all my colleagues from the chemotherapy department come every day.
For example, each of us, daily, see from 10 to 15 patients. In some [departments], it’s 40, 60 patients a day; depends on the day. Our hematologists are also consulting the onco-hematology patients every day.
So, patients with solid tumors and onco-hematology patients—[with the] exception of bone marrow transplantation—just daily chemotherapy, we’re providing these services daily, on a daily routine.
What is the state of your patients? I mean, there’s a war going on. Are you also treating non-cancer patients?
NV: It depends on stage because some patients, we’ve been treating for a long time, so they know what they want, they are instructed, they’re used to live with the disease, they know their prognosis. This is easy.
And also it depends because many patients from Kyiv suburbs—for example, today my patient came, she was evacuated from Hostomel, so she has to cope with the stress after this terrible situation for two weeks, and then she comes for her treatment. So, she was scared, but now she’s coping with this well. So, she decided, after two weeks off to rest, to continue her treatment and it’s very good for me.
Other patients are quite calm. So, they’re coming and planning to come to us in the three weeks. So, it depends from person to person, from the health situation, on the diagnosis and prognosis of each individual patient.
Really, patients are very grateful for us, many of them. So, now maybe we’ve really started to understand each other better, to help each other. It’s not only doctors, but every person in Ukraine which I see—I can tell from my personal experience, I can tell what I see—so from my side, I see many people are really grateful, really try to help each other and also patients, because they realize this situation.
Sometimes, really, prognosis is not very good. It’s really hard to talk with patients, especially palliative patients. I have this experience last week when our treatment stopped helping and this patient should receive only symptomatic and palliative care; it’s really hard.
She’s afraid because what I have to do, it’s a quite stressful situation because she didn’t know who to call in an emergency, so it took a very long time to explain where to call, what will happen, especially when we all live in this uncertainty.
So, it’s really double stress if our treatment doesn’t help. And in this situation, sometimes it’s very hard, really.
It sounds like you have patients coming into Kyiv from other parts of Ukraine, right?
NV: Some patients who come from Kharkiv, which was terribly bombed. Some people come from Kyiv suburbs, not from Kyiv, because Kyiv is a huge megalopolis, and many people live in a Kyiv suburb and used to work or come to Kyiv. So, on the individual transport, for example, they come. It depends on the situation.
We don’t know what will happen tomorrow or in a few hours, so we are just looking and listening on the news and doing what we have to do, some rules; we have to follow them strictly now.
I’m seeing efforts to evacuate people out of Kyiv, but I’m amazed to hear that there are so many cancer patients who are still remaining there. Are they choosing to stay, or maybe they don’t have the option to leave?
NV: So, some patients are choosing to stay. Some patients don’t have options for evacuation.
Some patients have disabled relatives, for example, and they cannot leave them, they can’t leave mom for example, or dad, so they stayed with the relatives and come to ask for treatment. Kyiv is very big, so we have a million people living here normally.
So, we see many people every day.
Are the medical supply lines for Kyiv still open?
NV: As I said before, we have medication. Many volunteers helping us. We see some interruption with some drugs, but then we see those drugs, for example.
The situation differs from day to day. We cannot make any prognosis. But now we’re supplied with essential medication, and all chemotherapy drugs, and drugs for supportive care.
This may sound like a random question, but it’s from my colleagues—you might have seen that we ran your NCI’s “Victory” mosaic as the cover art of our first Ukraine-focused issue as a symbol of the Ukrainian will to overcome. Is the mosaic still there? Is it okay?
NV: Yes.
Good. I forgot to ask: you made the drive out west and you drove back. Could you describe what that drive for you was like?
NV: I can reach my job by my personal car, for example.
And now, I have a possibility to stay in the hospital. Sometimes it’s much safer to sleep here, and then return to my job, so it depends on the situation. Sometimes I stay here, sometimes I live at home.
When you drove your son through so many hours and so much distance, what was that drive like? Was it safe? Was it hazardous?
NV: Yes, it was relatively safe, because they left Ukraine by the Hungarian border. I haven’t left Ukraine. And then, I returned to Kyiv by train.
Many U.S. and European cancer organizations have created this new network, a special network, to support Ukrainian cancer patients. What advice do you have for them and what else can they do right now to help you and your patients?
NV: It’s hard to say in one sentence, because there are many categories of patients who really require help. Many organizations are helping children [in] childhood oncology.
So, they have been taken care of by SIOP and many organization. Many of our patients who immigrated, fled outside Ukraine—I mean, Poland, Romania, for example, and these countries try to help them as much as they can, but of course, they have the oncology patients.
So, maybe some networks are more close with our hospital to easily communicate, to provide some medical documentation, because many patients left the country without any documentation, I guess, and I believe this is a problem for my colleagues outside Ukraine—for example, to build some network, maybe Zoom conference, something like this, to contact directly hospitals, and maybe some consultation with oncologists who are left in Ukraine.
This is for patients who left Ukraine. For patients who stay in Ukraine, currently, we have drugs, but what will happen later on? We don’t know. Maybe we will really require some humanitarian help, either chemotherapy or targeted therapy. So, we will see how the situation will develop.
So, there are three huge parts, patients who left Ukraine, patients who live in Ukraine, and medication supplies—currently not so acute as it seems—but what will happen, we’ll see.
So, I think that communication and direct communication will be very helpful, and building some networks on a regular, constant basis in consultation, maybe building some closer relationships, something like this, I think it will be good with American and European colleagues.
And also, I would like to thank all organizations, for all of my colleagues outside Ukraine, for huge help and support that we are really feeling that really helps our patients and us. So, thank you very much.
What is the morale like in Kyiv right now? What are you seeing? Are people feeling more hopeful about how the whole situation is progressing?
NV: We are quite optimistic and really believe that we will stand, and we will win.
That’s great to hear. Did we miss anything? Do you have any other comments that you think are important to get across to our audience?
NV: No, thanks. I don’t feel that we missed something.
Well, thank you so much for speaking with us and taking the time to do this again.
NV: Okay. Thank you very much.
