Can you imagine, as a radiation oncologist, you have to shelter your patients in a Co-60 vault to protect them from missiles, provide them with water by melting snow, feed them, keep them warm by using a backup power generator, and evacuate them just two hours before the missile destroys the radiation oncology department?
What if, as a radiation therapist, you volunteer to live in the radiation oncology department 24/7 to scan wounded patients using a CT simulator?
Imagine, as a medical oncologist in the busy cancer center, treating double the usual volume of patients—and continuing to receive calls from patients from the train stations, requesting appointments to resume their chemotherapy treatment as their houses were bombed and they had to flee to a safer area with no belongings.
Can you imagine, as a nurse caring for cancer patients, worrying about your mom you could not connect with for three weeks, knowing that she is living in the basement, without water, heat, electricity in a constantly shelled area?
Imagine performing a surgery while worrying about your son and husband, who are fighting against the Russian invaders.
That’s not some dystopian novel. That’s the horrifying reality Ukrainian cancer practitioners are living through right now. And that’s because, in the 21st century, Russia decided to start the imperialistic full-scale invasion of Ukraine.
The Russian invasion of Ukraine, on Feb. 22, 2022, started an absolute horror of destruction and chaos for everyone in its path, killing tens of thousands of civilians—including many children.
Many more have been wounded, and approximately a quarter of the population of Ukraine is displaced as of July 8—that’s 5.5 million as refugees in Europe, and 6.3 million as internally displaced due to the war.1
The Russian army is obliterating Ukrainian cities, targeting civilian infrastructure with missiles, deliberately damaging and destroying hospitals and clinics, in violation of the Article IV of Geneva Convention.2
According to Ukraine’s Minister of Health, Viktor Liashko, during the 100 days of war, more than 600 healthcare facilities sustained damages, 105 of which were rendered beyond repair. In addition, the Russian army deliberately targeted and damaged around 450 pharmacies and 200 ambulances.3
Even if the war stopped today, the inflicted damage to the healthcare infrastructure will last for years to come without world’s continuing support.
How can you help?
A team of oncology practitioners in the U.S. and Australia organized Help Ukraine Group (HUG) to connect with cancer care providers in Ukraine and establish a feedback loop of determining the need and providing support for the need.
We interviewed Dr. Andriy Beznosenko, chief medical officer of the National Cancer Institute in Kyiv and the president of the Ukrainian Society of Medical Oncology.4,5
“There is an acute need for chemotherapy medications and disposable medical devices. The supply chains became disrupted by the war, and the hospital is running out of medication,” said Dr. Beznosenko.
Many medical warehouses were destroyed or are unavailable due to logistical issues, airports are not operational, many bridges and highways damaged. Tender agreements are challenging to procure during the war. Disposable devices and chemotherapy medications are needed in almost every radiotherapy center.
Ruslan Zelinskyi, the president of the Ukrainian Association of Medical Physicists, and Oleksandr Sakharenko, counsel of Aretera Public Affairs, collected the data on the radiotherapy needs.
HUG members petitioned the vendors to donate devices and successfully applied for a Union for International Cancer Control (UICC) Solidarity Fund grant to pay for devices that were not donated.6
Ukrainians are grateful to Orfit and CIVCO for donating the radiotherapy devices. The first shipments of radiotherapy immobilization devices have already been delivered to busy cancer centers in Ukraine.
Dr. Beznosenko has collected the list of pharmaceutical needs from all the cancer centers in Ukraine. HUG members shared the list with ECO/ESMO/ASCO with a call to run the “Support Ukraine” fundraiser with their membership and the industry to provide help for Ukraine in the time of war.
Image 2,3,4: Damage to Kharkiv Regional Oncology Center.
Ukraine, a country of 44 million population, has only three PET/CT scanners, all in Kyiv—with only two of them functioning after the war broke out—so the patients from all over Ukraine have to risk their lives and travel to Kyiv for a diagnostic or follow-up CT scan.
Many patients just abandon the scan altogether. According to the European Association of Nuclear Medicine, there should be at least one PET/CT scanner per 1.5-2 million people, which would translate into 22 scanners for Ukraine.
In an effort to reduce oncologic morbidity and mortality as a result of the war, Dr. Beznosenko and Dr. Oleh Duda, deputy chief of surgery at Lviv Regional Cancer Center, are calling on PET/CT scanner and cyclotron vendors to donate at least one PET/CT and cyclotron to the Lviv cancer center.
Upon Dr. Beznosenko’s request, HUG members are organizing training opportunities in the U.S., Canada, and Australia for the Ukrainian female physicians of various oncology specialties (radiation oncologists, medical oncologists, surgeons, anesthesiologists, pathologists) and medical physicists. These training opportunities are offered to female doctors, because Ukrainian men between the recruitment age of 18-60 years old are not allowed to leave the country.
Please contact the authors if your institution is willing to provide funding for a visiting scholarship. Nelya Melnitchouk, through her 501(c)(3) non-profit organization, Global Medical Knowledge Alliance (GMKA),7 has created a fundraiser to help collect funds to cover the travel and initial expenses for Ukrainian female physicians and physicists.8
Ukraine needs help in modernizing the training for radiation oncologists and medical physicists, as professional training in Ukraine is based on Co-60 technology, but more and more centers have transitioned to modern Intensity Modulated Radiation Therapy (IMRT), and the modern radiotherapy machines are either installed or waiting to be installed.
We are grateful to Elekta and Varian for organizing free online training courses for Ukrainians to help them transition to the modern therapy on the recently purchased equipment. HUG members are also creating educational materials for transitioning from 3D radiotherapy to IMRT and are grateful to Rayos Contra Cancer for donating training videos for us to translate.9
We call on professional organizations and cancer care institutions to help fund the training opportunities for Ukrainian oncology professionals.
Right: Bohdana Bachynska, of OKHMATDYT’s, treated a five-year-old boy who had a large wound on his back. Asked whether he was in pain, the boy responded: “I am holding on despite the pain.”
A team of Stanford medical and computer science students led by Solomiia Savchuk has created a TeleHelp Ukraine initiative to provide remote medical advice and mental health support for Ukrainians in Ukraine and Poland with the help of American doctors-volunteers and the team of interpreters.
HUG members are grateful to MIM Software Inc. for proving a free software license to host a MIM cloud DICOM repository for medical images from Ukrainian patients that further inform the video consultations.
This telemedicine effort urgently needs physicians of various specialties, including oncologists.10
We are grateful to Limbus AI Inc. for providing free licenses for automatic contouring software and RADformation for donating automatic 3D-planning, automatic contouring, secondary plan check, secondary MU calculation to Ukrainian cancer centers, which will facilitate streamlining the radiotherapy treatment planning workflow.
We call on all oncology vendors to provide their support, donate equipment and software, enhance support for equipment maintenance and service, and provide training. Ukrainians are grateful to all the vendors currently supporting Ukraine.
The Ukrainian cancer care system has been severely damaged by the Russian invasion, and it will take years to recover, even if the war were to stop today. It’s imperative that the effective cancer recovery plan in Ukraine is guided by precise coordination between governing bodies, professional organizations, patient organizations, multidisciplinary professionals, and industry.11
But all these efforts start with individuals, and individual power and will of Ukrainians to fight for their cancer patients is truly inspiring. You don’t have to be Ukrainian to help Ukraine, you just need to be human. Think about how you can help Ukraine today.
We are humanity of almost 8 billion: together we are strong, we can come together as a community and help the Ukrainian oncology professionals to be victorious over two evils: cancer and war.
Corresponding author:
Nataliya Kovalchuk, PhD
Clinical associate professor,
Stanford University
+1-507-269-6071
natkoval@stanford.edu
References
- https://reliefweb.int/report/ukraine/ukraine-situation-report-8-jul-2022-enruuk
- https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.33_GC-IV-EN.pdf
- https://moz.gov.ua/
- Kizub, D., Melnitchouk, N., Beznosenko, A., Shabat, G., Semeniv, S., Nogueira, L., Watson, P.J., Berg, K., Trapido, E.J., Espinel, Z., Shultz, J.M. Resilience and perseverance under siege: providing cancer care during the invasion of Ukraine. Lancet Oncology. 2022
- Kovalchuk N, Beznosenko A, Kowalchuk R, Ryzhkova J, Iakovenko V, Kacharian A. While Ukrainian Soldiers Are Fearlessly Defending Their Country, Ukrainian Oncologists Are Bravely Battling Cancer. Adv Radiat Oncol. 2022;7(6):100965. Published 2022 Apr 20. doi:10.1016/j.adro.2022.100965
- https://www.uicc.org/news/uicc-solidarity-fund-ukraine-opens-call-grants-qualifying-organisations
- https://gmka.org/
- https://www.paypal.com/donate/?hosted_button_id=QVHU9LZCX9X7J
- https://www.rayoscontracancer.org/training-programs
- https://www.telehelpukraine.com/i-want-to-help-1
- Price P, Sullivan R, Zubarev M, Zelinskyi R, Radiotherapy in conflict: lessons from Ukraine, Lancet Oncology, 2022 DOI:https://doi.org/10.1016/S1470-2045(22)00298-4
