• Posted June 9, 2023

Ukraine: The War on Cancer, Fought in a War Zone

Dr. Olena Postuypalenko was caring for patients at Kyiv City Clinical Oncology Center on Feb. 24, 2022, when her mother called to ask what seemed like an odd question: Has Russia invaded Ukraine?

"My mom called me and said, 'There are explosions. Has the war begun?' And honestly, at that time, I didn't believe it. I didn't understand what had happened,"said Postuypalenko, who specializes in onco-gynecology.

Postuypalenko's chief soon verified that the attack was underway. The hospital began sending patients home if they were well enough or leading them into an underground bunker, where they could shelter and keep receiving cancer care.

Postuypalenko wound up spending two weeks in the bunker, providing patients with chemotherapy and tending to them as the opening days of the war raged above them.

The hospital is located near the northwestern border of Kyiv, only about 4 to 6 miles from the fighting, she said.

"For those two weeks, every day we had explosions,"Postuypalenko said. "Sometimes between air raid sirens we could go out from the shelter, and we allowed the patients to go out from the shelter. But when we hear sirens, back in the shelter."

The war is now nearly a year and a half long. Ukraine has put up strong and unexpected resistance, pulling Russia into a grinding conflict.

But cancer is cancer, and Postuypalenko has no shortage of patients for whom to care.

Out of a population of 44 million, there are more than 1.3 million Ukrainians living with cancer and about 160,000 new cases of cancer each year, according to estimates.

Postuypalenko was part of a 10-person Ukrainian delegation that attended the annual American Society of Clinical Oncology meeting in Chicago last weekend. She and her colleagues came to learn, to share their stories, and to seek help.

One project the doctors promoted is a series of U.S.-Ukraine cancer medicine observerships, with different American cancer centers hosting Ukrainian doctors for a week-long information exchange.

"Ukraine needs more experience and expertise to improve health care, to improve cancer care,"said Dr. Rostyslav "Rosty"Semikov, a Ukrainian cancer researcher now living in Houston who is helping organize the observerships. "We want to make personal connections. I'm focused on having Ukrainians come to the U.S. and make connections with local people, local clinics, local doctors and nurses, which could bring experience and expertise into Ukraine."

The Ukrainian doctors also promoted direct aid to their medical centers, from pharmaceutical companies and from donors in the United States.

"All resources of our country are redirected to the Army because we want to survive,"said Dr. Arman Kacharian, lead for cancer control at the Ministry of Health of Ukraine. "We have to win this war to survive, and that's why it would be great to have some support in drugs and funding."

Kacharian lives in Kyiv, and he remembered being awakened by explosions on the first day of the war.

"I woke up and the first feeling, honestly, that was fear,"Kacharian said. "I was expecting the war, but you can't be prepared, you know?"

To keep himself busy, Kacharian went to his office at the Ministry and started fielding incoming calls.

"I remember we started to see a lot of calls from different regions of Ukraine -- from northern region, eastern, southern region -- because we were not expecting that there will be a full-scale invasion from all directions,"Kacharian said. "So we started to receive different calls, what should we do, where we go, especially from emergency medical services, because they were the first in health care system who started to receive requests, calls after the missile strikes."

Western Ukraine started to receive a flood of refugees fleeing from the Eastern part of the country, where the most territory was lost, Kacharian said.

About 6.5 million people were displaced within Ukraine, and another 4.2 million fled to neighboring countries, the doctors said.

Those refugees included cancer patients, but unfortunately many medical supplies allotted for their care had to be abandoned in the areas lost to the Russians.

"We lost a lot of cancer drugs in hospitals that were occupied and are still occupied,"Kacharian said. "People went to the Western parts of Ukraine and [medical] storages in the Western parts of Ukraine became empty very shortly."

These shortages led to many acts of personal bravery.

One medical director, Dr. Viktor Paramonov, skirted battlefields in a 120-mile drive from his hospital, the Cherkasy Regional Oncology Center, to northern Kyiv storage facilities in search of medical supplies, Kacharian said.

The manager of the storage facility couldn't risk the trip because it was located too close to the battle front, so Paramonov took it upon himself to make the delivery.

"He went by himself by car to that storage,"Kacharian said. "He took all the necessary cancer drugs and brought them back to the regional center, despite the danger."

After two weeks spent living in the Kyiv City Clinical Oncology Center's shelter, Postuypalenko left the bunker and went to Poland to help care for Ukrainian refugees there.

In Poland, Postuypalenko encountered another serious problem facing Ukraine's cancer patients -- a lack of medical records.

Ukraine had only started shifting to electronic health records when the war commenced, Kacharian said. Most records are still on paper, and they had to be left behind by refugees.

"Patients asked often how they can retrieve their medical history,"Postuypalenko said. "What was their diagnosis, what treatment they received, maybe some CT scans, records of incidents and so on. For cancer patients, it's a very important thing, and this was very disruptive to their care."

Other Ukrainian refugees simply didn't bother getting checkups, because they no longer could see the hometown doctor with whom they'd formed a bond, Postuypalenko said.

"They don't go to a doctor, and I now see a lot of cases with advanced stages of cancer,"she said.

Back home in Kyiv, the shelter at Postuypalenko's hospital remained open for six weeks. During that time, cancer patients could receive chemo but no radiation or surgery.

By mid-March, many types of cancer treatment had been restored, including some surgery, the doctors said. But a lot of patients still did not receive timely care.

"Treatment of such patients was almost always delayed, one months, two months, three months,"whether they remained in the country or fled abroad, Postuypalenko said. "Almost always it was delayed. They had no possibility to get that treatment, not because they didn't want to do it."

Doctors gave patients the best cancer care they could, Postuypalenko said, but only time will tell how badly this delay in care cost people in terms of their long-term health.

Olena Postuypalenko consumer.healthday.com

And Postuypalenko works at one of the top Ukrainian cancer clinics, Semikov said.

"Imagine all the other 90% of clinics, and the patients who got disrupted treatment,"Semikov said. "We just don't have the data at the moment for long-term outcomes, but it certainly is not good."

Things have returned closer to normal regarding cancer care in Ukraine, thanks to support from the international community, Kacharian and Postuypalenko said.

Hospitals have been provided their own generators, which can help them withstand Russian attacks on Ukrainian infrastructure, Semikov said.

"We have a lot of stories and videos where doctors finish operations in full darkness,"Semikov said. "During the war, Russians target critical infrastructure and they particularly target a lot of hospitals."

However, in many parts of the country chemo and radiation therapy are still available only on a limited basis, the doctors said.

The world has been pouring money into large international aid groups like the Red Cross, but that money is only dribbling into Ukraine, Semikov said. He urges people to donate directly to the Ministry of Health or humanitarian aid groups that are working on the ground, such as his Peace and Development Foundation.

The doctors are also reaching out to pharmaceutical companies, to see if they can either donate cancer drugs or offer them at a discount.

"We're not a rich country. We couldn't provide patients with expensive targeted therapies before the war, and of course we can't do that now,"Kacharian said. "But donations or discounts could help support our patients."

More information

The Peace and Development Foundation has more on donating to Ukraine aid.

SOURCES: Olena Postuypalenko, MD, Kyiv City Clinical Oncology Center; Arman Kacharian, MD, lead, cancer control, Ministry of Health of Ukraine; Rostyslav "Rosty"Semikov, MD, CEO, Audubon Bioscience, Houston