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Cancer diagnoses put one and a half hundred thousand Ukrainians a year – and the Ukrainian healthcare system as a whole coped with this flow. However, in the midst of hostilities, Ukrainian clinics were not up to these patients – they were overloaded with emergency care for the wounded. If international organizations have managed to arrange a quick and efficient evacuation of children with cancer from Ukraine, then adults often have to rely only on themselves. And neighboring countries worry that difficult Ukrainian patients (cancer is one of the most difficult and expensive to treat) will overwhelm their own health care systems.
It is difficult for people with cancer to get help in Ukraine during the war
By February 24, at least hundreds of thousands of Ukrainians were being treated for cancer in the country’s medical organizations. It is difficult to establish their exact number, but it is huge – only in 2020 oncological diseases in Ukraine diagnosed 163 thousand people. They all need medical attention.
Cancer care is now available in Ukraine far from everywhere and not in full. By some estimatesa third of cancer centers cannot provide care to patients (here, for example, how looks in Mariupol). According to the representative of the Ministry of Health of Ukraine, who spoke at the conference of the World Health Organization on April 26, and WHO Representative, oncological diseases are not a priority in the current situation – first of all, care is provided to people with war-related injuries and infectious diseases. of the same opinion stick to some humanitarian organizations. However, sometimes work continues even in areas that have been or are being attacked by Russian troops: in some places there are oncologists and other specialists who, to the best of their ability, help people with cancer.
According to Ukrainian doctors, the situation with drugs for the treatment of cancer is not so bad: they are still available. Thanks also to the help charities, pharmaceutical companies and the fact that medical organizations share with each other stocks (greatest risks – in patients who participated in clinical trials and used drugs that have not yet entered the market, however, in this case, pharmaceutical companies find ways to continue treatment).
However, the situation is very far from normal, so even where assistance is provided, schemes are chosen chemotherapywhich are easier to control adverse reactions (including remotely). Due to power outages Until recently not performed at the National Cancer Institute radiation therapy. There are fewer complex operations that require a long stay in the hospital and active care. Actually decreased the number of any oncological operations – including becausethat surgical interventions are urgently needed for people injured during the hostilities. Not to mention that in Ukraine impossible perform a bone marrow transplant from an unrelated donor, because the donor (often found abroad) cannot be brought to the patient.
Even in peacetime, there are situations when you have to take a break in the treatment of cancer. for exampleif a person’s condition has deteriorated greatly during chemotherapy. It is believed that such a pause should not greatly affect the outcome of treatment. But the patient during this period needs special care and therapy, which will reduce the risk of developing infections in him and help him cope with unwanted reactions.
Even radiation therapy can theoretically be interrupted, but one must understand that no one fully knows how this will affect the result of treatment. For example, there is data, which indicate that the two-week break significantly (and negatively) affects the outcome. Postpone the operation not always possible without additional risks.
In addition, the best treatment consists of quality drugs, a well-thought-out therapy plan, modern diagnostic equipment, competent care and competent specialists – if you are left without all this for an indefinite period, then the risks are obvious. They are also obvious during the evacuation of patients from Ukrainian hospitals: according to an oncohematologist from Nikolaev, this is “a break in treatment, separation of the family, a violation of continuity in diagnosis and treatment, shelling of convoys.”
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To help patients, Ukrainian oncologists at the beginning of the war began to apply to international cancer societies with a request to help transfer patients to other European countries. This process demanded from doctors, by their own admission, a huge amount of time and effort.
Children are helped by Unicorn Clinic in Poland
After the start of the war, children with cancer from Kyiv and other cities pretty fast evacuated both to the west of Ukraine and to other countries. Including had to to transport children after bone marrow transplantation, which was a rather risky operation for their health. To distribute them to clinics in Europe and North America, a center called The Unicorn Clinic was organized in Poland. It was created by the project SAFER Ukraine. In progress SAFER Ukraine participate medical associations and charitable foundations of different countries. Now, by words doctor Anna Sonkina-Dorman, who works with SAFER Ukraine, more than 1,000 patients have been registered in the project, and more than 600 have already been taken out of Ukraine.
In the Unicorn Clinic for children distribute volunteer doctors from different countries (by the way, now there is there is a special need for pediatric oncohematologists, who are invited to come to Poland for two weeks).
Doctors who in Western countries accept patients from Ukraine, indicate that people come (at best) with documents in Ukrainian. It happens that even these documents cannot be taken out, and the parents themselves do not know what drugs are used in the treatment of children, or how exactly the radiation therapy was carried out. There are no tomography results, no tissue samples for research. In addition, the treatment provided in Ukraine is not always applied in the country where the child has ended up. The studies conducted in Ukraine also do not always inspire confidence, they have to redowhich may lead to changes in diagnosis and treatment. It must be said that in Ukraine the mortality rate of children with oncological diseases is one of the highest in Europe.
“Other problems were more from the field of culture, and not medicine,” write Italian doctors who have been seeing patients since the beginning of March. “For example, there were unexpected difficulties with adapting to Italian food and especially to the one given in the hospital (in some cases, patients even developed problems with the gastrointestinal tract).” Other everyday difficulties arose: for example, patients could not be discharged because they had nowhere to go.
One more problem is is that it is difficult for health care systems in different countries to cope with such an influx of new and difficult patients.
It is more difficult for adult patients to get help abroad (and young men are not released at all)
If the Unicorn Clinic effectively distributes children to hospitals, then adults getting harder. A single distribution center simply does not exist. Most adults remain in Ukraine, which is why the burden on clinics in the west of the country increased several times. Leaving the country primarily women with breast cancer and older men with prostate cancer (these are fairly common diagnoses): younger men do not release abroad.
Oncological services in neighboring countries are not always ready to accept foreign patients. Back in late March, member of the WHO Emergency Committee Richard Sullivan pointed out that even a hundred new patients is a big challenge for the healthcare system in Moldova. Now, according to the director of the Oncological Institute in Chisinau, Ruslan Baltagi, who spoke at the WHO conference on April 26, patients from Ukraine stand in line for treatment on an equal basis with citizens of Moldova – and someone, in order not to delay therapy, went to Turkey for their money. In Poland expect a 10% increase in the number of patients with cancer – and this is quite difficult for the healthcare system of even a relatively rich country.
However, there are countries in which the situation is more favorable, and for them problem in that patients are simply unaware of the possibilities that exist. You can find out about different treatment options by calling specially organized hotlines or in responsible organizations.
Patients will have to return – and re-arrange treatment
Now the evacuation of patients, treatment and even living expenses abroad are often paid for by philanthropists and various states. But obviouslythat this cannot last long, so the question of the future fate of people with cancer is acute. This is also why Ukrainian doctors try not to send patients abroad without special need. In the end, sooner or later, these people will be forced to return to Ukraine, where can be difficult continue the treatment started in Western clinics (for example, because not all necessary medicines are available in Ukraine).
However, before the war in Ukraine, every month diagnosed 13,000 people have oncological diseases, and, most likely, refugees diagnosed abroad will sooner or later be treated in their homeland. True, according to statistics, migrants receive a diagnosis at a later stagethan would have happened if they had stayed in their home country.
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