Cancer Care for Ukrainian Refugees in Poland

Host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, interviews Professor Piotr Rutkowski, of the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, about plans to provide cancer care for Ukrainians fleeing the war in Ukraine.   Transcript Dr. John Sweetenham: Hello, I’m John Sweetenham, the associate director for Clinical Affairs at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News Podcast. As many of you all know, 2 million people have now fled the war in Ukraine, according to the United Nations Refugee Agency—the UNHCR. Today, we’ll be discussing efforts underway in neighboring Poland to provide health care and other support to Ukrainian refugees, particularly for patients with cancer. It’s an honor to welcome Professor Piotr Rutkowski, who leads the department of Soft Tissue and Bone Cancer at the Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Poland. He also serves there as the deputy director of the Institution for National Oncological Strategy and Clinical Trials. Additionally, Professor Rutkowski serves as the President-elect of the Polish Oncological Society. My guest and I have no conflicts relating to our topic today. Our full disclosures are available in the show notes, and disclosures relating to all guests on the podcast can be found on our transcripts at asco.org/podcast. Dr. John Sweetenham: Professor Rutkowski, thank you for coming on the podcast today. We are really pleased to have this opportunity to speak with you during what must be an incredibly difficult time. Dr. Piotr Rutkowski: Thank you for the invitation. That’s true, with this horrible time. And to be honest, we haven’t expected how it can be going on. But now we have a new reality, and we have to fight on. Dr. John Sweetenham: Just beginning with that new reality, my first question to you was going to be to ask you a little bit about details of the decisions made by Poland’s parliament. So, your parliament has adopted new legislation that provides health care for Ukrainian refugees and enables the creation of a call center at Poland’s National Health Fund. Could you give us some more details about these new developments, and how you anticipate this will help the Ukrainian refugees who are suffering, particularly those who are suffering with cancer? Dr. Piotr Rutkowski: Yes, that’s true. Until now, we have nearly 1 and a half million people from Ukraine who arrived in Poland during the last 2 weeks. And because of the increasing numbers of patients with cancer coming to our institution but also all the oncology call centers in Poland, the Polish parliament—together with the Polish National Health Fund decided that all refugees of war from Ukraine are authorized to receive health care the same as citizens of Poland. This is very important because it resolves a lot of bureaucratic issues. We do not need to get specific permission to treat the patients. And we can provide them the same care as every citizen of Poland, in terms of outpatient treatment, admission to the hospitals, surgical procedures, access to the drug, prescriptions of the drug . . . it is absolutely important. It also means that within the framework of this new law, we can treat the patients according to all the same regulations, or the same standards, as Polish oncological patients. Of course, I have to stress it, but Ukrainian oncological patients—except, of course—have no priorities. They are going to the same queue and [are under] the same care as Polish patients. Moreover, this is very important because for newly diagnosed oncological patients in Poland—we have so-called oncological cards, which allow for faster diagnosis including pathological evaluation, molecular evaluation, and imaging. So, they are undergoing the same diagnostic procedures as Polish patients. Of course, last week, we have admitted around 100 children in need of oncological treatment to centers in Poland. But probably it was the first wave of patients. Now we have an increasing number of normal adult patients with lung cancer, breast cancer, [and] GI cancers, coming to us. Some of them also need the continuation of the treatment, or they have to start specific treatment with innovative drugs—if they are reimbursed in Poland—it’s also allowed to treat with all these medicines in Poland. So, the second point which you mentioned that the Polish National Health Fund established this special, general, official hotline for oncological patients from Ukraine—and also a webpage. This hotline is in Ukrainian, Russian, English, and Polish languages, and with the use of this hotline, we are trying to direct the patients to the proper oncological centers because this hotline from the National Health Fund cooperates with 20 top Polish comprehensive cancer centers. So, using this official hotline, it’s much easier to be directed to the correct hospital treating the given type of cancer. This is very important because [patients can] contact directly to the hotline of the National Health Fund or the hotline of the oncology call centers in the region where the patients are temporarily staying in Poland. So, it’s the best we can recommend and this is what has been done until now in our country. Dr. John Sweetenham: It’s incredible how quickly the Polish government has moved to help the many Ukrainian patients with cancer and other patients who are coming into the country. The cancer centers in countries such as yours, who are accepting and treating these Ukrainian patients, presumably are going to struggle to have sufficient resources in terms of space, equipment, drugs, and staff to handle the large number of patients from Ukraine who will be showing up at your doors. What resources does Poland have? And what do you need from the international community to be able to help with this very large additional patient load that you’ll be seeing? Dr. Piotr Rutkowski: Yes, thank you. This is an excellent point because now, of course, the enthusiasm dominates, and normal human help—we involved everybody. So Polish oncological societies are working together, and we are providing different materials: translation for the patients; we also ask the pharmaceutical companies to provide the Ukrainian language material, which we had in the countries, and also patient advocacy groups are really helpful. And we are sending the required medical resources to Ukraine in some official actions. However, of course, you are right that the Polish oncological system had, even before, this increasing number of patients which we can calculate means that we’ll have 10 percent more patients with cancer in this year. So, it’s a really huge number. Until now, we also had some limitations in resources. The basic drug reimbursement was at a good level when we compare it to other central-eastern European countries, so we had a relatively good system. We also started, 2 years ago, our new national oncological strategy. However, we also transformed to this 3-level system of comprehensive cancer centers of reference.  So, we are also at the level of some transformational oncological systems. So, it's not the easiest time, especially, but generally, the numbers of nurses and health care providers, including different oncological specialties, are limited in Poland. And when we calculate per number of patients, it’s one of the lowest in Europe. Generally, we can expect a shortage of human resources. Of course, we can count that we easily and temporarily facilitate the qualification of Ukrainian medical staff for Poland. And this is also included in this package of new laws. But on the other hand, still, we are facing the problems of communication, even with medical staff. So, it’s not so easy. Moreover, when we calculated nowadays this number of patients, it costs about 50 to 70 million Euros per month additionally. So, it changes the priorities in health care in Poland. So, I cannot tell you now, but maybe we can make some calculations in 2 or 3 months. But nowadays, we can still resolve these issues, but what will be in 3 or 4 months, I really don’t know, And how delayed will the oncology health care be due to [the] increasing number of patients? So, it is what we can anticipate, and we try to reorganize at the level of different hospitals now. We had some meetings with the Ministry of Health and our National Health Fund. And the normal functioning levels—we cannot see. Things are changing. We have first patients now, but the numbers are increasing every day. So, I cannot definitely say what resources, except human resources, and of course, increasing funding, we need in the near future. We try to collaborate with different organizations. I really appreciate the meeting with ASCO and ECO that took place recently about how to transfer some patients to other oncological centers. However, it’s not so easy when we can’t transfer the patients somewhere else if the patient started the treatment in 1 given center. So, this is the situation now, and what we expect, but it can be more difficult in a few weeks or months. Dr. John Sweetenham: Yeah, thank you. I’d like to perhaps, pick up on that last point you made about medical information on patients that you’re accepting. So as a clinician yourself, how are you handling the issue of prior treatment history, and medical information of patients who are coming into your system? For example, are you able to get access to their pathology reports, their imaging, or their prior treatment reports? And if you don’t have access to those, how are you facing the challenges of treating those patients with an incomplete medical history? Dr. Piotr Rutkowski: Of course, we have to translate it. So, we have help in our institution, but it’s not common practice everywhere. Some of the patients have translated documents. We do not insist on the certified translations, just the original documents or copies of the documents with translation into Polish, because not all words are even well understood. The problem is that the level of health care in Ukraine is sometimes lower, and pathology reports are not perfect. So even if the pathological report, which we are receiving . . . if it’s even available from the patients . . . sometimes we need to redo the biopsy and establish some molecular factors. One patient who was admitted to my department yesterday with sarcoma, we redid the biopsy last week because the report was not complete. And we completely changed the diagnosis in 3 days. Other patients will probably also need [to be] re-biopsied. Sometimes we are lacking imaging . . . but some of the patients arrive with at least CDs of CTs or MRIs, so it’s much easier. Some of the refugees have only the copy in their mobile phone . . . so the documents are at a very different stage. If we have information about how the patient was treated in Ukraine, it’s perfect because they can continue the treatment. But not all kinds of treatment in Ukraine were provided according to the standards which we have in Poland. So, it’s also difficult because we have to discuss with patients how to change their treatment. There are really individual situations. This is what I can say. We have a lot of volunteers now helping with translation. We also employed some additional staff and it’s easier. But the problems with the documentation probably will also be increasing, that’s true. However, we try to simplify as much as possible, and in some situations, redo the biopsy and re-establish the diagnosis, if we have enough information. It’s really resolved case by case. Dr. John Sweetenham: Yes, gotcha. It sounds as if it certainly can add to everybody’s workload and degree of stress, unfortunately. Because of the additional tests that some of these patients are now having to face, on top of everything else that they’ve already confronted over the last couple of weeks. One of the other things which I think will be of interest to our listeners in that regard is whether you’re experiencing patients who are coming in, who have been part of a clinical trial? And if so, whether there are any mechanisms in place for that situation, or perhaps, a patient on a relatively early-phase clinical trial, who may have received part of their initial treatment in Ukraine? Dr. Piotr Rutkowski: Probably it is the easiest part because, for the last year, I have treated several Ukrainian patients in a clinical trial where they had access to new drugs. And we had the possibility, at least before the pandemic because the pandemic also complicated the transport or movement of patients.  But before, we had several patients in clinical trials, and many of them have relatives and are accompanied by translators who provided for compliance with the requirements for informed consent and of course, understanding all procedures. But because some companies ask us for [the] possibility to transfer patients from Ukraine to Poland within the clinical trials, so they are providing us the certified translation of the documents and also the informed consent in Ukrainian—at least 2 or 3 companies, because I’m responsible for clinical trials in our institute. So, they contacted us and of course, we agreed. This is much easier because it’s professional machinery and they have at least documents in the forms of CRF (case reporting form) so we can get the full history, and how the patient was treated, [and] in the majority of cases also imaging. So, it’s much easier because everything is provided, and we also inform the bioethical committee about the situation. But it’s probably, also, a little more work in the next few weeks. Dr. John Sweetenham: Yes, well it is good to hear that those patients are able to continue their treatment on trial, thanks to all of the backup support that you’ve been able to provide. I want to conclude by saying thank you, Professor Rutkowski, for coming on to the podcast today. And for everything that you and your colleagues, your institution, and the Polish people—are doing to support patients with cancer during what are obviously extremely difficult times. Dr. Piotr Rutkowski: Thank you very much. You know, cancer is a matter for all of us, and cancer has no borders, so we have to help each other in these difficult times, that’s true. Thank you very much. Dr. John Sweetenham: Thank you to our listeners, for your time today. If you’re enjoying the content on the ASCO Daily News Podcast, please take a moment to rate and review us wherever you get your podcasts.    Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness   Dr. Piotr Rutkowski: Honoraria: Bristol-Myers Squibb, MSD, Novartis, Roche, Pfizer, Pierre Fabre, Sanofi, and Merck Consulting or Advisory Role: Novartis, Blueprint Medicines, Bristol-Myers Squibb, Pierre Fabre, MSD, Amgen Speakers' Bureau: Pfizer, Novartis, Pierre Fabre Research Funding (institution): Novartis, Roche, Bristol-Myers Squibb Travel, Accommodations, Expenses: Orphan Europe, Pierre Fabre   Disclaimer:   The purpose of this podcast is to educate and to inform, this is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.