Update from Poland: Cancer Care for Ukrainian Refugees

Professor Piotr Rutkowski, of the Maria-Sklodowska-Curie National Research Institute, discusses how Poland is managing the influx of 5 million Ukrainian refugees since the war began and tells host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, about the future health needs of Ukrainian refugees with cancer. TRANSCRIPT  Dr. John Sweetenham: Hello. I’m Dr. 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. My guest today is Professor Piotr Rutkowski, who leads the department of Soft Tissue and Bone Sarcoma and Melanoma at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland. Prof. Rutkowski is also the deputy director for the National Oncological Strategy and Clinical Trials, and serves as president of the Polish Oncological Society. Prof. Rutkowski spoke with us earlier this year as millions of people were fleeing the war in Ukraine, and he described the really remarkable response from both the Polish government and his institution to this crisis. He's back on the podcast today to tell us about cancer care for Ukrainian refugees 5 months into the conflict, and how health systems are coping with the influx of millions of refugees. He will also share his insights on the kind of support that will be needed long-term to care for these patients in the future. 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/podcasts. Professor Rutkowski, thank you for being on the podcast today. It's been about 4 months since we last spoke. How are you doing? Dr. Piotr Rutkowski: I'm very privileged that we can speak again. I'm talking probably on behalf of many Polish physicians and citizens involved with this dramatic situation of war in Ukraine and helping our patients and citizens from Ukraine. And I feel okay, but of course, the situation is still dramatic, and we don't know what will happen during the next months. What we can tell, first, is what has been changed for these last 4 months, it is the number. So as of now, almost 5 million people from Ukraine crossed the border between Ukraine and Poland. And we can estimate that about 3 million refugees stay temporary or maybe even permanently in our country. This is a completely new situation because it means that it's about 10% of our citizens now. And what didn't change but still the cancer care for Ukrainian patients is the extension of regular cancer care within our national oncology network and our national health fund with this Polish insurance system. And this is the same for patients in Poland. And so all refugees from Ukraine are entitled to receive the same care as citizens of Poland. Still, this extraordinary legislation, which was adopted by the Polish parliament, covers all the refugees of war, social security, and health insurance. And we have a better situation because all comprehensive cancer centers or major cancer centers organize the help with a hotline, not only on the level of the whole country but also on the center level in the Ukrainian language. And the majority of these centers have staff speaking the Ukrainian language. Moreover, what I can say as a president of Polish Oncological Society, recently, with the help of an educational grant, we bought electronic translators for major oncological cancer centers. So they can help in the situation, like in the emergency situation, when we have access to live talk. So they can be used in that situation. And in my opinion, it is very, very helpful. So this is the current situation. And of course, I will present further the structure of oncological patients from Ukraine in Poland now and what's been done. Dr. John Sweetenham: Thank you. It's really quite extraordinary to grasp that your patient population almost overnight increased by 10%. That's just quite extraordinary. What aspects of the cancer care would you say are working well at the moment and what are your greatest remaining challenges with this population as of now? Dr. Piotr Rutkowski: First, with this challenge for the pediatric cancer population, and about 1,000 children with cancer were evacuated from Ukraine. They were transported to the Ukrainian hub near Lviv in western Ukraine and thereafter to Polish hub. And with help of many nongovernmental organizations (NGOs) and many organizations, many hospitals from Europe but also U.S. and Canada, many institutions helped within this operation to transfer after triage the pediatric, so children with cancer, to Polish, German, and U.S. physicians. So more than 1,000 children were transferred to these different hospitals around the world—so Europe, the USA, and Canada. But of course, when we look at specific other issues with Ukraine refugees with cancer, first we have a very extraordinary situation and demography because the majority are women with children and only a very small percentage of males, mostly in older age. So when we looked at the cost of hospital admission of patients from Ukraine until May, the signs and symptoms were not in abnormal laboratory tests, or not otherwise classified. So generally, [these were] different conditions, mostly internal conditions. The second one was obstetric gynecology, so pregnancy, childbirth, etc. And the third in the rank were neoplastic diseases. I looked also carefully how it looks on the level of our institution because Maria Sklodowska-Curie National Research Institution is the largest oncological center in Poland. And we have the central part in Warsaw, but also we have 2 branches in Poland. So when we looked at the populations, all together, we had about 1,000 visits with new patients in our institutions. And number 1 was breast cancer. And second were gastrointestinal, and thereafter gynecology. And the fourth in the rank was melanoma and also soft tissue tumors or cancers probably related to the younger population. But melanoma was also relatively frequent. But number 1 was breast and reconstructive in all our branches. And of course, the distribution of patients is also different. In the whole of Poland, the largest numbers are in our region because probably because Warsaw is the largest city in Poland. So they have a lot of relatives or colleagues. So about 20% of patients from Ukraine are concentrated in our region, but more than 10% are also near Katowice or Gliwice. So it's Silesia and also near Krakow. So this central and southeastern part of Poland have the majority of Ukrainian patients now. However, of course, some of the patients were also transferred to other parts of Poland. But as I said, in some of the departments, more than 10% of patients are now from Ukraine, especially in breast cancer units and also gynecological units. When I look in the department which I'm chairing, department of soft tissue, bone sarcoma, and melanoma, we have mostly patients from Ukraine involved in the treatment of advanced melanoma, some with earlier stages, and some patients with sarcoma, especially if they were contacted by physicians from Ukraine specifically for this type of disease. But generally, the state of disease is a little bit more advanced. So, many of these patients are receiving neoadjuvant therapy in breast cancer or they are going directly to treatment of stage IV disease with modern drugs like immunotherapy or targeted therapy for melanoma. This is also the real situation. One of my points I want to mention is, if the access to the cancer care, regular cancer care probably is good for patients, but the problem with communication exists, and still I think that patients or citizens from Ukraine do not participate too much in prevention programs because the participation in mammography, cytology for cervical cancer and other screening programs are at very low levels. So, of course, it's a new situation for these people. But still, probably it will be one of the points for which we have to undertake some strategies. Because we do not know how to get information on if they will be staying longer in our country what we can anticipate for next months and even years. So this can be problematic because it means that we'll have more and more advanced stages of disease. Dr. John Sweetenham: It's very interesting, and of course not surprising, that you have this very skewed demographic of predominantly female patients. I wonder whether you have any insights into whether the—maybe resistance to screening is the wrong word—but the reluctance to be screened? Is that do you think, a reflection of screening services in Ukraine? Or do you think it relates more to the current stresses and priorities that these patients face? Dr. Piotr Rutkowski: I think whether it's first for our colleagues from Ukraine, it's a new situation, and they still are not in a normal life. So I agree that first, of course, the participation in the screening programs in Ukraine is on the lower level, but still, maybe the people do not consider staying here, staying at home, of course, and staying in their own country. So they are a little bit in between of normal life and living as refugees only. So they did not start all normal activities. And of course, the information about the screening programs, about the normally functioning health care, it's also probably a little bit more difficult for them because they may not understand all the details of our health care. So I think that it is one of the points which we have to think about for new strategical enterprises in the coming months. So as I mentioned, for normal access to health care, I do not foresee now that it's problematic. Of course, it can be problematic if we'll have a shortage of our people. But still, we can manage this on a regular level. But as I mentioned, when I talked to our colleagues from the department of prevention, the percentage of the people who are coming for screening programs is very low as compared to the total number of refugees. Dr. John Sweetenham: You mentioned that the future for many of the Ukrainian refugees is uncertain at the moment. Now that the heaviest fighting appears to be concentrated on the east of the country, are you seeing any signs that Ukrainian patients will be able to go home for their treatments at any point in the near future? Dr. Piotr Rutkowski: Yes, I think so. Some of the refugees even started to come back home to Western Ukraine, especially when they felt that it was a little bit safer. But as we know, still the situation on the front and the plans of the Russian invaders are not predictable. So we cannot say how even we can behave in this situation. So, for example, in my hospital, we have psychologists from Ukraine who first escaped from Donbas to Kharkiv. And when Kharkiv started to be shelled by bombs, they escaped to Poland. So it's sometimes really dramatic fates for these people. So, of course, the movements between the border are relatively high because some of the people are trying to come back because they feel more comfortable in their homeland, in the country where they can all speak one language, but others they feel they've started to adapt to in living in Poland and we have more and more patients who are accompanied by people speaking Polish. So they started to try to live more normally in our country. I also noticed that we have some patients from Ukraine in the clinical trials. Of course, we also adapted the informed consent and some information sheets into the Ukrainian language. So Ukrainian patients interested in taking part in clinical trials are also included based on normal inclusion criteria. This is also important that we can propose this to patients from Ukraine because if they want to stay longer so they can get extra treatment within the frame of clinical trials. What is also interesting with our National Science Center is that it started to support researchers who are fleeing from war. And they prepared the special funding scheme for researchers from Ukraine to encourage the grant winners to employ researchers from Ukraine on ongoing projects. So there are many specific actions to adapt the citizens of Ukraine in Poland, and of course allow them to undertake normal work. We also allowed for specific temporary work in health care for physicians and nurses. And as it was announced recently by the Polish Minister of Health, more than 2,000 physicians from Ukraine decided to work in the Polish health system. So this is what we can do now. And probably we can do follow-up in half a year again. We'll see what will happen. Dr. John Sweetenham: I thank your responsiveness and that view of government. So this situation has been really remarkable and also remarkably quick. And as you've already pointed out, these patients are going to have needs for many months and many years to come. And you've touched on some of those, specifically the needs around cancer screening. Do you have any other insights into what you think the most pressing future needs for these refugees will be? And then what support your health system, which is presumably already overstretched, what additional support will it need to cope with the ongoing demands and needs of this population? Dr. Piotr Rutkowski: We really appreciate the help from the international community with material for our Ukrainian patients. Probably the next step will be a specific maybe European Union (EU) fund for a health care system which is affected now by numbers of patients from Ukraine, because, of course, we are doing this with our internal Polish funds. But I don't know how it would affect the next year with regular health service in Poland. So this is one of the points. The second point, of course, which we are always afraid of is the situation with the staff shortage for regular health care because Poland, generally in our part of Europe, we can see the shortage of nurses and educated oncological physicians. This is what we included in our national oncological strategy. However, we didn't anticipate it would have such an extraordinary situation which we have to face now. So these points can be one of the problems which can be raised next month. Dr. John Sweetenham: And so you you've indicated the potential support from the EU and other international agencies. I wonder if we could take that question a little bit further to the international oncology community, including organizations like ASCO, the European Cancer Organization (ECO), the American Cancer Society, and others, who've been collaborating to support Ukrainian patients and the oncology community in Poland and in the region. How do you think the international oncology community can continue to respond and help in the coming months and years? Dr. Piotr Rutkowski: It seems that it's a very continuous effort. So we have regular meetings between the national representatives, ECO, as you mentioned, ASCO, and also some NGOs to discuss the hottest problems with the situation in Europe and also how we can find solutions. Colleagues from Ukraine are also asking us about these specific issues like access to radiation therapy and the possibility to transfer the patients because the equipment is not working perfectly in the whole of Ukraine. This effort is very, very important. I feel that it will be a very excellent platform for next month, maybe for next year. I think that it's extraordinary because it was organized very fast, and it was not temporary, but it seems that it will be continuous for a long time. As I mentioned in this platform, we can exchange some materials, and some information very quickly and in an efficient way. I would like to thank you, ASCO, and ECO for the organization of this platform. Dr. John Sweetenham: Well, Professor Rutkowski, I want to thank you again for taking the time to join us for a follow-up discussion regarding the situation in your country with respect to Ukraine, and express, once again, our respect and admiration for the way that you and your colleagues and your country have responded to the crisis. It's been a real pleasure having you on the podcast today. So thank you for joining. Dr. Piotr Rutkowski: Thank you very much. Goodbye. Dr. John Sweetenham: And 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. 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