War in Ukraine: Treating Patients Under Fire

Host Dr. John Sweetenham, of the UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, interviews Dr. Mariia Kukushkina, of the National Cancer Institute of Ukraine in Kyiv, on the heroic efforts of oncologists to treat patients with cancer during Russia’s invasion of Ukraine. From her home in Kyiv, Dr. Kukushkina recounts how “some cancer centers have been destroyed.”   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. On February 24th, Russia launched an unprovoked attack on Ukraine, which has led to international condemnation and sanctions against the Russian government. ASCO has joined its Ukrainian members, the worldwide oncology community, and healthcare providers in condemning Russia's invasion of Ukraine and has called for an immediate cessation of the hostilities and full protection and safety for all Ukrainian patients, healthcare workers, and medical facilities.  Today we'll be discussing the impact of the war on patients with cancer and how oncologists the coping under these extremely difficult circumstances. Joining me for this discussion is Dr. Mariia Kukushkina, a senior research associate in the Department of Skin and Soft Tissue Tumors at the National Cancer Institute of Ukraine in Kyiv. My guest and I have no conflicts relating to our topic today. Our full disclosures are available in the show notes and disclosures of all guests on the podcast can be found in our transcripts at ASCO.org/podcasts.   Dr. Kukushkina, we are so glad to speak with you today. I understand that you're speaking with us from your home in Kyiv, is that right?    Dr. Mariia Kukushkina: Yes, absolutely right. Thank you very much for this invitation and for this opportunity to share the information about the situation in Ukraine now.    Dr. John Sweetenham: Well, we really appreciate your taking the time to speak with us. Could you begin by describing the current situation, which is facing oncologists and patients under your circumstances at the moment?    Dr. Mariia Kukushkina: Okay. First of all, I would like to thank for incredible support Ukraine and Ukrainians all over the road. It's helped us to be strong, and I am very appreciative of ASCO Daily News for this opportunity to discuss the situation with cancer care in Ukraine. So, what do we have nowadays? Unfortunately, only some cancer centers in our country are working. Some cancer centers have been destroyed. Others are in areas where there are active hostilities.  In the majority of cases, active cancer centers can provide only outpatient-intended treatments and urgent surgery, and some staff are unable to get to work due to lack of public transport, as you will understand.   On the other hand, cancer centers in the west of Ukraine are overloaded by patients coming from other regions. And a lot of our patients are on the road because some countries, like Poland, Romania, Hungary, Slovenia, Baltics declared that Ukrainian refugees are entitled to the same medical services as Polish or Romanian, etc, and insured people without payment or social health insurance.  And on behalf of Ukrainian people, I would like to thank all countries that are accepting our patients, and helping them as much as they can. But some patients cannot leave their cities as you understand, and families, and so they are still staying in Ukraine. And almost all stopped except those who are mobilized into the army, or those who have decided to stay to take care of our patients because people in these countries are hit by both war and cancer, and almost all Ukrainian oncologists are providing free online consultations and try to help. Our oncologists, nurses, ambulances, volunteers, radiologists, surgeons, and everyone else in healthcare, do everything in their power to ensure that patients can continue treatment. And I really admire these people.    Dr. John Sweetenham: Yes, this is really absolutely remarkable under these really extraordinary circumstances. We've seen some news reports about pediatric patients with cancer who've been receiving their treatments in the basements of hospitals because obviously that was regarded as being the safest location for them. Can you comment a little on what is happening within inpatient cancer care in Ukraine at the moment, and perhaps also comment on whether you feel that the healthcare workers who are providing this essential care are placing themselves in the way of danger in those hospitals?    Dr. Mariia Kukushkina: No doubt that health workers and patients are in extra danger in the hospital nowadays because they are forced to be treated and to treat in conditions of hostilities. First of all, it's difficult to get to cancer centers. For example, I live on the one bank called the Dnieper River, but the National Cancer Institute where I work on the other bank [of the river]. And we now have the problems with public transport. So it's very difficult to get to work. And I prefer to do something like my online consultations, organization work, et cetera.  And of course all patients and our staff must go down to the shelter or basement during each air raid. And sometimes it could be up to 10 times per day. some cancer centers, the systemic treatment can be provided only in these basements. So these videos that you mentioned, it's true. Absolutely. And of course, all our patients and doctors don't know if the building will be intact when they come back from the shelters.    Dr. John Sweetenham: Of course. Yes. You mentioned online consultations and telehealth. And has that been adopted widely in Ukraine during the war so far? And also, could you comment on whether the COVID pandemic had helped you to enhance your telehealth capabilities in the country?    Dr. Mariia Kukushkina: I want to emphasize that nowadays we consult patients absolutely free. It's something like volunteer work for us. So a lot of our doctors and me too, post on Facebook, our own phone numbers. It's our private phone numbers because we understand that patients need help. Sometimes they need only something, right. And we need to call them. And it's very important too, but sometimes we can do something very practical for them even from a distance.    Dr. John Sweetenham: You mentioned earlier that many of your patients are now taking opportunities to be treated in other countries, such as Poland and Romania. Can you describe how you are able to find care for these patients in these other countries and whether the patients are needing help to leave the country?    Dr. Mariia Kukushkina: In my opinion, nowadays we have two different problems. One of them involves the cancer patients that stay in Ukraine and the other one is a system for Ukraine and the refugees. And as I know from the media that nearly one million people nowadays left Ukraine, one million people. And a lot of them are cancer patients and they need treatment. And now we need assistance for these refugees; safe passage for cancer patients and people in a similar situation. They need safe passage out of the country and support for the [health] structures in countries receiving Ukrainians. Again, I want to thank my colleagues in different countries [who are helping].  First of all, I want to thank my colleagues from Poland and Romania because on the first days of the war, they helped us. They made something like a list of cancer centers with contacts in which our patients can go. So it wasn't only let's go to Poland or let's go to Romania and you will receive the treatment. It was absolutely thanks to specific cancer centers. And I want to say, thank you again for my colleagues from all countries that have supported us. I'm sorry, I'm sure that I have maybe forgot someone now, but it wasn't intentional. We are currently under a lot pressure so you must understand.    Dr. John Sweetenham: You mentioned that you need assistance and I wonder what kind of assistance and what kind of supplies do you think is most useful to the oncology community and to other healthcare facilities right now? What are you most in need of in terms of assistance and supplies?    Dr. Mariia Kukushkina: I think that we need something like a list of cancer centers for every specific type of cancer [and their contact information]. It will be very useful for our patients. And of course, we need help with safe passage for our patients. Nowadays, it's very difficult to get to the west Ukraine and to cross a border. And of course, it's difficult for healthy people and [so] it's much more difficult for patients with cancer. And it's very important to note that sometimes our patients don't have medical documentation with them. Some of them don't have access to this medical documentation because their house was destroyed. And it's difficult to get this documentation for cancer centers in Ukraine, for example, because it's impossible to get to the office [or cancer center] or the building is maybe destroyed too.    Dr. John Sweetenham: Yeah. So if I understand you correctly, the urgent needs are number one, making sure that the patients are able to get to ongoing care, if not in Ukraine, then in one of the neighboring countries. Then number two ensuring their safe passage so that they can get to that country and receive their care.    Dr. Mariia Kukushkina: Yes. And I want to say that one of the biggest problems, in my opinion, is their palliative care in our country nowadays because a lot of patients don't have this opportunity - they don't have opportunity to go home. And we have a lot of difficulty with palliative care now and honestly said, I don't know how to solve this problem. When for example, Kyiv is bombed every couple of hours.    Dr. John Sweetenham: Right. What can organization like ASCO do at the moment to help Ukraine's oncology community?    Dr. Mariia Kukushkina: Now, the support of ASCO is very important for Ukraine's oncology community. Because our main task, even during the war is the treatment of cancer patients. Nowadays, we have a lot of tasks in our country. I want to say that a lot of pharmaceutical companies and a lot of hospitals are ready to help us and ready to donate drugs for our patients. And today we are working on the least number of drugs we need because we don't know how many patients go abroad. [We don’t know] how many patients stay in Ukraine.  And we are working on legislative documents that will allow the importation of drugs and provide patients with free medicines. And, of course, the big problem is how to transport these drugs to the different regions of Ukraine. So we have a lot of tasks in our own country and, in my opinion, the oncological community can help our patients with drugs and with supportive care and with assistance for our patients who [left Ukraine and] are now abroad.    Dr. John Sweetenham: One other important question to ask is how are you personally coping under what must be extraordinarily difficult circumstances at the moment?    Dr. Mariia Kukushkina: We have a lot of tasks and we don't have time for ourselves. We try to do as much as we can and all of us have families and we try to support our families too. Because in the majority cases, our relatives live in different regions of our country. So our mornings start with phone calls to all of our relatives, all our friends, but then we start to work. We begin to work from 6:00 AM and sometimes we finish it after 11:00 PM, but we are fine. I think that our situation, oncologists' situation, is much better than cancer patients’ situation.    Dr. John Sweetenham: Well, thank you. I know that I would speak on behalf of all of our listeners by just commenting on how much I personally and I'm sure they would agree with me, number one, the fact that the international oncology community has come to the assistance of cancer patients and cancer healthcare providers in Ukraine, it's good to hear that. And I would also comment, if I may, very humbly on your remarkable dedication to cancer care and to your patients. And we certainly thank you for coming onto the podcast today. We hope that you and your family will stay safe and please know that you and our other colleagues in Ukraine and the patients and their families are very much on our minds during these difficult days. We hope everyone will be safe. And thanks again for sparing some time to join us today.    Dr. Mariia Kukushkina: Thank you very much.    Dr. John Sweetenham: Thank you. And thank you to our listeners for your time today. If you're enjoying the content of 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. Mariia Kukushkina: None disclosed. 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.