Resilience and perseverance under siege: providing cancer care during the invasion of Ukraine

• Published in: The lancet oncology 2022-05, Vol.23 (5), p.579-583
• Main Authors: Kizub, Darya, Melnitchouk, Nelya, Beznosenko, Andriy, Shabat, Galyna, Semeniv, Solomiia, Nogueira, Leticia, Watson, Patricia J, Berg, Kim, Trapido, Edward J, Espinel, Zelde, Shultz, James M
• Format: Article
• Language: English
• Subjects: Cancer; Cancer screening; Cancer therapies; Chemotherapy; Coronaviruses; COVID-19; Diagnosis; Disease transmission; Evacuations & rescues; Grief; Health care; Hospitals; Humanitarianism; Humans; Infections; Infrastructure; International law; Life span; Medical diagnosis; Medical screening; Neoplasms - epidemiology; Neoplasms - therapy; Oncology; Palliative care; Pandemics; Patients; Post traumatic stress disorder; Psychopathology; Survival; Ukraine - epidemiology; War
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(22)00189-9

Conflict-associated disruptions in cancer treatment and survivorship care differ by locale and change as the military operations unfold. Since the beginning of the war and as of the writing of this Essay, the capital city of Kyiv has been protected by a robust anti-missile defence system and sustained less damage despite persistent bombardment, allowing some patients with cancer—including children—to evacuate safely. Individuals diagnosed with certain cancers, especially those with haematological malignancies and those receiving highly immunosuppressive chemotherapy, are especially susceptible to severe and life-threatening infection.7 With the omicron variant predominant, Ukrainian surveillance data reported a 7-day moving average of 27 538 COVID-19 cases on Feb 23, 2022, 1 day before the invasion, representing an incidence rate of 63 cases per 100 000 people. Ukrainian oncologists acknowledge that the pandemic resulted in delays in cancer screening, early symptom evaluation, and timely detection of cancer resulting in later stage at diagnosis, more limited treatment options, and worse outcomes.8 The care of patients with COVID-19 was overshadowed by the urgent needs to treat wounded military and civilians. Mental health and psychosocial dimensions Even in peacetime, and in the absence of a global pandemic, patients with cancer face combined challenges of health consequences and emotional distress associated with cancer diagnosis and treatment, including frailty, pain, and fears of cancer recurrence and shortened life expectancy.