By Nataliya Kovalchuk, PhD; Ruslan Zelinskyi, MS; Andrii Beznosenko, MD; Nelya Melnitchouk, MD; Viktor Iakovenko, PhD; Roman Kowalchuk, MD; Andrii Hanych, MD; Yuliia Severyn, MD; Bohdana Bachynska, RTT; Oleh Duda, MD; Serhii Brovchuk, MS; Natalka Suchowerska, PhD
This blog is based on excerpts from a manuscript previously published in Advances in Radiation Oncology.
The full-scale Russian invasion of Ukraine on February 24, 2022, started an absolute horror of destruction and chaos for everyone on its path killing tens of thousands of civilians. Many more have been wounded, with approximately a quarter of Ukraine’s population displaced as of July 20.1 The Russian army is obliterating Ukrainian cities, targeting civilian infrastructure with missiles, deliberately damaging and destroying hospitals and clinics in violation of the Article IV of Geneva Convention.2 According to Ukraine’s Minister of Health, Viktor Liashko, during the first 100 days of war, more than 600 health care facilities sustained damages, 105 of which were rendered beyond repair. In addition, the Russian army deliberately targeted and damaged around 450 pharmacies and 200 ambulances.3
Before the full-scale Russian invasion, according to unpublished Ukrainian NCI (Tumor Registry) data, in Ukraine with a population of 44 million, an estimated 139,000 people were living with newly diagnosed cancer, and between 1,000 and 1,200 children were receiving active cancer treatment (AB, unpublished).4 As to radiation therapy, Ukraine is classified by DIRAC IAEA as a Low Middle Income country with level of availability 2.6 External Beam Radiation Therapy (EBRT) machines per 1 million of population.5 Prior to Russian annexation of Crimea, parts of Donetsk and Luhansk regions in 2014, Ukraine had 52 radiation therapy centers with 86 Co-60 machines (81%) and 20 linear accelerators (19%).5 Since 2014, Ukraine has lost control of 10 cancer centers and over 13 EBRT machines in the occupied part of Donbass and five machines in Crimea (a total of 17% of Ukrainian EBRT machines).6
To remedy the growing need, 16 linear accelerators were installed by 2022, and the ratio of Co-60 to linear accelerators became 54% to 46% (excluding EBRT machines in the occupied territories since 2014). The Ministry of Health of Ukraine planned to purchase an additional 20 linear accelerators, but this plan did not materialize as the Russian full-scale invasion shattered Ukraine. In six months of the war, in addition to 10 cancer centers occupied since 2014, three other cancer centers are under occupation, three cancer centers suspended operation, and two cancer centers are under constant shelling. Even if the war stopped today, the inflicted damages to the health care infrastructure will last for years to come.
Help Ukraine Group – How can you help?
A group of oncology practitioners organized Help Ukraine Group (HUG) to connect with cancer providers in Ukraine and establish a feedback loop of determining the need and providing support. We interviewed Dr. Beznosenko, Chief Medical Officer of National Cancer Institute in Kyiv and the president of Ukrainian Society of Medical Oncology,7 who said, “There is an acute need for chemotherapy medications and disposable medical devices. The supply chains became disrupted by the war, and the hospital is running out of medication.” Many medical warehouses were destroyed or are unavailable due to logistical issues, airports are not operational, many bridges and highways damaged. Tender agreements are challenging to procure during the war. Disposable devices are needed in almost every radiotherapy center.
The HUG members collected the data on the need and requested donations from CIVCO and Orfit. For items that were not donated, HUG members applied for Union for International Cancer Control (UICC) Solidarity Fund and obtained the funding.8 Many thanks to CIVCO and Orfit for their generous donations. First shipments of immobilization devices are on the way to Ukraine. More sustained support needs to be established to provide disposable medical supplies and chemotherapy medications. We call on the professional organizations to organize a “Support Ukraine” fundraiser with their membership and industry.
Ukraine has only three PET/CT scanners, all in Kyiv, only two of them functioning after the war broke out. Patients from all over Ukraine have to risk their lives and travel to Kyiv for a diagnostic or follow-up CT scan, leading many to abandon the scan altogether. According to the European Association of Nuclear Medicine, one PET/CT scanner is needed per 1.5-2 million people, which would translate into 22 scanners for Ukraine. In order to reduce oncologic morbidity and mortality as the result of war, HUG members are calling on PET/CT scanner and cyclotron vendors to donate at least one PET/CT and cyclotron to Lviv Oncology Regional Therapeutic and Diagnostic Center to overcome war-related disparities.
In response to Dr. Beznosenko’s request, HUG members are organizing a training program in the U.S., Canada and Australia for the Ukrainian female physicians of various specialties, including radiation oncologists, medical oncologists, surgeons, anesthesiologists, pathologists and medical physicists. The first set of trainees arrives at Stanford in August. Please contact HUG if your institution is willing to provide funding for a visiting scholarship for the Ukrainian female doctors or medical physicists. Ukraine needs help in modernizing the training for radiation oncologists and medical physicists as the training in Ukraine is based on Co-60 technology. HUG members are also creating educational materials for transitioning from 3-D to IMRT/VMAT. We thank Rayos Contra Cancer for donating training videos for us to translate.9
A team of Stanford medical and computer science students led by Solomiia Savchuk created a TeleHelp Ukraine initiative to provide remote medical advice and mental health support for Ukrainians with the help of American doctors-volunteers and interpreters. HUG members are grateful to MIM Software Inc. for providing a free software license to host a MIM cloud DICOM repository for medical images from Ukrainian patients that further inform the video consultations. This telemedicine effort urgently needs physicians of various specialties.10
We call on all radiation oncology vendors to provide their support, donate equipment and software, enhance support for equipment maintenance and service, and provide training. Ukrainians are grateful to Varian and Elekta for organizing free training courses for Ukrainian radiation oncologists and physicists. We are also grateful to Limbus AI Inc. for providing free licenses for automatic contouring software and RADformation for donating automatic 3-D planning, automatic contouring, secondary plan check and secondary MU calculation to Ukrainian cancer centers, which will facilitate streamlining the treatment planning workflow.
Even if the war were to stop today, the long-lasting effect of the decimated health care system in Ukraine will last for years. It is imperative that the effective cancer recovery plan in Ukraine should have radiation therapy at its heart with precise coordination among governing bodies, professional and patient organizations, multidisciplinary professionals and industry.11 But all these efforts start with individuals, and the individual power and will of Ukrainians to fight for their cancer patients is truly inspiring. Let’s help these Ukrainian doctors-heroes to win over two evils: the cancer and the war.
HUG also encourages you to view and share this video, created by Dr. Kovalchuk, to see first-hand accounts of the devastation of oncology facilities in Ukraine. If you are interested in providing support for Ukrainian cancer centers, please consider contributing to this Go Fund Me fundraiser, organized by HUG, and share the link with colleagues.
- Kizub D, Melnitchouk N, Beznosenko A, Shabat G, Semeniv S, Nogueira L, Watson PJ, Berg K, Trapido EJ, Espinel Z, Shultz JM. Resilience and perseverance under siege: Providing cancer care during the invasion of Ukraine. Lancet Oncology. 2022 May;23(5):579-583.
- Starenkiy VP, Petrichenko OO, Averyanova L. External beam radiotherapy facilities in Ukraine. Trends and challenges. Problems of Atomic Science and Technology. 2017;112(6):126-129.
- Kovalchuk N, Beznosenko A, Kowalchuk R, Ryzhkova J, Iakovenko V, Kacharian A. While Ukrainian Soldiers are Fearlessly Defending Their Country, Ukrainian Oncologists are Bravely Battling Cancer. Adv Radiat Oncol. 2022 Apr 20;7(6):100965.
- Price P, Sullivan R, Zubarev M, Zelinskyi R. Radiotherapy in conflict: Lessons from Ukraine. Lancet Oncology, 2022 Jul;23(7):845-847.
Kovalchuk – PhD, Stanford University, Stanford, CA, USA
Zelinskyi – MS, Spizhenko Clinic, Kyiv, Ukraine
Beznosenko – MD, National Cancer Institute, Kyiv, Ukraine
Melnitchouk – MD, Brigham and Women’s Hospital, Boston, MA, USA
Iakovenko – PhD, University of Texas Southwestern Medical Center, Dallas, TX, USA
Kowalchuk – MD, Mayo Clinic, Rochester, MN, USA
Hanych – MD, Mariupol Oncological Dispensary, Mariupol, Ukraine
Severyn – MD, National Specialized Children's Hospital OKHMATDYT, Kyiv, Ukraine
Bachynska – RTT, National Specialized Children's Hospital OKHMATDYT, Kyiv, Ukraine
Duda – MD, Lviv Regional Cancer Center, Lviv, Ukraine
Brovchuk – MS, Kyiv Regional Cancer Center, Kyiv, Ukraine
Suchowerska – PhD, University of Sydney, Sydney, Australia