Editorial
Conflict in Ukraine and its impact on cancer care
More than 2 million refugees have fled Ukraine since
the Russian invasion began on Feb 24, 2022, and over
4 million people, 10% of the population, are expected to
be forcibly displaced as they seek safety, creating a wide-
ranging humanitarian crisis. Ukraine has a high cancer
burden with more than 160 000 new diagnoses in 2020
alone. The country also has one of the highest childhood
cancer mortality rates globally. Thus, disparities in
cancer care in Ukraine were already high before Russia’s
unprovoked aggression and will now undoubtedly
worsen as a result of the conflict.
WHO estimates that at least 3·8 million Ukrainians
affected by the crisis require health services and those
with cancer are especially vulnerable if their care is
interrupted by Russia’s violence against the country.
Continued access to oncology services must be available
for displaced people, regardless of which country they
ultimately arrive in to avoid life-threatening disruptions
to their cancer care. Maintaining that continuity of
care, however, will be very challenging because many
refugees will not have identification or current medical
records with them. Language barriers might also exist
and if medical records are available, they will need
to be translated quickly and accurately. Additionally,
treatment regimens prescribed in Ukraine might not
be available in the patient’s destination, and although
most European countries have agreed to provide free
health care for refugees, provision will vary according to
the capacity of the available services and what prevailing
treatment guidelines are in place in the host countries.
There are only a finite number of medical oncologists,
surgeons, and specialist facilities. And this is without
the added pressures that the COVID-19 pandemic has
already placed on health-care resources worldwide.
Consequently, there are concerns that Ukranian people
with cancer could overwhelm other health-care systems
very quickly.
Ukraine’s remaining cancer networks, which were
already fragmented, are now focused on evacuating
patients to the west of the country, where cancer
centres are still relatively safe and operational. If key
facilities remain available, there will be new competing
health priorities, including emergencies and trauma
caused by military operations. For example, on the
day of the invasion, all elective surgeries in Ukraine,
www.thelancet.com/oncology Vol 23 April 2022
including cancer surgery, were cancelled. In areas where
movement has been prohibited by Russia, health-care
workers and patients alike are sheltering in underground
Abaca Press/Alamy Stock Photo
facilities and hospital basements. As the fighting
continues, access to essential health-care services
including diagnostics, chemotherapy, and radiotherapy
will probably be disrupted as the infrastructure and
access to supplies deteriorates. Many of the country’s Published Online
March 11, 2022
health facilities, including the National Cancer Institute, https://doi.org/10.1016/
are in Kyiv, which is one of Russia’s primary military and S1470-2045(22)00149-8
political targets. Water and electricity supplies have been For more on refugees see https://
www.unhcr.org/ua/en/43001-un-
disrupted, food insecurity prevails, and there are barriers seeks-us1-7-billion-as-humani
in accessing cancer drugs and other medicines, oxygen, tarian-needs-soar-in-ukraine-
and-neighbouring-countries.html
medical equipment, blood products, perishable goods, For Ukraine’s cancer burden see
and specialised medical staff because air transport is https://gco.iarc.fr/today/data/
factsheets/populations/804-
suspended and roads are impassable. ukraine-fact-sheets.pdf
More than 1500 children with cancer in Ukraine are For more on cancer mortality
estimated to be receiving treatment and, with 80% of rates see https://apps.who.int/
iris/bitstream/handle/10665/
childhood cancers curable, it is vital that they continue 351857/9789289057615-eng.
to receive access to multidisciplinary care. WHO has pdf?sequence=2&isAllowed=y
For more on Ukranians affected
convened regional, national, and international partners and evacuated, and children
to support an immediate and coordinated response to with cancer see https://cancer
letter.com/the-cancer-letter/
ensure that as many patients with cancer as possible 20220304_3/
continue to receive lifesaving treatment, whether For more on supply chain
they remain in Ukraine or have fled to other countries. disruptions see News
Lancet Oncol 2022; published
With international efforts to help Ukraine’s patients online March 3. https://doi.
with cancer, many oncology societies, including the org/10.1016/S1470-
2045(22)00130-9
American Association for Cancer Research (AACR), the For the AACR statement see
International Society of Paediatric Oncology (SIOP), https://www.aacr.org/about-the-
aacr/newsroom/news-releases/
and Childhood Cancer International (CCI) have issued aacr-statement-on-the-russian-
statements declaring their solidarity with Ukraine and invasion-of-ukraine-and-the-
threat-to-cancer-patients-and-
the need to alleviate the suffering of the people. There research/
have been verified reports of direct Russian attacks on For the SIOP statement see
many hospitals. More than 200 health facilities are now https://siop-online.org/news/
siops-statement-on-ukraine/
along conflict lines or in areas under Russian control. For the CCI statement see
The sanctity and safety of health care, including https://www.childhoodcancer
international.org/ukraine-
that of workers and patients, must be respected and statement/
protected during a time of conflict under the First For more on verified reports see
Geneva Convention. This abhorrent war is mercilessly https://www.who.int/
publications/m/item/emergency-
killing and injuring innocent civilians, is interrupting in-ukraine---situation-report-1
the essential work of clinicians as they find themselves For more on the health facilities
see Editorial Lancet 2022;
working tirelessly to save lives while risking their own, 399: 1023
and is putting the lives of many Ukrainian patients For more on the safety of health
with cancer in grave peril. This carnage must stop now. care see World Report Lancet
2022; 399: 896
■ The Lancet Oncology
439