Introduction by Croakey: A team of oncology practitioners from Ukraine, Australia, Canada and the United States has formed the Help Ukraine Group (HUG) to provide ongoing support to cancer care in Ukraine during the war with Russia and to help rebuild its health system afterwards.
The recent Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference heard their passionate call for medical radiation science services, organisations and vendors to donate money, equipment and expertise, as Croakey editor Marie McInerney reports.
Bookmark our coverage of #ASMIRT2023 here.
Marie McInerney writes:
One of the earliest Zoom calls that Sydney medical physicist Natalka Suchowerska had with cancer colleagues in Ukraine is still vivid in her mind.
As they spoke in the first weeks after the 2022 Russian invasion, the Ukrainian clinicians told her a tank was firing off a rise not far from their centre.
“They were saying that their walls were shaking and they could really feel the rumble every time the tank boomed,” remembered Suchowerska, an Associate Professor in the School of Physics at Sydney University, who until recently led medical physics research at the Chris O’Brien Lifehouse cancer centre.
Yet, she told Croakey, “they stayed calm and looked after their patients”.
It was one of many displays of courage and dedication she has witnessed during the war from Ukrainian health professionals — people she describes as “ethical and extremely self-sacrificing” and for whom she is appealing for help from Australian colleagues.
“War goes on but cancers don’t stop and you can’t say wait until the end of the war for us treat you,” she told the recent Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference in Sydney that prompted ASMIRT to hold an impromptu board meeting that launched an appeal among members for funds, equipment and expertise.
Suchowerska said other nations had a lot to learn from Ukraine’s “heroic” health workers and how they have adapted and continued to care for the most vulnerable in society, including “people fighting the dual battle against cancer and invaders”.
She was joined on stage via Zoom by two of her Ukrainian HUG colleagues – radiotherapy technologist Bohdana Bachynska and medical physicist Dr Serhii Brovchuk, who described their efforts to continue treatment when patients were having to sleep in their clinics because their homes had been occupied, while others had fled to western Ukraine or beyond to Europe.
Bachynska told the conference she was one of three radiation therapists at her Kyiv clinic when the war began. Since then, one had joined the army and another was evacuated with her children to western Europe, leaving Bachynska to deliver treatment solo for months before she was joined by a colleague evacuated from besieged Mariupol.
“I think that brings it home to you,” Suchowerska told delegates, urging them to encourage their organisations, services, institutions and vendors to donate money, equipment, training and expertise to Ukrainian cancer care.
Desperate efforts
Suchowerska is of Ukrainian descent – her parents fled the country in World War Two. Fluent in Ukrainian, she is a founding member of the Help Ukraine Group (HUG), formed in early 2022 by oncology practitioners from Ukraine, Australia, Canada and the United States to support cancer centres in Ukraine through the war.
Its members hold fortnightly Zoom meetings, led by Associate Professor Nataliya Kovalchuk from Stanford University, to address clinical issues and provide ongoing education and training support in cancer treatments.
They discuss not only the urgent need now, amid massive dislocation of patients and staff, destruction of facilities, ageing equipment, and disrupted access to medications and care, but also plan for what happens after the war, whenever that comes, and the rising demand for cancer treatment that will follow.
Suchowerska told Croakey she had worked in the oncology profession for more than 40 years, and had “attracted big research grants, invented impressive stuff and mentored hundreds of professionals for Australia”.
But this work with HUG in Ukraine “is without doubt the most important thing I will do as a health professional and human being”, she said.
As well as providing clinical and training support, HUG members also try to get word out globally about the issues facing Ukraine’s cancer patients and specialists.
An article she and her colleagues published in the Advanced Radiation journal in July 2022 documented the desperate efforts by those working in Mariupol Oncological Dispensary to care for their patients as the eastern Ukrainian city was besieged.
It quotes Dr Andrii Hanych, chief of the Radiation Oncology Department, as saying eventually the clinic had to stop treating its patients, to save their fuel to melt snow for water, and use its generator for cooking and feeding patients and staff:
“To hide from the missiles, we decided to house our patients in the corridors and vault of the Co-60 (radiation therapy) machine,” he said.
One night, “as the fighting was approaching and becoming more intense”, Hanych asked the Ukrainian military to start evacuating their patients. A missile hit the facility two hours after the evacuation bus had left.
Damage to infrastructure
Suchowerska said that prior to Ukraine’s extended conflict with Russia it had 55 functional cancer care centres, 52 of which provided radiotherapy with 106 radiation treatment units, many of which still involved old Soviet technology.
When Russia annexed part of Ukraine in 2014, control of 10 radiotherapy centres with 17 external beam radiation therapy machines was lost, she said. Through 2022, arterial and aerial bombing of hospital sites affected electricity supply, internet connection and caused vibration and structural movement, all factors which significantly impact imaging and treatment delivery, she said.
Radiotherapy has suffered the most disruption, she said, reporting a decrease of close to 40 percent in treatment. While many cancer patients, particularly children, have been able to flee to safety in the West, that can bring its own longer-term risks, with delayed and disrupted care.
A snapshot by UK not-for profit E-Cancer cancer charity detailed the early impact on cancer care in the war, with less urgent procedures abandoned as surgical oncology teams focused on malignant tumours, while some advanced techniques, such as laparoscopic surgery, were constrained by shortages of surgical supplies.
Clinical trials had to be abandoned and people living with cancer were thrown into a state of great anxiety, separated from their clinical teams and even their medical records, it reported.
On top of that, the destruction of health facilities and capacity has been massive.
According to a February 2023 report in the BMJ, more than 700 attacks on hospitals, health workers, and other medical infrastructure in Ukraine had been reported in the year since the Russian invasion began.
“Over that period, there were 292 attacks that damaged or destroyed 218 hospitals and clinics, 181 attacks on other health infrastructure (such as pharmacies, blood centres, and dental clinics), and 65 attacks on ambulances. There were also 86 attacks on healthcare workers, with 62 killed and 52 injured,” it said.
It’s what’s called the ‘killing twice effect’, Suchowerska told #ASMIRT2023, a term given in disaster medicine to the increased deaths that follow the wreckage of healthcare services and loss of medical professionals.
Suchowerska and her HUG colleagues have written that Ukraine’s ability to reconstruct after the war will be affected for years, possibly decades, as a direct consequence of the abrupt interruption of education and livelihood of medical professionals, particularly those who are in training.
In response, it has set up training positions for Ukraine oncology professionals, usually female clinicians who are able to leave Ukraine to train overseas, because they are not required to fight. So far they have been placed in US facilities, including Stanford University, Harvard Medical School and the Mayo Clinic, with two in Australia with the ICON Group Cancer Centres.
Suchowerska is awaiting news on an application through the Department of Foreign Affairs and Trade to bring another six clinicians to Australia, where they will be supported to develop cancer treatment training programs for Ukraine.
But she is urging greater involvement from the Australian cancer care sector, saying it is well placed to play a significant role in education and training in radiation oncology, medical physics and radiation therapy, by offering remote courses and fellowships. As an example of what can be done, she said one Australian university is currently translating its radiation therapy course into Ukrainian.
The need to build up capacity for the future is clear from a paper published last year in JCO Global Oncology on armed conflict and the impact on patients with cancer in Ukraine that warned bluntly: “war breeds cancer”.
Its authors wrote:
War increases the risk of cancer. War interrupts and prevents effective treatment for cancer. War exposes vulnerable patients with cancer to infections and threatening conditions. War diverts resources from cancer care. War leads to delays in diagnosis – as those involved seek shelter and safety, ignoring concerning signs and symptoms, and the very hospitals and clinics are overrun, damaged, or destroyed.”
Suchowerska has been buoyed by the response to her #ASMIRT2023 presentation. As well as ASMIRT’s appeal launch, universities have reached out to her, as have a number of clinicians wanting to go to Ukraine to assist with training.
But with the task ahead both acute and long-term, she is urging the wider sector to reflect on what being a health professional means and to think about the broader meaning of collegiality, the need to “make sure your team is okay”.
“At a time like this for Ukraine, we are their team.”
Watch this video by Stanford Medicine.
Via Twitter
Read previous articles from #ASMIRT2023 for Croakey Conference News Service here. Follow this Twitter list for more conversations on medical imaging and radiation therapy sector post-conference.
