“Refugees and displaced people may see their cancer treatment interrupted, or they may develop a new cancer while they are in host countries. They often present with advanced disease and suffer more complications. These patients have poor outcomes because of poor hygiene and living conditions, as well as the limited health education, limited access to care, and limited resources available to them. They are usually unfamiliar with the health system in their asylum countries, and they are not enrolled in screening programs.”¹

Four years ago, Nagi S. El Saghir, MD, FACP, FASCO, and his co-authors summarized the plight of displaced patients with cancer in their paper, “Cancer Care for Refugees and Displaced Populations: Middle East Conflicts and Global Natural Disasters,” for the 2018 ASCO Educational Book. They also noted at the time, “Cancer services have been a severely neglected dimension of refugee health, and the global health community must overhaul its perception, vision, and strategy for tackling this issue.”

This issue is now at the forefront for many Ukrainian people. ASCO and its members are working to provide active support for oncology care in Ukraine and in countries that are receiving displaced patients with cancer. With ASCO and the Sidney Kimmel Cancer Center - Jefferson Health, the American Cancer Society (ACS) has launched the ACS Clinician Volunteer Corps so oncology professionals can offer information and guidance to caregivers in the impacted areas.

It is difficult to pinpoint exactly how many patients with cancer were in active treatment when Ukraine was invaded, but World Health Organization (WHO) Globocan data from 2020 estimates that there were 162,594 new cancer cases that year and a 5-year prevalence rate of 405,693.² Whatever the exact number, we know that people who are fleeing their homes in Ukraine must now seek cancer care in unfamiliar surroundings, many with limited or no access to their medical records and with minimal resources.

Since the Russian invasion began, ASCO has been in ongoing communication with oncology care providers in Ukraine and in the neighboring countries that are receiving the majority of Ukrainian refugees, who are estimated to number about 1 million to date, as well as working with WHO and other organizations around the world to provide and coordinate assistance.

“We are sickened and distraught over what’s happening, and we all want to do whatever we can to help,” said ASCO chief medical officer Julie R. Gralow, MD, FACP, FASCO. “Working together in partnerships and collaborations, we have the best chance of avoiding duplication of efforts, leveraging each organization’s strengths, and providing the types of support that are truly needed—all with the overarching goal of helping to avoid life-threatening disruptions in the cancer care of these displaced patients.”

ASCO is in constant communication with its members in Ukraine and the neighboring countries, Ukrainian-American members, and leaders in the region, including National Cancer Institute of Ukraine chief medical officer Andriy Beznosenko, MD, PhD, MBA, to help make connections, understand what is needed by both patients and providers, and develop and provide resources.

ACS Volunteer Corps of Clinicians

Recently, ASCO and ACS entered a collaborative partnership to share patient information on each other’s websites. Building on this collaboration, ACS reached out to ASCO as ACS started to receive inquiries from doctors in surrounding countries who weren’t oncologists but who were seeing displaced patients with cancer and needed help answering general cancer-related questions. For example, "Is a patient who was treated with radiation therapy one week ago considered radioactive?" and, "What special measures or protective equipment is needed in this case?" To help with these queries, ASCO is establishing a group of ASCO member volunteers, including members who speak Ukrainian and other Eastern European languages, to volunteer their expertise to answer the questions that are coming in. ACS has set up a webpage that links to the volunteer portal and also contains other relevant resources, including a crisis hotline, resources for patients and caregivers, and a call for cancer support resources.

“We have no way of knowing what the volume of calls and inquiries is going to be, so we’re putting together an immediate core group of dedicated volunteers and then we can scale up if needed,” Dr. Gralow noted.

Compiling a List of Resources

Other inquiries relate to where refugees with cancer can access treatment. To help address this need, ASCO is collaborating with the European Cancer Organisation, WHO, and others to identify and compile a list of regional facilities that can serve as referral centers for the Ukrainian refugee population. For example, an ASCO member in Poland has shared a Ukrainian language listing of Polish cancer centers accepting refugees for care. It is expected that this inventory of available facilities will be made available through the ASCO, ECO, and the WHO websites in the coming days.

To rapidly assess and respond to additional needs as they are identified, ASCO and ECO, which represents and convenes member organizations working in the oncology field in Europe, have established a steering group with representatives from both organizations that includes representatives from Ukraine and the region. This steering group will meet routinely over the next few weeks as the humanitarian crisis in Ukraine evolves to identify other priorities and needs, as well as methods for providing support.

Resources for Patients, Caregivers, and Family Members

ASCO is also hearing from its members about ideas and ways to provide assistance. One ASCO member in Romania indicated there’s a need for materials on psychosocial topics for patients, caregivers, and families in Ukraine. Cancer.Net, ASCO’s patient website, has responded by creating and translating information on managing cancer care during an emergency and linking to information in several languages about common side effects from ACS. In addition, Fay J. Hlubocky, PhD, MA, Cancer.Net’s editor for psychosocial oncology, is developing content on coping with the psychological impact patients and refugees often experience when they are displaced. This information will be made available on a dedicated Cancer.Net web page in the coming days.

Resources for Medical Professionals Providing Cancer Care to Displaced Ukrainian Patients

ASCO recognizes that many health care providers throughout Ukraine and bordering nations are trying to provide medical care under less than ideal, and in some cases dire, circumstances. In an effort to support critical health care decisions that need to be made regardless of circumstances, the Society has compiled a list of relevant journal articles and resource-stratified guidelines. ASCO will continue to collate resources and make these available through its website.

“By working in concert with other cancer and health organizations around the world, we hope our collective efforts will serve to support patients, providers, families and caregivers in need in the war-torn region,” Dr. Gralow said. “In this way, we also demonstrate our global solidarity with the cancer care community in Ukraine and surrounding countries.”

Read ASCO’s statement of support for the Ukrainian cancer community.

Related Resources

• View a list of relevant journal articles and resource-stratified guidelines from JCO Global Oncology.
• View our central resource center for Ukraine-related information.

References

1. El Saghir NS, Soto Pérez de Celis E, Fares JE, et al. Cancer Care for Refugees and Displaced Populations: Middle East Conflicts and Global Natural Disasters. Am Soc Clin Oncol Educ Book. 2018;38:433-40.
2. World Health Organization. International Agency for Research on Cancer. Ukraine. Source: Globocan 2020. March 2021. Accessed March 2, 2022.