Q&A: Olena Yefimenko on Cancer Care, Research in Ukraine

When the Russian military invaded Ukraine on February 24, 2022, basic research nearly ground to a halt, and clinical care and research were stymied (Cancer Discov 2022;12:1178; Cancer Discov 2022;12:1400). Since then, hundreds of medical facilities have been destroyed or seriously damaged, including oncology clinics, but researchers and clinicians have persevered, with most work continuing except in areas of heavy fighting or significant destruction. And although no new clinical trials have been launched there since the war began, “it is no exaggeration to say that about 80% of cancer patients didn't have to interrupt their treatment,” said Olena Yefimenko, MD, director of the National Cancer Institute of Ukraine in Kyiv, thanks to supplies that flowed into the country from around the world.

In April, Yefimenko and three other leaders from the country's medical and cancer community traveled to the United States to attend the American Association for Cancer Research Annual Meeting 2023, thanks in part to funds raised by the organization (see sidebar). While there, Yefimenko spoke with Cancer Discovery's Suzanne Rose about the challenges they have faced and how they'd like the Ukrainian cancer enterprise to grow in the years to come. Some of their discussion, which has been edited for length and clarity, follows; portions of the interview can be viewed at https://vimeo.com/850195825.

What happened when the war began?

Right after the invasion, bridges had been detonated and delivery of supplies was challenging. Kyiv was almost fully surrounded—patients came to us through a small corridor. When the evacuation of citizens started, the Ukrainian railroads were transporting everyone for free. Volunteers joined in also and helped with transportation for everyone, and in all directions, wherever there was a need. The evacuation of citizens was centralized, and we evacuated them in ambulances, on buses. The only people who deeply suffered were those who couldn't leave the occupied territories.

Some of our pharmaceutical factories and warehouses were destroyed. The European and American community very quickly organized and sent us a great number of medical supplies. That saved us. That saved our patients.

How many patients continued treatment?

About 80%. Of the 20% who didn't, some couldn't get care because of rapidly occupied territory. Some cancer patients went to the front. And some people were initially in despair and refused treatment. They focused on other problems, the problems of relocation, everyday life, and so on. But in about a month, there was a turnaround, and they slowly did return to treatment. Nowadays, we practically are overbooked at our clinics because we're treating people who had relocated…. Our soldiers beg us to make them well enough so they can return to the front lines and fight for our country's independence.

Ukrainian soldiers were diagnosed with cancer during the war because they were wounded?

Yes, some soldiers found out that they have cancer when they got wounded. When the evacuation of the wounded soldiers takes place, they are taken into the best clinics, and when they are scanned—either through diagnostic ultrasound or CT scan—in order to find out what kind of wound it is, cancer was found.

What has happened with clinical trials? Are fewer people enrolling? Are you able to start new trials?

Unfortunately, we don't have any new clinical trials. We have to be methodical when we conduct trials, and we can't now. It's a big problem for us.

We didn't interrupt any ongoing clinical trials. We even continued through the occupation. We provided therapy for those already in clinical trials, taking them through the end of the trial. The patients in our care who had participated in trials got their treatment and continued receiving care.

Prevention efforts, screening, and diagnosis undoubtedly slowed during the COVID-19 pandemic, and the war has probably compounded that problem.

Ukraine reacted to COVID very quickly. For a couple of years, we've had reform in the health care sector. We have many hospital beds and a large number of doctors, and this worked to our advantage during the pandemic. We could dedicate whole hospitals for COVID treatment. Many medical professionals were involved. Everyone jumped into diagnostics for early COVID detection—all of the clinical labs and private labs. We can't ignore that many people fell victim to COVID; cancer patients were ill and were dying from COVID. But the Ukrainian health care system faced COVID very well.

To say that COVID helped us face the challenges of war, yes, it helped us focus. With COVID vaccination efforts, particularly the mass mobile vaccination efforts, you can say that COVID helped us prepare to respond to this crisis.

For diagnosis, during the war and in this post-occupation period, we got help from international clinics and volunteers. A lot of doctors reached out to the Ministry of Health and came to help us. A lot of young medical professionals had left the country; nurses with small children had left Ukraine during the evacuation. A lot of pharmacies closed. Medical institutions, small facilities closed in towns and villages. But Doctors Without Borders helped us with mobile medical care visits to houses in the villages after the occupation. The diagnostic teams included gynecologists, cardiologists, psychologists, and so on. Referrals were often given for further screenings and diagnostics.

To say that we were conducting massive oncological screening, no. That didn't happen, unfortunately. We don't have enough radiologists…. We didn't turn away anyone who would be coming to any of our clinics, but we couldn't do preventative outreach efforts.

What do you see as the biggest challenges going forward and in rebuilding?

We don't think about the future, as our future is every day. We just live. We don't wait for the future. We are already rebuilding every day. We are rebuilding what's destroyed. And what's impressive is that right after the sirens are over, all the service teams gather around the destroyed buildings, and it's not just debris removal that's happening, but it's also trash removal, and full cleanup so that the walls are standing and people don't lose the desire to live. The same goes for our work.

What can the cancer community do to help?

We would ask you for educational help—training of our doctors, nurses. We need to rebuild destroyed clinics and purchase medicine for free distribution.

But we also would want help directing clinical trials…. Our laboratories are state of the art, we've bought a lot of good equipment, we have equipment that's the best in the country. We would want help to train our medical professionals.

We would want help to write grants. We know that a lot of grants exist, but we don't know the best way to secure them. We want to win as many grants as possible to help us as we develop science in Ukraine. We want to be involved with global science, with other countries. We understand that our data and other materials aren't being used as well as they could be to help humanity in the fight against cancer.

I also wanted to add that now we're just starting endeavors, like psychological support, and I liked learning about this a lot [during our trip]. We also wanted to absorb experiences around rehabilitation in cancer treatment. We are opening a division soon, but now we're concentrating on rehabilitation of military wounded, as well as psychological support for cancer patients. What we still need to improve is social support, legal support. Unfortunately, we only treat the body now. We want to be at the next level so that we can treat the soul and the body and support the family.

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