Access to cancer treatment during the war - results of scientific research
The medical sector was significantly affected by Russia’s full-scale invasion of Ukraine. It is not only about the physical destruction of hospitals, but also about the availability of medicines or the accessibility of specialists on the ground. The shortage of the former or latter is especially acute for adult cancer patients whose treatment cannot be postponed.
Global Medical Knowledge Alliance in cooperation with the Inspiration Family (Foundation for Support of Adult Oncology Patients), the Ukrainian Union of Clinical Oncologists OncoHub and the National Cancer Institute conducted a study to analyze the availability and quality of medical care for cancer patients in the context of current conditions and challenges including war.
The study analyzes the results of a survey of 522 people diagnosed with cancer from four Ukrainian Cancer Centers located in Kyiv, Dnipro, Kharkiv, and Cherkasy.
Whether the surveyed patients were forced to interrupt or postpone their treatment due to the hostilities, which state-covered services patients pay for most often, and how much cancer patients are aware of their disease, treatment, and the possibility of receiving psychological assistance – mentioned in the study
Socio-demographic indicators
Among 552 respondents:
- from 18 to 25 years old – 1%
- 26 to 35 years old – 5%
- from 36 to 45 years old – 12%
- from 46 to 55 years old – 21%
- from 56 to 65 years old – 31%
- over 65 years old – 30%
The majority do not work, including 44% of respondents who are on an old-age retirement, 10% on a disability retirement, and 18% do not work for another reason.
Regarding the level of well-being, 34% of respondents said they have enough money only for food, 35% – only for basic necessities, 25% – for everything they need, but without savings, and only 5% said they live in full prosperity or have savings.
Characteristics of cancer and its treatment among respondents
Among the 522 people who participated in the survey:
- 91% were undergoing cancer treatment at the time of the survey
- 7% – within the last year.
65% of respondents were diagnosed less than a year ago.
The most common types of cancer among respondents:
- Breast cancer – 32%
- Rectal cancer – 10%
- Cervical cancer – 9%
- Lung cancer – 7%
- Lymphoma – 7%
Among women, the most common types of cancer are breast cancer (51%), cervical cancer (14%), rectal cancer and lung cancer (4% each). Among men, rectal cancer (18%) and lung cancer (12%) are the most common, with prostate cancer accounting for 9%. 23% said they had another type of cancer, including 29% of men and 19% of women.
Among those surveyed, 39% had early (I or II) stage cancer. Early stage cancer was more common among women (46%, most cases were breast and cervical cancer) than among men (27%, most cases were colon and lung cancer). 38% had stage III and IV, 23% did not know their stage of the disease.
70% (136/203) of patients with stage I and II cancer were diagnosed within the last year. Among patients with stage III, there were 59% (65/111), and with stage IV – 58% (52/90).
23% did not know their cancer stage, including 17% of women and almost a third (32%) of men. Young and elderly respondents were more likely to not know their stage (18-22% among 18-45 years old, 25-29% among 56+ years old, and 13% among 46-55 years old).
Impact of hostilities on access to treatment
Among the 522 respondents, 89% did not have to interrupt or delay their treatment due to hostilities. Among those who had to interrupt or postpone their treatment, 5% did so because they could not get to an oncology center or hospital, and 5% due to the lack of treatment drugs in oncology centers, hospitals or pharmacies. Postponement of treatment due to hostilities does not depend on gender, age, place of residence (Kyiv, regional center, small town, village).
The most difficulties with treatment were experienced by respondents in Kharkiv, where 23% of respondents said they had interrupted or postponed their treatment because of the hostilities (11% of all respondents), most likely due to shelling and proximity to hostilities. In Kharkiv, 14% had problems getting to the oncology center or hospital, and 11% had problems related to the lack of treatment drugs.
Among respondents who said they had enough money only for food or basic necessities, 12-13% interrupted or postponed treatment due to the hostilities (5-7% because it was impossible to get to the hospital and 5-6% because there were no medicines), compared to 4-8% among people with higher levels of income.
Medical infrastructure for diagnosis and treatment
A little over half of the respondents (57%) sought diagnostics at public health facilities in their city/town, 28% received diagnostics at public facilities in other places, 20% and 29% at private clinics in their own or other places, and none – abroad.
Among respondents from small towns or villages, 60-73% sought diagnostics in public facilities in other cities, compared to 8-10% of respondents from Kyiv or oblast centers.
People who said that they had enough money only for food or the most necessary things rarely received services in private hospitals (31-36% vs. 48-61%), but more often in medical facilities in another city (29-34% vs. 15-20%).
Among the 192 (37%) respondents who visited private clinics for cancer diagnostics, the most common reason (for 60% of patients) was the long waiting time in public institutions or because public institutions in the locality do not perform the necessary diagnostic procedures (23%). In small towns (50%) and villages (36%), the main reason is the lack of necessary diagnostic procedures.
Cancer diagnosis: waiting time for diagnosis and paid services
It took less than 1 month for 68% of respondents to get a diagnosis of cancer, 1-2 months for 19% of respondents, and more than 2 months for 10% of respondents. Younger respondents were more likely to wait more than a month for a diagnosis (33-40% vs. 27-30% in other age groups).
The level of wealth, city, and type of city of residence did not affect the time from seeking medical care to diagnosis.
Among 522 respondents:
- 46% of patients received diagnostics at public healthcare facilities free of charge (28-59% depending on the location)
- 43% paid for some aspects of diagnostics (36-66%)
- 11% paid for all aspects of diagnostics.
The highest proportion of fully paid services was in public healthcare facilities in Kharkiv – 27% compared to 6-11% in other locations.
Official payments for diagnostics were most frequently made for CT scans (73% of 433 people who had this procedure), MRI (72% of 224 people who had MRI), PET-CT (44%), biopsies (31%), immunohistochemistry (30%), ultrasound (26%), and blood tests (22%).
Only 3-11% of respondents reported unofficial payments for diagnostics, depending on the type of diagnostics. Among unofficial payments in public healthcare facilities for diagnostic procedures, the first place is occupied by biopsy payments (13% of all biopsies performed).
Cancer treatment: waiting time for cancer treatment
The most common treatment methods among the respondents are chemotherapy (77%), surgery (60%), radiotherapy (42%), and hormone therapy (14%). Targeted therapy was recommended for only 6% and immunotherapy for only 2% of patients.
Among the 241 (46%) who waited more than one month to start treatment:
- 25% said it was because of hostilities
- 17% – because the equipment was not working or there were no consumables
- 13% – there was a waiting list
- 12% – there were no free medicines.
The waiting time was more common due to hostile (27-30%) in Kyiv and Kharkiv compared to Dnipro and Cherkasy (18-22%). The reasons mentioned do not depend on the level of wealth.
Cancer treatment: paid services
Depending on the cancer center, 28-59% of patients received all treatment free of charge, compared to 6-27% who reported having to pay out of pocket for all aspects of treatment, and 34-66% who received some care free of charge and had to pay for specific types of cancer diagnosis or treatment.
In terms of payment for treatment, chemotherapy was the most commonly received free of charge (61%), followed by radiotherapy (49%) and surgery (47%). Official payments were made most often for surgery (36%), radiotherapy (25%), and less often for chemotherapy (23%). The most frequent official or unofficial payments were made for surgery in Kharkiv (55% vs. 41-50% in other locations); payments for chemotherapy did not differ between cities.
Among the 201 (39% of 522) who officially paid for treatment:
- 32% did it to buy instruments that were not available;
- 29% – to buy medicines that were not available;
- 16% – made a charitable contribution;
- 10% – to get treatment without waiting in line.
Unofficial payments were rare:
- 11% in case of surgery,
- 8% in case of chemotherapy,
- 4% in case of radiotherapy
Among 522, 11% said they had changed their place of treatment to get some medications or procedures for free. Patients from Kharkiv did this most often (21% compared to 7-10% in other locations).
Specifics of treatment services
Only 10% of 90 patients under the age of 45 were recommended to undergo procedures or receive medications to preserve their reproductive capacity as part of their cancer treatment, including 15% of patients aged 18-35 and 8% of patients aged 36-45 (in these age groups, 4% and 2%, i.e. one third of patients were unable to undergo the recommended procedures).
Most often these recommendations were made to patients in Cherkasy (12%) and Kharkiv (4%), and not at all in Dnipro and Kyiv.
Only 13% of patients were recommended to have their cancer tested for genetic mutations. Such recommendations were more often given to younger patients (24-30% of patients aged 18-45 years and 10-12% of 46-65+).
Recommendations were more common for patients in Kyiv (16% compared to 7-12% in other types of settlements; 17% in Kyiv compared to 7-13% in other cancer centers), and for patients with higher income (23% among those who save, 7% among those who said they have enough money only for food, 15-16% among other patients).
Awareness of possible additional services of a rehabilitation therapist or psychologist is rather low, only 35% knew about this possibility in general and 9% said that there were services of a psychologist, and 4% said that there were services of a rehabilitation therapist.
Awareness of additional resources
The vast majority of patients (93%) received information about cancer treatment from their doctors. Awareness of charitable organizations and foundations that care for adult cancer patients is very low and further work is needed to raise it.
Out of 522 respondents:
- 47% did not know that patient organizations existed;
- 29% did not know what kind of help they could get;
- 27% had no additional needs;
- 5% did not trust patient organizations.
Only one in five respondents could recall at least one such organization when prompted, and 96% have not applied to any organization for help.
Video presentation of the survey results (in Ukrainian):
Фото: Anadolu Agency/Getty Images
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