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Evacuating Patients With Pediatric Cancer From Ukraine: Impact on Medical Care Capacity in Poland
Aleksandra Oszer1, Khrystyna Kliuchkivska2, Julia Kołodrubiec1
1Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.
Insights
The influx of Ukrainian child cancer patients strained Polish pediatric oncology centers, significantly increasing patient-to-staff and patient-to-bed ratios. This impacted cancer care delivery and delayed medical procedures for all patients.
Area of Science:
- Oncology
- Public Health
- Pediatrics
Background:
- The 2022 Russian invasion of Ukraine prompted an evacuation of Ukrainian children with cancer, primarily to Poland.
- This created an urgent need to assess the impact on Poland's pediatric cancer care system.
Purpose of the Study:
- To evaluate the effect of the sudden increase in pediatric cancer patients on Polish Pediatric Oncology Centers (PPOCs).
- To analyze changes in PPOC capacity and patient care during the initial phase of the refugee crisis.
Main Methods:
- A multicenter, longitudinal study involving all 19 PPOCs in Poland.
- Comparison of patient-to-physician (PtP), patient-to-nurse (PtN), and patient-to-bed (PtB) ratios before and during the first 11 weeks post-invasion.
- Analysis of delays in medical procedures requiring general anesthesia using national leukemia clinical trial data.
Main Results:
- 237 Ukrainian refugee children with cancer were treated, with 60% arriving in the first 21 days.
- Significant increases in average PtP (85%), PtN (131%), and PtB (105%) ratios were observed.
- The proportion of patients experiencing delays for procedures requiring general anesthesia rose from 15% to 18.2% (P = .043).
Conclusions:
- The influx of Ukrainian pediatric cancer patients significantly reduced the capacity of Polish centers, negatively affecting care for all patients.
- Maintaining pediatric oncology care standards in Poland necessitates international collaboration and patient referral to global facilities.
Purpose:
Soon after the Russian invasion of Ukraine in February 2022, an initiative was organized to evacuate Ukrainian children with cancer, most initially to Poland. This study assessed the impact of this rapid increase in clinical need on the Polish system of pediatric cancer care.
Methods:
This multicenter longitudinal approach was performed among all 19 Polish Pediatric Oncology Centers (PPOCs). We compared PPOC capacity before the invasion with that during the first 11 weeks after the invasion, using three ratios: patients to physicians (PtP), patients to nurses (PtN), and patients to beds (PtB). In addition, we used national data from an ongoing leukemia clinical trial to assess differences between the two study periods in the time required to comply with protocol-indicated medical procedures requiring general anesthesia.
Results:
During the study period, 237 Ukrainian refugee children with cancer were treated in PPOCs; 60% of them arrived during the first 21 days of the war. The relative increase in patients varied significantly among the PPOCs, ranging from 42% to 460%. The average PtP, PtN, and PtB ratios increased significantly by 85%, 131%, and 105%, respectively. The portion of patients experiencing a delay in obtaining medical procedures requiring general anesthesia increased from 15% before the war to 18.2% (P = .043).
Conclusion:
Because of the large number of Ukrainian children with cancer were evacuated to Poland, capacity of PPOCs was reduced, affecting cancer care for all patients. Maintaining standards of pediatric oncology care in Poland would not be possible without further patient referral to medical facilities around the world by international humanitarian collaborative action.
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