Building an Effective International Medical Evacuation Program for Ukrainian Patients With Cancer Amid Prolonged Military Conflict.

Abstract

During military conflicts, the immediate response to a severely disrupted health care system often overlooks the needs of patients with cancer who require continuous specialized care. The full-scale Russian invasion of Ukraine in February 2022 was no exception, leaving many Ukrainian patients without access to essential care. We conducted a retrospective cohort study to assess the impact of the MedEvac program, facilitating the transfer of Ukrainian patients with cancer to European Union (EU) institutions for treatment, and to describe its components. Patient data from the Ministry of Health of Ukraine (MOH) database (April 2022-April 2023) were analyzed. Of 639 applications in the MOH database, 339 (53.1%) had sufficient data for analysis and, of those, 281 (82.9%) were evacuated to EU hospitals. Median age of evacuated patients was 47 (IQR, 38-58) years and most were newly diagnosed (94.0%, n = 264). Predominantly, patients were evacuated for systemic cancer therapy (81.9%, n = 230). Multivariate logistic regression analysis revealed that a good performance status (Eastern Cooperative Oncology Group 0-2) was the most significant factor associated with evacuation (odds ratio [OR], 9.64 [95% CI, 3.08 to 30.23]). Patients with melanoma were more likely to be evacuated, even after adjustment for performance status (OR, 2.56 [95% CI, 1.14 to 5.72]), while patients with head and neck cancer were significantly less so (OR, 0.20 [95% CI, 0.06 to 0.72]). MedEvac program provides a viable model for medical evacuation and management of patients with cancer amid prolonged military conflict, highlighting the importance of international cooperation and setting a precedent for other crisis responses. Continuous evaluation and adaptation are essential to ensure the program's effectiveness and sustainability.