Csaba Dégi - Caring for the Emotional Wounds

When the invasion began, we were prepared – sort of.

Months prior, with Russian troops amassing on the Ukrainian border, our Ukrainian colleagues were telling us that cancer patients were starting to relocate away from the front lines, so we began discussing their eventual needs. When the fighting actually started, we were ready with an Excel list of all psycho-oncologists in Ukraine and their contact information, and it was posted on Facebook.

Those support services, however, were designed for cancer patients remaining in Ukraine. Many were fleeing the country, and they suffered the most because it was difficult to provide them with needed psychosocial support on the phone.

Within weeks, the International Psycho-Oncology Society responded by holding a board meeting to identify resources within neighbouring countries: Poland, Slovakia, Romania, and the Czech Republic. But these countries have long histories of focusing more on medical oncology, and much less on psycho oncology. To complicate matters, we saw cancer patients migrating to countries even farther away. This was now a trans-European issue. The European Commission declared mental health a priority, especially for people with cancer fleeing the war, and it began funding new digital resources. These included special apps that allowed patients, wherever they are, to connect with Ukrainian psycho-oncologists back home.

Valuable support also came from the European Cancer Organisation and its dedicated website, onco-help.org, which details services – including psychosocial support – available to cancer patients in thirty EU countries. Updated regularly, it provides contact details translated into Ukrainian and a variety of languages.

Psychosocial issues are very language dependent, especially when patients are face-to-face with medical staff. How do you say you're suffering if you don’t have the words? The refugee patients were often going to their hospital rooms and they were crying. But because of the language barrier, it was very hard for anyone to understand or to help, and interpreters were in very short supply.

By the beginning of summer, fortunately, more Ukrainian psychologists started getting involved – not only psycho oncologists – and they were eager to work with us. My fear now is that we are all getting war fatigue, and that we are losing the sense of urgency.

It is important to remember that there is no cancer experience without psychosocial suffering, and that we must always prepare for the extra burdens that may come along.

This is hard to do. In our initial shock and despair at the start of the war, we forgot the basics of our profession, like psychological first aid and trauma prevention. We must be better prepared beyond the core needs.

Another lesson from this crisis, is that we need more trained professionals. Patients can search for information online. But if they’re coping with both cancer and war, they have to share their experiences with someone. They have to talk with professionals, and there are not nearly enough of them.

The third lesson is that we need to be more proactive. Cancer patients are not accustomed to asking for help. So we need to reach out to them and say ‘maybe not now but please know that you can call us; you can talk to us’. We need to think ahead. It's not okay for us as professionals to wait for those suffering to come knocking on our door, because this is the last thing they do, especially in this part of the world.