The global burden of cancer is growing worldwide, with 12.1 million (mln) new cancer cases and 7.1 mln deaths from cancer in 2020 (Source: GLOBOCAN, 2022). 36% of the new cases and 28 % of the deaths occurred in Europe. Incidence trends for all kinds of cancer have continued to rise in many European countries, although at a slower pace in recent years. Ukraine is classified within the lower-middle-income (LMIC) group and had a population of 44 mln people in 2018. The cancer incidence rate is distributed unevenly among different population categories in Ukraine. Females are more often diagnosed with cancer than males, and morbidity rates of oncological diseases among urban populations prevail over rural ones. The cancer care system in Ukraine, inseparable from the general health care system, remained virtually unchanged throughout the entire period after gaining independence in 1991. Yet, healthcare financing reform, launched in 2017, brought positive changes that introduced a diagnosis-related groups-based funding system, set up a strategic purchaser and gave hospitals managerial autonomy to cancer care delivery in 2020. The care provided for patients with oncological diseases requires a multi-dimensional approach, i.e., different means and methods should be applied at both population and individual levels. These levels are applied sequentially, starting from primary prevention, early detection and screening, diagnostic evaluation, primary, neo-adjuvant and adjuvant treatment, follow-up care, treatment of recurrent cancer, and ending with palliative care and end-of-life care, which are often combined in one. The burden of cancer is distributed unevenly among the regions of Ukraine. In 2021, Dnipro, Kharkiv, and Lviv regions and Kyiv city had the highest rates of oncological diseases (more than 7,000), while Chernivtsi, Luhansk, and Volyn regions represented the lowest incidence rate, with less than 3,000 new patients with cancer. The heterogeneity of the incidence rate of cancer could be partly explained by the regional characteristics of the incidence of COVID-19 and the respective change in access to the treatment and detection settings. However, the different levels of medical personnel competence, the presence of modern equipment, and the development of the infrastructure are factors that primarily affect the uneven distribution of the oncology burden among regions of Ukraine.

1. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer in Europe: Incidence Rates
The global burden of cancer is
growing worldwide, with 18.1
million (mln) new cancer cases
and 9.6 mln deaths from
cancer in 2018; 23 % of the new
cases and 20 % of the deaths
occurred in Europe.
Incidence trends for all kinds of
cancer have continued to rise
in many European countries,
although at a slower pace in
recent years. Ukraine is
classified within the lower-
middle-income group, and had
a population of 44 mln people
in 2018.
According to GLOBOCAN
estimates, there were 170,000
new cancer cases and 98,000
deaths from cancer in Ukraine
in 2018.
Despite the significant burden,
the age-standardized
incidence rates (ASR) 258.3 per
100,000 in males, 203.6 per
100,000 in females) are among
the lowest in the region(1).
The oncological burden of
disease in Ukraine poses
considerable pressure both on
patients and healthcare (HC)
facilities to manage early
detection, diagnosis,
treatment, rehabilitation and
palliative care. The incidence
of cancer among the 30-69 yo
age group in Ukraine is the 2nd
highest among the other
European countries.
In the internal structure of
morbidity in 2020, the share of
neoplasms (C00–C97; ICD-10)
takes the 3rd place in Ukraine in
the general disease
architecture after
cardiovascular diseases (CVD)
and respiratory system
diseases.
However, malignant neoplasms
constituted the 2nd main cause
of deaths of Ukrainians in 2020
with a high rate of avoidable
deaths.
The fight against malignant
neoplasms and overall cancer
rates is one of the most
important HC problems in
Ukraine, the relevance of which
is determined by the constant
growth of morbidity, frequent
failure in timely diagnosis, high
cost and complexity of
treatment, and high disability
and mortality rates.
However, the estimated age-
standardized incidence rate in
Ukraine, presented in the
figure, seems to be much lower
than in other European
countries. At glance, it is meant
to be a positive trend in
prevention and early diagnosis.
Yet in a bird's eye view, this
index depicts a negative
tendency toward
underdiagnosis of oncology
provoked by the low cancer
awareness at the primary
medical care level, and the lack
of systematic nationwide
public health screening
programs aiming to increase
early detection of cancer.
More than half of all cancer
sites are diagnosed at the late
stages (III-IV) in Ukraine which
highlights the core problem of
the oncology service—
inefficient diagnostic strategy.
Besides, the high rates of
cancer recurrence are
associated with insufficient
diagnostics methods which, in
turn, could make the course of
disease more predictable and
controllable, less costly and
add QALYs to a patient with a
history of cancer.
The global burden of cancer is growing worldwide, so the incidence trends for all kinds of cancer
have continued to rise in many European countries, although at a slower pace in recent years.
Source: GLOBOCAN 2020, WHO, Cancer Atlas, (1) "Adult Cancer Arises because of the Life Lived, and
in Children—It Is a Congenital Disease", January 2018, Radio Svoboda
9
Figure 1. Estimated
Age-Standardized
Incidence Rates
(World) in 2020
all cancers,
both sexes,
all ages
Ukraine
212.8
Romania
263.1
Lithuania
293.4
Latvia
301.5
Estonia
278.5
Finland
271.2
Sweden
288.6
Norway
327.5
338.2
Czech Republic
Moldova
227.0
Germany
313.2
France
341.9
Spain
277.2
Italy
341.9
Switzerland
317.6
Serbia
299.2
Greece
264.7
Albania
148.1
North
Macedonia
220.4
Portugal
261.8
UK
319.9
Ireland
372.8
Iceland
265.1
Bosnia and
Herzegovina
227.1
Slovenia
309.0
Netherlands
349.6
Belgium
349.2
Denmark
351.1
Poland
267.3
Austria
255.7
Bulgaria
247.1
Croatia
290.8
Hungary
338.2
Slovakia
296.8
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2. September 2022 White Paper: Cancer Care System in Ukraine: Current Status, Impact of War, Further Development |
Cancer Incidence Rates by Regions of Ukraine
The burden of cancer is
distributed unevenly among
the regions of Ukraine. In 2021,
Dnipro, Kharkiv, and Lviv
regions and Kyiv city had the
highest rates of oncological
diseases (more than 7,000),
while Chernivtsi, Luhansk, and
Volyn regions represented the
lowest incidence rate, with less
than 3,000 new patients with
cancer.
The heterogeneity of the
incidence rate of cancer could
be partly explained by the
regional characteristics of the
incidence of COVID-19 and the
respective change in access to
the treatment and detection
settings. However, the
different levels of medical
personnel competence, the
presence of modern
equipment, and the
development of the
infrastructure are factors that
primarily affect the uneven
distribution of the oncology
burden among regions of
Ukraine.
As for the distribution of
oncological morbidity by
stages, oncological diseases at
the first stage were detected
in 23.2 % of patients, at the
second—in 24.4%, at the
third—in 17.9%, at the fourth—
in 21.0%.At the same time, in
2020, there were more
detected cases in the first two
stages (25.3%; 26.2%) and
approximately the same
detection level at the third and
fourth stages.
While remaining on the same
level, the number of new
cancer cases at the fourth
stage is relatively high
compared to other European
countries and indicates
significant problems in the
organization of cancer
diagnosis. The reasons for
underdiagnosing are
described on page 9.
Furthermore, in 2021, the
detection rate at professional
examinations of all medical
facilities was at the level of
19.8% on average in Ukraine,
from 1.4—9.8% in the Volyn,
Zakarpattia, Ivano-Frankivsk,
Odesa, Cherkasy, and
Chernivtsi regions to 50.1% in
Kyiv.
Analysis of the level of
oncology detection at the
professional examinations
indicates the ineffectiveness
of the latter. This is because of
the poor awareness of the
population regarding the
purpose of preventive
examinations and the
increasingly low level of
oncological vigilance not only
among family doctors but also
among specialists in
specialized medical care,
including in the diagnosis of
the so-called visual
localization of STDs—lip, oral
cavity, anus, skin, mammary
gland, cervix, vulva, vagina,
penis, testicle, eye, thyroid
gland.
Summarizing those mentioned
above, the most problematic
areas in the organization of
cancer control remain the
timely detection of oncological
diseases, adequate staging of
the malignant process as well
as the system of dispensary
monitoring of patients with
oncology, without the
establishment of which it is
impossible to achieve success
in increasing the survival rate
of patients with oncology.
The burden of cancer is distributed unevenly among the regions of Ukraine
due to variance in access to the treatment and detection settings
10
Figure 2. Incidence Rates (New Cancer Cases Registered in 2021
all cancers, both sexes, all ages
Kyiv
Region
Kyiv
City
3,633
Chernihiv
Region
4,600
Vinnytsya
Region
6,148
Odesa
Region
4,409
Cherkasy
Region
3,583
Sumy
Region
8,787
Kharkiv
Region 2,153
Luhansk
Region
3,494
Zhytomyr
Region
4,173
Khmelnitskiy
Region
2,897
Zakarpattya
Region
7,615
Lviv
Region
2,898
Volyn
Region
2,806
Rivne
Region
4,137
Ivano-
Frankivsk
Region
3,789
Mykolayiv
Region
3,602
Kropyvnytskyi
Region
3,593
Kherson
Region
4,959
Zaporizhzhya
Region
Crimea AR
10,239
Dnipro
Region
4,429
Poltava
Region
3,061
Ternopil
Region
4,187
Donetsk
Region
1,764
Chernivtsi
Region
4,915
9,942
>10,000
7,000-10,000
4,000-7,000
<2,000
2,000-3,000
New cases registered
Territories of Ukraine temporary
occupied by Russia
Sources: NCRU, Bulletin of the National Cancer Registry of Ukraine Vol. 23, 2021
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