Medical institutions in Ukraine try to cope with rise in thyroid cancers (08/17/97)

Medical institutions in Ukraine try to cope with rise in thyroid cancers

by Khristina Lew
Kyiv Press Bureau

KYIV - The Ukrainian Academy of Sciences' Institute of Endocrinology is located on the northern outskirts of Kyiv. It is a foreboding building, its unlit hallways frequented by women with gauze dressings wrapped around their necks.

In the institute's surgical division, freshly washed disposable rubber gloves line the radiators beneath dusty windows. Surgeons perform operations in the remnants of scrubs, their heads swaddled in gauze.

The surgical division has 50 beds, and its four surgeons perform eight to 10 thyroid-related operations a day, three days a week. In 1996 the institute's surgical staff performed 663 thyroid operations; in 1980, 391. Since the 1986 explosion at the Chornobyl nuclear power plant some 60 miles north of the institute, each year 50 to 60 of those patients have been children.

Most of the equipment in the operating room was donated as humanitarian aid by Italians and Germans. The institute is currently awaiting the arrival of a gamma camera donated by the European Association of Thyroid Gland Specialists.

"We have no money, no budget, no equipment," explained Dr. Ihor Komissarenko, chief of the institute's surgical department, who with his late father, Dr. Vasyl Komissarenko, created the institute in 1965.

Across town, in Kyiv's eastern reaches, is the Ukrainian Center of Endocrine Surgery and Transplantation. Created by presidential decree in 1994, the center rents space from the Kharkiv Raion Hospital, and is sponsored by Ukraine's Ministry of Public Health. Dr. Komissarenko serves as the center's general director, and splits his time between the institute and the center.

The 60-bed center takes up three floors of the Kharkiv Raion Hospital and is equipped with modern technology. The Ministry of Health purchased $1 million in equipment for angiograms for the center, and it boasts a separate cytology laboratory, biochemical laboratory and diagnostics room. It also has a school for diabetics, where instruction is supplemented by computers and videoplayers. Surgeons perform operations in brightly lit rooms, to strains of classical music.

In 1996 the center performed 770 thyroid-related surgeries.

Despite the improved conditions at the center, both the institute and the center are overwhelmed by an increasing number of thyroid cancer patients. "No other country has as many thyroid cancers as Ukraine," said Dr. Komissarenko, who has traveled to Italy, France and the United States to observe how those countries treat thyroid tumors and cancers.

According to an April 19, 1996, article in Science magazine, 700 cases of pediatric thyroid cancer were reported in children living in areas surrounding Chornobyl. The article predicted that the number of thyroid cancer cases in Ukraine and Belarus would range from 4,000 to 6,000 in the next 10 years. Despite earlier assertions to the contrary by the International Atomic Energy Agency, the study "Childhood Thyroid Cancer Following the Chornobyl Accident," published by the Endocrinology and Metabolism Clinics of North America in March 1996, noted that "subsequent and persistent reports describing an increasing incidence of childhood thyroid cancer led to the realization that the Chornobyl accident was indeed the probable cause."

Dr. Komissarenko and his staff at both the institute and the center live those statistics, and they are desperate for technical assistance from the international community. "These cancers are very specific. They are fast-growing and produce earlier metastases. If caught on time there is a 90 percent cure rate, but we do not have the equipment and are not prepared to deal with the quantities," he said.

Dr. Komissarenko dreams of creating an independent clinic that does not rely on support from Ukraine's Academy of Sciences or the Ministry of Public Health. In June he traveled to the United States to meet with surgeons at New York Eye and Ear Infirmary and discuss possible collaborative efforts. His trip was organized by a Ukrainian American surgeon, Dr. Oleh Slupchynskyj, chief resident of head/neck and reconstructive surgery at New York Eye and Ear Infirmary.

Dr. Komissarenko traveled to New York with two teenage girls suffering from thyroid tumors. On June 17 he observed Dr. Slupchynskyj and Dr. Jordan Stern, director of head and neck surgery at New York Eye and Ear Infirmary, perform the two-and-a-half-hour surgeries.

Dr. Slupchynskyj reported that 16-year-old Julia Kaznacheva and 17-year-old Anna Sopryk, both formerly from the Chornobyl area, suffered no complications from their surgeries. They recuperated at the Ronald McDonald House in Manhattan and each was awarded a $430 stipend by the Ukrainian Association of Glen Spey, N.Y., and Veterans of the 1st Division of the Ukrainian National Army.

In addition to observing surgery in the United States, Dr. Komissarenko had an opportunity to share his expertise in pediatric thyroid cancer. He lectured at New York Eye and Ear Infirmary on June 18 and St. Vincent's Hospital on July 19. "Dr. Komissarenko's lectures presented grim clinical realities on pediatric thyroid cancer never before observed in any part of the world," Dr. Slupchynskyj noted.

Dr. Slupchynskyj is also well-versed in Ukraine's plight with Chornobyl-related cancer. On the joint initiative of Drs. Slupchynskyj and Stern, and Tamara Gallo, president of Gallo Consultants Inc., Dr. Slupchynskyj visited Kyiv's Franco-Ukrainian Clinic in April 1996. He examined 22 children identified with airway complications due to thyroid cancer.

He also delivered a $6,000 laryngoscope and $10,000 worth of equipment and supplies donated by Aztec Medical Corp. to the Kyiv Institute of Otolaryngology.

In May 1996 he presented his findings to staff at New York Eye and Ear Infirmary, and in August he returned to Kyiv to conduct another clinic.

Cooperation with the Kyiv Institute of Otolaryngology resulted in the first physicians' exchange with New York Eye and Ear Infirmary in December 1996. At that time Drs. Dmytro Zabolotny, director of the institute, and Valerii Hayovii and Evhen Shubin traveled to New York to study American surgical procedures. Dr. Slupchynskyj's clinical work in Kyiv and the exchange program at New York Eye and Ear Infirmary were sponsored by a grant from the Samuel Freeman Charitable Trust.

"Thyroid cancer is a devastating reality in Ukraine," Dr. Slupchynskyj observed. "Although Ukrainian physicians are competent, they need technical assistance and supplies."

While Dr. Komissarenko is optimistic about future collaboration with American surgeons, he is forthright in his appraisal of Ukraine's inability to tackle the problem on its own. "Chornobyl can happen in any country, and only through international cooperative efforts will mankind learn how to deal with its aftereffects."

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