Cancer care in wartime Ukraine: disruption, resilience and recovery.

Before Russia's full-scale invasion in February 2022, Ukraine maintained a well-functioning oncology system, supported by universal health coverage and expanding access to advanced diagnostics and clinical trials. The war caused profound disruptions across all aspects of cancer care-diagnostics, treatment, research and palliative support-yet the system demonstrated exceptional resilience. While hospitals in combat zones were forced to pivot to trauma care, oncology facilities in safer regions were rapidly reorganised and adapted. By late summer 2022, core cancer care in government-controlled territories largely recovered to near pre-war levels through coordinated leadership, emergency regulations and international support, though this recovery remains fragile and uneven, with some patients still facing barriers related to displacement, insecurity and disrupted pathways. Partnerships with the WHO, European Union and oncology societies helped with drug supply, telemedicine, workforce training and patient evacuation abroad. Despite early shortages, drug and radiotherapy capacity has rebounded, aided by modernisation efforts and advocacy networks. Clinical trials, initially halted, are being gradually restored under decentralised and cross-border collaboration models. Grassroots and non-profit organisations have been essential for patient navigation and advocacy, also addressing challenges of treatment delays, drug access, psychological support and palliative care. Looking ahead, Ukraine's National Cancer Control Strategy 2030 prioritises workforce development, early cancer detection and quality improvement to strengthen system resilience. Ukraine's experience demonstrates that even amid prolonged conflict, coordinated governance, adaptive regulation and international collaboration can sustain complex cancer care and offers a practical framework for rebuilding oncology and other non-communicable disease services in conflict-affected settings.