Cancer care during a time of crisis: Israel’s experience during wartime.

Abstract

e23030 Background: During the last decades, there have been many crises in the world, including COVID-19, the Ukraine-Russia war and major tsunamis and earthquakes. These situations create challenges for providing appropriate care for cancer patients. It remains an important research priority to understand how to improve care delivery for cancer patients under conditions of stress or emergency. Methods: Israel has one of the highest-quality healthcare systems in the world. Strengths of the health system include advanced technology, universal health insurance, and four strong health maintenance organizations. Israel’s health system recently performed relatively well during the COVID-19 pandemic. Here, we report on system efforts to continue providing care despite the massive terrorist attack by Hamas of October 7, 2023, the ongoing rocket fire, and the mobilization of young and middle-aged adults to the army, which led to staff shortages. Our report focuses in particular on efforts to maintain continuity and quality of care for cancer patients. Results: There have been three main pillars of Israel’s efforts to maintain care for cancer patients despite the challenges. 1) We activated strategies learned from previous events, including the COVID-19 pandemic and other wars. This enabled continuing treatment of cancer patients, including those who had been evacuated from border-adjacent areas, in oncology departments that are either missile-proof or adjacent to a protected area. 2) The existence of universal health insurance, together with strong health maintenance organizations, enabled us to fill in gaps in social needs and ensure that no patient is “left behind”. This, in turn, allowed patients and their care teams to continue their cancer care without reimbursement barriers or other interruptions, despite the challenges. 3) There was a massive groundswell of volunteerism and lay-led social service initiatives. Almost half (48.6%) of the Israeli population engaged in some volunteer activity during the first two weeks of the war. This included volunteers who provided transportation for patients to and from treatments, donation of medications aimed at helping evacuees from border areas, and volunteer medical staff, such as recent retirees. These civil initiatives played a critical role in providing the initial response to the urgent needs that were left unaddressed by the government. Conclusions: We identified three main pillars that enabled continuity and high quality of care for cancer patients to continue despite a major crisis. A rapid response due to having similar, previous experiences and ready plans. A high-performance and resilient health delivery system, and lay volunteerism in times of crisis. While Israel’s challenges in the present period are unique, nevertheless lessons can be learned by health systems that wish to become more resilient and able to provide adequate care in times of crisis.