Tbilisi

Clinical and pathology labs and blood bank

• The assessment identified a lack of quality assurance programmes for laboratory medicine, including blood banks.
• Quality standards for cancer pathology reporting varied.
• There was no established protocol for specimen transportation.
• The number of voluntary blood donors was limited (nearly all blood banks were commercial).

Surgical care

• The data revealed a lack of quality assurance programmes in surgical departments.
• There were no written protocols for cancer surgeries (including safety protocols).

Medical oncology (adult and paediatric)

• Tbilisi had no list of essential oncology medicines, which hindered their prioritisation in terms of funding by insurance policies.
• A low proportion of cancer patients received chemotherapy.
• The quality and safety of chemotherapy preparation were not guaranteed in all centres offering oncology services.

Medical imaging (radiology and nuclear medicine)

• The assessment noted difficulties in accessing stored images of PACS systems from different hospitals.
• There was a lack of standardised reporting for radiology.
• There was also a lack of external quality assurance in diagnostic radiology and nuclear medicine.
• Tbilisi had no capacity to produce ratio-isotopes locally.

Palliative and supportive care

• There was no comprehensive policy on palliative care, including hospitalisation and hospital discharge criteria.
• The system of opioid prescription was restrictive.

Radiotherapy

• Quality criteria varied across different radiotherapy departments.

• Both referral and counter-referral systems for cancer patients were sub-optimal.
• The number of hospitals offering cancer care services had proliferated.
• Financial coverage of cancer patients was limited.
• Diagnosis of cancer was not reimbursed by universal health coverage.
• Current cancer care tariffs did not reflect market prices.
• The quality of existing medical residency programmes varied from one site to the next.
• Medical practitioners were unable to enjoy organised, continuous medical education across different cancer care disciplines.
• There was a lack of subspecialty programmes in cancer care.
• Awareness levels of palliative care at primary healthcare level were low.

• Multidisciplinary cancer teams were often absent from joint clinical decision-making.
• Existing compliance guidelines were not adequately tailored to reality in Georgia.
• Adherence to clinical guidelines and treatment protocols in cancer surgery, systemic therapy and radiotherapy was limited.
• There was a lack of accreditation of hospitals with cancer care services.
• Internal quality control and external quality analysis mechanisms were lacking for most services.
• Data on post-operative complications and mortality in some surgery departments was insufficient.
• Data completeness and the quality of the population-based cancer Registry were both sub-optimal.
• There was no hospital ethics committee.

• Referral and counter-referral criteria did not exist and were not understood by patients or health professionals.
• There was no comprehensive financial package for cancer patients.
• Cancer patient education programmes were lacking.
• Few civil society organisations supported cancer patients.