Why it matters
196.1Cancer incidence rate (per 100,000)
1.18 MTbilisi population
113.0Cancer mortality rate (per 100,000)
2.97 MPopulation reached
Main needs and challenges in Tbilisi
The following needs assessment is guided by a questionnaire designed to systematically collect data on the quality and capacity of cancer care services in the city. It addresses the extent to which patients are placed at the centre of care by also assessing community access and integration of care within the city.
Availability of cancer care services
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).
- 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.
- Quality criteria varied across different radiotherapy departments.
Management of cancer care services (including education and professional training)
- 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.
Quality of cancer care services
- 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.
Community access to cancer care services
- 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.
Projects in Tbilisi
The City Executive Committee identified 12 projects to transform the way Tbilisi treated cancer. These projects were designed to create fresh guidance for cancer care professionals, raise the standard of training for both young and experienced care workers, and develop a brand-new organisation focused specifically on cancer care.
Key achievements toward sustainable impact
The project team has already delivered a range of achievements to raise the quality and equity of cancer care through effective multidisciplinary collaboration:
The C/Can approach is unique for Tbilisi: it not only brought patients into the equation, but also health care providers and policymakers. Tbilisi City Hall, the Ministry of Health, the Patient union and NGOs all became partners.
Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia
Tbilisi City Hall
Georgia Patients’ Union
Europa Donna Georgia
National Centre for Disease Control and Public Health
Mardaleishvili Medical Centre
Clinical Medicine Scientific Research Center
Mardaleishvili Medical Center
Pathology Research Center
Universal Medical Center
Institute of Clinical Oncology
High Technology Medical Centre
National Center of Urology
Radiation Medicine Center
National Screening Center
Consilium Medulla- Multiprofile Clinic
Zodelava Hematology Clinic
Aladashvili University Clinic
Eristavi National Center of Experimental and Clinical Surgery
TSMU First University Clinic
Regional Hospital (Caucasus Medical Center)
Institute for Personalized Medicine
M. Iashvili Children’s Central Hospital
The National Center for Disease Control and Public Health (NCDC)
Georgian Patient Union
Europa Donna Georgia
Tbilisi State Medical University
Caucasus Medical Center