Mar 04, 2015
In April 2015, Georgia will host ASCO International’s new Cancer Control in Primary Care Course. The course provides primary health care providers (doctors, nurses, and others) with practical and specific knowledge about oncology that can be incorporated into their daily practice. ASCO Connection speaks to Levan Jugeli, MD, MSc, about the current state of cancer care in Georgia.
For the past 15 years, the Georgian health care system has undergone major reforms. Currently, 90% of the health infrastructure has been privatized, including primary and secondary care facilities. Given the existing situation, some key priorities of the new cancer control plan in Georgia are:
- to develop regulation and referral systems for newly evolved private health infrastructures;
- to implement primary and secondary cancer prevention programs;
- to enhance current cancer screening programs;
- to increase the capacity of medical professionals, including primary care doctors and nurses; and
- to establish a population-based cancer registry.
The majority of cancer patients arrive at special institutions with cancer already in stages III-IV. While 60% of the patients diagnosed at stages III-IV are practically incurable, the rest require long-term expensive treatment, which doesn’t usually result in promising outcomes. Some of the main reasons for late detection in Georgia are:
- low health literacy and disregard for cancer prevention among the population,
- lack of knowledge regarding the signs and symptoms of cancer among primary care providers,
- low level of supervision over persons with chronic and pre-cancerous diseases/conditions, and
- insufficient coverage of the population by existing screening programs.
All of this points to gaps in public education campaigns regarding cancer awareness. As a result, my colleague, Dr. Rema Gvamichava, and I decided to introduce various cancer screening and prevention projects in Georgia.
Cancer-screening programs in Georgia
The National Screening Program for breast and cervical cancer was launched in 2008 and was co-funded by Tbilisi Municipality and United Nations Population Fund (UNFPA) Georgia and with support of First Lady of Georgia. Subsequently, the National Screening Center (NSC) was established and given responsibility for launching and operating four pilot cancer screening programs to serve the Tbilisi municipality (breast and cervical in 2008; colorectal and prostate in 2010). The aims of the screening programs were:
- to reduce morbidity and mortality from these cancers;
- to ensure equitable access for the targeted age groups/populations;
- to ensure that cancer care services are acceptable and appropriate for the needs of the population; and
- to achieve high standards of program management, service delivery, accountability, monitoring, and evaluation.
In 2011, based on the success of the Tbilisi pilot programs, the Georgian government decided to introduce breast and cervical cancer screening in all the regions of Georgia. The NSC was selected to implement and operate the national screening programs.
This innovative project is one of the first of its kind among Eastern Europe and Central Asia. It aims to increase the detection of reproductive cancers earlier and raise awareness of reproductive cancer screening and prevention in order to reduce the morbidity and early mortality rates of women caused by these diseases.
In January 2009, at the Cervical Cancer Prevention Summit, organized by the European Parliament, European Cervical Cancer Association, and Politicians for Cervical Cancer Prevention, this project was awarded a “Pearl of Wisdom” award.
Another screening program is also being developed by the National Centers for Diseases Control and National Cancer Screening Center, with support from UNFPA. This program will implement an organized cervical cancer screening program in Eastern Georgia. It will serve as a model for the implementation of other cancer screening programs, including breast and colorectal cancer. One of the main objectives of this project is to engage primary care givers to help improve cancer screening and early detection. This also requires capacity building and educating the providers about aspects of oncology, from prevention and referral for suspicious cases to supportive counseling services.
Nearly 35 primary care doctors will be involved in launching the organized cancer screening project in Eastern Georgia. This course is accredited by the Ministry of Labor, Health, and Social Affairs and will be use as a model to train primary care providers in the national rollout of the organized cervical and breast cancer screening program.
Cancer care in Georgia and ASCO
ASCO can play an important role in capacity building for health professionals engaged in cancer care, including those practicing primary care and nursing education. Georgia can serve as an educational hub for countries in the Black Sea region for various disciplines of cancer care.
Levan Jugeli, MD, MSc, is a medical doctor currently engaged as national consultant of the reproductive cancer screening project funded by UNFPA and Georgian government. Prior to this assignment he served as the Deputy Minister of Labor, Health, and Social Affairs of Georgia. He played a leading role in national health policy development and health care reform implementation.