By Gevorg Tamamyan, MD, MSc, DSc
It was February 7, 2019. The lobby of the Hematology Center in Yerevan, Armenia, was full. It was the day when the existing pediatric hematology and oncology units in Armenia got merged into one: the Pediatric Cancer and Blood Disorders Center of Armenia (PCBDCA). The newly formed center was located at the Hematology Center, which was reconstructed in 2016.
A few months ago, at an international hematology/oncology conference in Armenia, I was giving a presentation about the accomplishments over the past 3 years that have resulted from the centralization of all pediatric hematology and oncology facilities. Centralization allowed us to unite our efforts and avoid duplication, and here I would like to mention some of those accomplishments:
- First pediatric autologous stem cell transplantation in Armenia and the first allogeneic stem cell transplantation
- Standardization of diagnostic and treatment guidelines for 24 pediatric cancer subtypes (in all, more than 4,000 pages of work)
- Creation of multidisciplinary cancer management groups (leukemias and lymphomas, solid tumors, musculoskeletal tumors, and neuro-oncology)
- Creation of the first pediatric hematology-oncology fellowship program at the Yerevan State Medical University (as a result, 12 fellows joined the fellowship program)
- Collection of 25 years of data for all pediatric cancer cases in Armenia
- Training for nurses and doctors
- Creation of the first pediatric palliative care clinic in Armenia by the City of Smile Foundation
- Fostering research activities
- Most importantly, with the help of charities, making sure that every patient younger than 25 receives all the necessary diagnostics and treatment for free
In my opinion, the last 3 years for PCBDCA team were very productive, but, of course, we need to build on these results and continue to improve.
Recently, I started reading the book Atomic Habits: Tiny Changes, Remarkable Results by James Clear. He describes how change happens by breaking down the whole process into small pieces, and then improving each piece by 1%; as a result, you get a significant increase when you put all the small pieces together.
Back in the early 1990s in Armenia, between the war and economic crisis, our mentors and teachers started doing chemotherapy for children with acute lymphoblastic leukemia, and very shortly after observed a sharp increase in survival from almost 0% up to 65% to 70%. It was a huge success. It was a miracle for Armenia. Afterwards, over the next 30 years, every day there was a small improvement, every day a small change...
Over the past few weeks, we have been having meetings with different departments and services of the PCBDCA—oncology (solid tumors and lymphomas), hematology (leukemias and benign blood disorders), palliative care, psychosocial, and nursing—to discuss the plans for this year. The question we asked ourselves was, what should we do and what could we do so that at the end of the year we feel satisfied with what we have done. We made a quite large wish list for each department and for the center as a whole: establishing a survivorship clinic and cancer predisposition clinic, pediatric immunology clinic and hemangioma and vascular malformations center, adolescent and young adult (AYA) clinic and clinical pharmacy, family house and hereditary hemolytic anemias registry, bereavement support, developing guidelines for the palliative care center, adopting a pain evaluation scale and patient satisfaction survey, expanding the space, sending doctors and nurses for training abroad, emphasizing safety and quality, beginning the first pediatric cancer clinical trials… This is not even the whole list! The list is really large and when you look at it, it seems very complicated. But one thing I know for sure—with united efforts, step by step, improving 1% every day, everything is doable!
Dr. Tamamyan is the head of the Pediatric Cancer and Blood Disorders Center of Armenia, and chair and professor of the Department of Pediatric Oncology and Hematology at Yerevan State Medical University, Yerevan, Armenia. He is a 2013 recipient of the International Development and Education Award (IDEA) and 2014 recipient of the Long-Term International Fellowship (LIFe) from ASCO and Conquer Cancer, the ASCO Foundation, and immediate past chair of the IDEA Steering Committee. Follow Dr. Tamamyan on Twitter @GevTamamyan. Disclosure.
2022 marks the 20th anniversary of the highly impactful International Development and Education Award (IDEA) from ASCO and Conquer Cancer.