Screening programs

  • What is “cancer screening”?
    Screening for any cancer envisages specific examination of people who don’t have any symptoms (asymptomatic), but belong to an age-specific cancer risk group. The purpose of any cancer screening is to detect the disease at an early stage, thereby reducing the mortality rate associated with that specific cancer, as well as to assess the risk of developing this specific cancer in case no symptoms are manifested. Screening can contribute to early detection of cancer, resulting in a higher chance of curability. Efficiently organized screening programs require availability of sufficient resources for screening, as well as appropriate diagnostic work-up for abnormal lesions followed by a timely, accessible, and effective treatment and management of the diagnosed disease.
    The internationally accepted methods of cancer screening programs are population-based/organized (defined target population) and opportunistic (when/where appropriate).

    Population-based screening programs
    Organized programs are characterized by centralized screening invitations to a well-defined target population, systematic call and recall for screening, delivery of test results, investigations, treatment and follow-up care, centralized quality assurance, and a program database with linkages to other information systems, such as cancer registration systems and death registration systems, for monitoring and evaluation of the program. The screening policy of an organized program defines at least the screening protocol, the repeat interval, and the determinants of eligibility for screening. Effective communications should also be supported enabling the target population to make an informed decision about whether to participate. In addition, organized programs include an administrative structure, which is responsible for service delivery, including follow-up of detected lesions, quality assurance, and evaluation.

    Opportunistic screening programs
    Opportunistic programs are not tailored to a predetermined eligible population and provide screening tests on request or at the time of routine health examinations. These programs are less amenable to quality assurance than population-based screening, due, among other things, to the lack of administrative and organization infrastructure. They rely on the initiative of individual healthcare providers to offer screening or to encourage participation in a screening program or outside the context of any program (so-called “wild” screening).

    Current cancer screening programs in Armenia
    Cervical cancer screening program

    Cervical cancer is the only type of cancer that can be prevented and treated. It develops during a period of about 10-20 years. If we have women dying from this disease in nowadays Armenia, it is the drawback of the country’s healthcare system in general, as well as the indifferent attitude of women towards their own health. Armenian women, taking up the comprehensive care of the family, usually neglect their own health and consult a doctor when the intervention may be too late. In 2015 a population-based cervical cancer screening program was launched throughout Armenia, using PAP smear test. Participation in the screening program is free for a target population group, please consult your primary healthcare staff if you meet the screening requirements.

    Cervical cancer screening program 2.5MB (pdf)

    Breast cancer screening pilot project
    In November 2019, through a competitive process, HENARAN foundation signed its 1st state-funded contract to develop the practical guidelines and operating procedures for the primary healthcare professionals (family doctors and general practitioners) for the purpose of early detection of breast cancer and organization of breast cancer screening pilot project in Lori, Tavush, and Syunik provinces of Armenia.
    Breast cancer screening protocol 4.3MB (pdf)
    Breast self-exam flyer 2.6MB (pdf)

Cancer control in Armenia

  • By the Order No.1984-A of the Minister of Health of the Republic of Armenia dated July 22, 2019 a national Board was established to coordinate the improvement and efficiency management of cancer care in Armenia.
    The Order also approves the structure and operations of the national Board. Among 18 members of the Board, HENARAN charitable foundation, as a cancer patient advocacy organization in Armenia, is the only non-governmental organization to represent the voice and interests of cancer patients.
    Since its inception in July 2019 the Board worked to draft the working document for the “Strategy for combatting malignant neoplasms 2019-2023” and its justification.

Palliative care in Armenia

  • Effective analgesia is accessible if appropriate analgesics of the appropriate size and quantity are prescribed. Despite many problems, especially in the provinces and rural areas, together we can improve the accessibility of palliative care in Armenia when patients are empowered and protect their rights.

    Unfortunately, most problems occur due to prescription or provision of strong painkillers of the inappropriate type, size, or quantity. Doctors avoid prescribing opioids for pain relief. Patients or their relatives most often mention that doctors do not prescribe morphine or other strong painkillers, saying, "There will be a heart attack", "Do you want us to be sued?", “We are not allowed to do that, it is the last resort” and other similar expressions. We urge doctors to strictly follow the established order and clinical guidelines for provision of narcotics and psychotropic substances that are approved by the orders of the RA Ministry of Health, to be guided exclusively by legal acts and not yield to stereotypes.

    The framework of legal acts and clinical expertise for provision of palliative care in Armenia includes:

    1. Criteria for provision of palliative care (RA Minister of Health Order No.45-N dated October 18, 2017)
    2. Clinical guidelines for prescribing narcotics and psychotropic substances for management of the pain syndrome (RA Minister of Health Order No.2910-A dated December 11, 2014)
    3. Clinical guidelines on assessment and management of the patient’s pain (RA Minister of Health Order No.751-A dated March 22, 2018 )
    4. Guidelines on arrangement of activities of doctors and nurses (RA Minister of Health Order No.2911-A dated December 11, 2014 ) and others.

    In compliance with the RA Government Decree No.642-Ndated May 30, 2019 , the drugs within the palliative care framework are provided with full or partial compensation to beneficiaries included in the list of social or special groups of the population.

    Palliative care is provided at institutions with a license for provision of out-patient or in-patient palliative care. Palliative care is provided to patients under two schemes: within the framework of the free state-funded healthcare and as a paid service or funded by other sources.

    Palliative care is provided by a multidisciplinary team, which includes a doctor, nurse, psychologist, social worker, volunteers, and other specialists, if necessary. Patients, their families and the community can also be involved in the activities of this team.

    Palliative care is provided to anyone who has a life-threatening disease or a life- limiting illness with essential restrictions, and the objective is to improve the patients’ quality of life. Palliative care aims to alleviate a patient’s pain and mitigate the disease-related physical, psychosocial, spiritual, and other problems through early detection and assessment thereof and arrangement of necessary interventions.

    In compliance with the RA Minister of Health Order No.17-N dated August 15, 2018 palliative care is provided in the cases of incurable diseases or conditions to patients who are divided into the following main groups: malignant neoplasms, chronic diseases of incurable stages, severe, irreversible post-traumatic consequences, HIV/AIDS, multidrug-resistant tuberculosis, congenital and genetic diseases typical of childhood, patients with severe developmental disorders, etc. Prescription of narcotics and psychotropic drugs within the context of palliative care is carried out with the objective of management of the pain syndrome, as well as in the case of severe short breathing in accordance with clinical guidelines. These drugs can also be prescribed in case of appropriate medical recommendations. The list of institutions providing palliative care can be found here under the heading "Palliative care and service".

    Palliative care can be provided in various methods:
    1. out-patient,
    2. mobile,
    3. hospital (in-patient),
    4. hospice.

    Outpatient palliative care is provided at the primary healthcare centers (PHC) of the Republic of Armenia (polyclinic) by a multidisciplinary team of palliative care clinics (around-the-clock medical surveillance in non-treatable cases, including home visits).

    Mobile palliative care is provided by a respective multidisciplinary mobile team to a patient who is unable to move on his/her own, or whose transfer is complicated or at the patient’s request.

    Hospital (in-patient) palliative care is provided by a multidisciplinary team in a hospital setting at a palliative care unit or a unit with specifically assigned beds or service.

    At a hospice the palliative care is provided by a multidisciplinary team to patients in the final stages of their disease who require continuous provision of in-patient care.

    Palliative care is an uninterrupted service provided 24/7. At polyclinics, palliative care services are provided during the work hours of the institution, including home visits.

    The principles of palliative care are:
    1. ascertain life by accepting death as a natural phenomenon,
    2. exercise control of pain and other heavy symptoms,
    3. neither hasten nor delay the death,
    4. if necessary, include psychosocial and spiritual vectors in the medical care provided to the patient.

    The activity of the multidisciplinary team specialists providing palliative care has the following principles:
    1. respect the dignity of the patient and his/her family,
    2. respond within their competence and show respect to the patient and his/her family members,
    3. respect the patient's choice of appropriate intervention, and administer the chosen intervention with informed consent,
    4. assess and direct, as needed, towards the receipt of psychosocial and spiritual support;
    5. ensure the continuity of palliative care, as needed,
    6. respect the right of the patient or his/her legal representative to refuse treatment.

    There are no effective analgesics other than narcotic (opioid) analgesics for treatment of moderate to severe chronic pain. Therefore, strong narcotic (opioid) analgesics are the necessary element within the framework of treatment of pain. Unfortunately, the lack of knowledge about opioid use and the associated fear often hinder the effective treatment of pain both in children and adults. The effectiveness of strong opioids for the treatment of pain has been proven: the indirect data and considerations derived from treatment of chronic, non-cancerous pain in adults justify the inclusion of morphine into the WHO list of essential drugs to be used for treatment of moderate to severe pain in adults and children.

    In compliance with the RA Minister of Health Order No.17-N dated August 15, 2018, the frequency of opioid drugs provision to patients during opioids treatment is determined by the treating physician. In the event of long absence from the patient’s place of permanent residence, the treating physician may prescribe opioids for the entire duration of the absence.

    Patients or their legal representatives can be provided with narcotics and psychotropic substances at the pharmacy only in case of physical presentation of an identity document, while the pharmacist makes notes in the prescription document on the recipient’s passport details, and correspondingly in case of physical presentation of the power of attorney the legal representative’s passport details are recorded. Patients or their legal representatives may receive these drugs from the pharmacy if they present:
    1. identity document,
    2. power of attorney signed by the patient and treating physician and sealed by the director of the medical institution that provides medical care,
    3. prescription required to receive the drug.

    The power of attorney is issued in two copies and approved by the head of the out-patient facility (polyclinic). One copy of the power of attorney is affixed to the patient's out-patient card, while the other copy remains at the pharmacy. On the reverse side of any prescription for drugs containing narcotics and psychotropic substances, the pharmacist must fill in the date (dd/mm/yyyy) and the quantity of drug(s) actual received (in letters), the recipient’s passport details and signature.

    In out-patient setting (polyclinic), the prescription of narcotics and psychotropic drugs is administered by the treating physician in the patient’s out-patient card recording in letters the exact quantity. Errors and overwriting are not allowed. In case of error, the correction is made by the treating physician who writes a note "the correction is done by me" and signs next to the note, and the document is then signed and sealed by the head or deputy of the medical institution.

    In out-patient setting (polyclinic), the doctor shall observe narcotics receiving patients at least once every two weeks. In case when patients are confined to bed, the doctor of the out-patient institution observes the patient at the latter’s home.

    In case when the patient’s relatives return the unused narcotics and psychotropic substances, it is necessary to present a copy of the patient’s death certificate stating the time (day, hour, and cause) of death.

    In case of hospitalization of patients who receive narcotics and psychotropic substances in out-patient setting (polyclinic), the process of prescription of these drugs is suspended by out-patient institutions. The drugs are then provided by the hospital facility, except for drug-addicted patients who receiving treatment by narcotics.

    The after-use empty drug packages (for all types and labels) are not subject to return.

    Unused narcotics and psychotropic substances, when returned by the patient or his/her relatives, are handed over to the head or deputy of the out-patient institution (polyclinic). A register is kept for return and detailed record by name and quantity of unused drugs. The pages of the register must be numbered, bound, and verified by the signature and of the director of the medical institution or a private individual and stamped (if available).

    The goal of “Life Without Pain” program is to improve access to palliative care and effective pain relief in Armenia. In case of chronic or cancer-related pain you can turn to your local polyclinic and receive effective painkillers. In the cases of non-adequate medical care provision and refuse of prescription of opioids for pain relief, you can send a message to our Facebook page or call the HOTLINE number at 094-422-922.

Against cancer

  • It is difficult to reconcile oneself to the diagnosis of cancer and this becomes a serious problem for many patients and their families.

    HENARAN Foundation can help you better understand the cancer-related issues, treatment options and support activities, as well as set up through a “support group” useful communication with other patients, including cancer survivors. HENARAN Foundation will help you understand how to navigate through healthcare system, give a briefing on your patient rights, as well as provide contact information of consultants, home care service providers, education and information centers.

    No person and family should be left alone in the fight against cancer. There are several non-governmental resources available in Armenia that could assist you and your family in different ways.

ACPAA Declaration

  • The 9th WE CAN Eastern Europe and Central Asia Advocacy Summit on Breast and Cervical Cancer was held in Yerevan, Armenia, on October 11-12, 2019.

    The international Summit was attended by 30 advocates from Armenia and another 25 advocates from 12 countries of the Eastern Europe and Central Asia. The US Ambassador Lynn Tracey and the RA Deputy Minister of Health Anahit Avanesyan delivered welcome speeches emphasizing the importance of the Summit. The very intensive programme of the two-day Summit allowed the participants to further enrich their knowledge base, network and establish new connections and form partnerships.

    The Summit was initiated by the Women’s Empowerment Cancer Advocacy Network (WE CAN – Women’s Empowerment Cancer Advocacy Network, HENARAN charitable foundation was the national hosting organization in Armenia, while the summit took place at the Armenian-American Health Center at no cost and with great service and reception.

    Within the framework of the Summit the Armenian Cancer Patient Advocates Alliance (ACPAA) was formed, and its members – cancer patient advocates - presenting themselves as civil society organizations of the Republic of Armenia, individuals, and cancer patients and survivors, declared their commitment to join efforts to prevent cancer and provide cancer patients with personalized support, ensure access to cancer treatment and care, strive for exercise and protection of healthcare and social rights.

    The Armenian Cancer Patient Advocates Alliance formed within the framework of the Summit authored a DECLARATION, with a call on specific actions and measures addressed to the RA Government, the RA Ministry of Health, the RA National Assembly, Yerevan State Medical University, state and non-state stakeholder organizations. The Declaration received a great response among the civil society and state authorities, whereby shortly after its publication authorized entities took specific measures to address some problems outlined in the Declaration, which will be a continuous process.