Medicines and Service Availability and Accessibility in Cancer

Medicines and Service Availability and Accessibility in Cancer Care in Georgia Tamari Rukhadze MD. Ph. D. Oncologist, International Expert in Palliative Medicine Head of Palliative Care Service of the National Cancer Centre, Georgia 28 th August 2012 Tbilisi

National cancer Centre of Georgia • Coordinates the cancer service in Georgia, • Determines the strategy of cancer fight and its prioritized directions, • Works out the cancer control programs, • Plans the scientific activities, • Conducts the organization- and methodological activities through the Regional Cancer Centers (5 branches try the country);

As there are over 43, 000 deaths per year in Georgia, over 25, 000 persons per year (60%) need palliative care. Palliative care and related pain relief are one of the major unaddressed public health problems in Georgia. In cases of cancer the need is higher. Nearly 7, 000 -8, 000 cases of new cancer are registered in Georgia per year and more then two-third of the cases require palliative care. The aim of the sudy was - To support the development of an adequate pain management system in chronic incurable (advanced cancer) patients, via recovering the deficit in knowledge and information in this regard.

Opportunities before 1 st September of 2012: The Federal program of Oncology in Georgia covers 100% of fees of diagnosis, treatment, follow-up and palliation of patients under 18 years and 70% of over 60 years. Private insurance companies have to cover 100% of fees for medical program for public living below poverty line – The Medical program for Public Living below Poverty Line. The oncology service of patients between the age range from 18 to 60 is covered by insurance exclude the palliative care, where program cover 70% of the service fees);

Opportunities after the 1 st September 2012: The most of the Federal programs will be closed; Most of the Aged people will be insured; Insurance have to cover Oncology expenses (90% of fees of diagnosis, treatment, follow-up and palliation) of patients over 60 years for Females and over 65 for Males, also students. Private insurance companies have to cover 100% of fees for medical program for public living below poverty line – The Medical program for Public Living below Poverty Line. The oncology service of patients between the age range from 6 to 60 (6 to 65 for males) is covered by personal insurance.

Medication Registration Price Financing Quality

Generic or original medication According the quality certificate generic is equal in pharmacokinetics and in pharmacodinamics It is possible to have variation in pharmacokinetics and in pharmacodinamics no more then 20%; Patients have to know about all above mentioned; Medical professionals have to inform patients and their care givers; Patients have to make decisions; Patients have to know information how to assess side effects and complications caused from as generic as original medication.

Health Care professionals have to have knowledge and experience: Communication skills; Professional knowledge and skills (follows to clinical practice guidelines approved by authority organizations); Skills to assess and follow up the complications and side effects of the cancer medication; In case of problems, transfer the information to WHO monitoring center; In case of quality problem of medications, let know to authority organization.

Nathan I Cherny MBBS, FRACP, FRCP (1), Franco De. Conno (2), Lukas Radrbruch MD (3) Shaare Zedek Medical Center, Dept Oncology Cancer Pain and Palliative Medicine Unit, Jerusalem, Israel. Chair European Society for Clinical Oncology Palliative Care Working Group Honorary Director of the European Association for Palliative Care Chair of Palliative Medicine, Aachen University, Aachen, Germany. President, European Association for Palliative Care

Figure 2: East v. West EUROPE, Morphine Consumption Average mg/capita*, 1980 - 2006 mg/capita Sources: International Narcotics Control Board; United Nations population data By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2008 * Average milligram per capita calculated by adding mg/capita statistic for each country and dividing by the total number of countries.

Medications Officially Administrated in Georgia Since 2003 Title 2003 2004 2005 2006 2007 Quota (gr) Import (gr) Used (gr) Quota (gr) Import (gr) Used (gr) Morphine 15000 12828 1183 3 19000 11824 1190 5 1900 0 1259 5 1092 1 1900 0 9306 8190 1900 0 4198 6337 Fentanil 38 15. 429 15. 5 38 16. 581 16. 35 40 19. 1 19 38 22. 367 22. 15 9 45 25. 06 25. 3 Promedole 10000 500 401. 2 9240 401 9240 550 455. 9 1300 600 495 1300 469 Methadon e 0 0 0 4500 1980 2. 7 1100 0 3717. 3 1796 1200 0 3622 4480 Codeine 10000 0 0 5000 0 0 500 44 24

Challenges: The main challenges on the way of PC development are: a) Lack of adequate information among the society (customers) as well as potential stakeholders and decision-makers; b) Lack of knowledge among healthcare professionals and society; c) Lack of finances; D) Lack of opioids availability and actability;

Thank You for Attention!