NEVER compromise your values! Pediatric oncologists are rebels :) - 5-year report and a farewell note

Exactly five years ago, I was appointed the Head of the newly established Pediatric Cancer and Blood Disorders Center of Armenia. The center was created by merging the existing pediatric hematology and oncology departments in Armenia, becoming the only such center in our country. A few days ago, on May 15, I submitted my resignation and stepped down from my position. The reason was my disagreement with the injustice that occurred when Dr. Samvel Danelyan, the Director of the Yeolyan Hematology and Oncology Center (PCBDCA is a part of it) and my mentor, a wonderful physician and? founder of modern pediatric hematology and oncology in Armenia, was dismissed for political reasons (for greeting Archbishop Bagrat, who is the leader of the opposition, and in the meantime, the Chairman of the Board of the City of Smile Charitable Foundation).

On the occasion of the center's 5th anniversary, I had planned to present a brief report, and now, as the former head of the center, I will present it. This is the result of a great and powerful team's work, and I must say that pediatric oncology and hematology have become one of the fastest-growing fields in Armenia. Today, we have a situation where people from different countries choose Armenia for their children's treatment.

Here are some data on our work, and I am confident that the excellent team we have built will continue to make even greater strides.

Over the past 5 years:

1) The Pediatric Cancer and Blood Disorders Center of Armenia unified all the existing departments in our country. This was necessary to combine forces and avoid duplication, following the best practices in best centers globally. With about 100 new cases diagnosed each year, this unification allowed us to centralize also clinical experience. This process, which is often very difficult in other countries, was carried out smoothly here, and the results were quick to follow.

2) In July 2019, for the first time in Armenian history, the Department of Pediatric Oncology and Hematology was established at Yerevan State Medical University, along with a fellowship program in pediatric hematology-oncology. To date, 14 clinical fellows have been accepted into this program. This is a significant number, considering the professional and psychological challenges of our specialty and its lack of popularity worldwide. Currently, the relative number of pediatric hematologists-oncologists per 100,000 people in Armenia is higher than in the US. Initially, we set high standards for admission, requiring scientific work and knowledge of at least two foreign languages (with English being mandatory); this was new to our country. As a result, the best students from the medical university applied. Almost all of them have undergone training at the world's best centers and studied at top universities. For example, 6 doctors from the Pediatric Cancer Center are graduates of Harvard University, having completed one-year programs there. Most importantly, we did not experience brain drain; on the contrary, we had a brain gain. No one has left Armenia so far.

3) Bone marrow transplants are now performed in Armenia, and children no longer need to travel abroad for this treatment. The program began in cooperation with the Italian Cure2Children Foundation and the German DKMS Foundation. As a result, children from different African countries come to Armenia for transplants. Last year, the Yeolyan Center's transplant department also performed transplants for leukemia cases. Today, various countries from Asia, South America, and Africa, send their children to Armenia for treatment.

4) With the support of the City of Smile Foundation, the first and only pediatric cancer palliative care center was established in Armenia and is successfully fulfilling its crucial role.

5) The first cancer survivorship clinic in Armenia was established and is operating successfully. Notably, the oral presentation of Irina Melnichenko, one of our first graduates and head of the survivors' clinic, won first place at the pan-European congress two years ago.

6) With the support of the Health Fund for Children of Armenia, the "Karina" Hereditary Cancer Predisposition Clinic was established and is operating successfully.

7) The Armenian Society of Oncology, Hematology, and Palliative Care Nurses was established and is running successfully. A week ago, the Society held its annual congress, and the hall at the medical university was so full that extra chairs had to be added. At the recent Easter and Mediterranean research seminar for nurses, one of the largest groups was from Armenia. Many of our nurses are also studying also at the American University's nursing bachelor's program in English language (this is a new program, which allows nurses in Armenia for the first time to get a degree).

8) For the first time, a nurse educator position was created, and our nurses are continuously undergoing various educational programs.

9) With the support of the City of Smile Foundation, four working groups on pediatric cancer were created: leukemia and lymphoma, neuro-oncology, sarcomas, and solid tumors. Each working group established connections with leading specialists at top centers worldwide, initiating twinning programs. In addition to discussing each case in a multidisciplinary international team, 21 disease guidelines, protocols, and family manuals (about 4,000 pages total) were translated and adapted. A professional textbook and several manuals are currently in the final stages of development.

10) Several dozen research studies conducted at our center were published in the world's most renowned journals and presented at international congresses, often winning various awards.

11) The Pediatric Cancer and Blood Disorders Center of Armenia is the only one that is a member of both the Eastern and Mediterranean Group and the European Group of Pediatric Oncology, acting as a unique bridge. I believe this is also why last year's Asian annual congress of the International Society of Pediatric Oncology held in Armenia was attended by many colleagues also from European and American clinics and became one of the most successful congresses. More than 500 specialists from around the world participated.

12) A large clinical trial on osteosarcoma, led by Dr. Ruzanna Papyan, head of our sarcoma working group, is currently starting in 28 pediatric cancer centers in 10 countries.

13) Another of our recent graduates, Julia Hoveyan, co-chairs the Neuro-Oncology Research and Care Network, and Shushan Hovsepyan co-chaired the GHN Education and Training working group of the International Society of Pediatric Oncology during her fellowship.

14) Armenia was the first country to join the Global Alliance created by St. Jude Children's Research Hospital and is one of the most active members.

15) With the support of the Bridge of Health and City of Smile Foundations, a database of 25 years of clinical data was collected and digitized in Armenia. These data are now being entered into the global registry for further analysis.

16) We also hosted the second annual scientific congress of the Pediatric Oncology Eastern and Mediterranean Group, attended by delegates from over 40 countries.

17) Under the initiative of Archbishop Bagrat, the first cancer survivors rehabilitation center in Armenia was established in the mountains of Tavush.

18) Efforts have been made to establish pediatric immunology and hemangioma and vascular malformations clinics at the center, which are planned to open this year.

19) The psychosocial program created in collaboration with Dana-Farber/Boston Children's became a successful project, assembling a strong team. The head of the service, Alisa Kamalyan, recently became co-chair of the GHN Psychosocial Committee of the International Society of Pediatric Oncology.

20) Clinical trials began for the first time, bringing a new culture and actively continuing and expanding these efforts.

If I forgot to mention anything, please, feel free to add.

As I mentioned above, all of this is the tremendous work of a great team—the BEST team in the world. The pace and scope of this work will not diminish. As I have often said, pediatric oncology and hematology will become one of our country's main successes, and people from all over the world will come to Armenia for diagnosis and treatment.

Thank you to every individual who has contributed, and the best is yet to come.

P.S. As I mentioned at last year's congress: NEVER compromise your values! Pediatric oncologists are rebels :)

Yours sincerely,

Gevorg Tamamyan

Chairman of the Department of Hematology and Pediatric Oncology, Yerevan State Medical University

CEO of the Immuno-Oncology Research Institute

President-Elect of the International Society of Pediatric Oncology Asian Continental Branch

President-Elect of the Pediatric Oncology Eastern and Mediterranean Group

Editor-in-Chief of OncoDaily