Comprehensive treatment, psychosocial support, and palliative care for children with cancer in Armenia

In Armenia, children diagnosed with cancer are treated by specialised medical teams within the public health system. Effective treatment, however, depends on more than just clinical expertise. Yet many essential medicines, tests, and supportive services, which are also important for successful therapy and better quality of care, fall outside state coverage, leaving families to absorb costs that are often beyond their means.

City of Smile, a UICC member organisation, emerged in response to this reality. Founded in 2014 by a group of oncologists, the organisation initially focused on raising awareness, providing information and psychosocial support to children with cancer and their families.

In 2018, the country’s largest foundation supporting childhood cancer closed, exposing the extent to which access to quality care for most families relied on charitable support, and that without a structured organisation covering treatment costs, many children would not be able to continue care.  

“I joined City of Smiles at this time, in 2018, when there was a strong need for the organisation to expand its mission beyond raising awareness and providing psychosocial support,” said Ester Demirtshyan, Executive Director at City of Smile. We do have amazing doctors, great professionals. But if you are not able to buy the medication, those professionals would not be able to help you.”

City of Smile works closely with clinicians at the country’s single paediatric oncology centre, where the foundation is based. Doctors refer families directly to the organisation at diagnosis, ensuring support begins immediately.

State funding in Armenia covers hospital infrastructure, staff salaries, and a limited range of tests and medicines. Most chemotherapy drugs, specialised tests, and supportive medicines fall outside the state programme.

This includes sourcing medicines that are not readily available on the local market. “Because Armenia is a small market, some drugs are not stocked by suppliers, or are difficult to procure through government tenders.” Mrs. Demirtshyan explained. “The foundation imports medicines directly or sources them through international partners when quantities are too small to interest commercial suppliers.”

City of Smile covers these costs directly for all children and young adults with cancer, up to the age of 25. Each year, around 130 to 140 new beneficiaries register with the foundation, with approximately 250 people supported annually. Since 2018, more than 1,000 have received assistance.

Armenia introduced a new universal health coverage programme in 2026, but its implications for childhood cancer are still unclear. While reforms are under way, Mrs. Demirtshyan noted that process the list of accessible medication and services through the health coverage programme still remain blurred.

“Although City of Smile is there to make sure that no child left without medication or treatment, there needs to be more sense of urgency on the state side as well”.

Care beyond medication

City of Smile’s approach extends beyond paying for medicines, however, to encompass essential supportive care, without which some children would not be able to continue treatment, or whose quality of life would be severely impacted.

The organisation provides meals for children during hospital stays, for example, addressing a practical but significant burden for families, particularly those travelling from outside the capital. It also provides psychosocial support services for children and their families, developed initially through international collaboration and now embedded in routine care.

In 2021, the foundation established Armenia’s first paediatric palliative care centre, providing end-of-life care for children with cancer. “Previously, children in palliative care and their families were just sent home with little to no structured support to help them manage it,” Mrs. Demirtshyan said. “Now we have a professional palliative care centre for all paediatric cancer patients.”

Another major milestone came in 2023, when bone marrow transplantation became available in Armenia. With City of Smile’s support for training and programme development, children no longer need to travel abroad for the procedure – a step that previously required families to raise large sums of money.

International partnerships play a critical technical role. “We have essential collaborations with organisations such as Dana-Farber and St. Jude Childen’s Research Hospital. They provide second opinions, and provide support for training and the development of psychosocial and clinical services.”

The foundation also collaborates with organisations that can help address medicine shortages. Donations of drugs through international networks have improved access to treatments that are otherwise difficult to procure in small quantities.

Each February for International Childhood Cancer Day marked on 15 February, City of Smile organises awareness and fundraising activities, including concerts and media engagements, showcasing how people-centred care can be delivered in practice, and how effective it is.

“Access to treatment and supportive care has a direct impact on outcomes. Childhood cancer survival rates in Armenia are estimated at around 70-75%. Without City of Smile and the work it does,” Mrs. Demirtshyan said, “they would likely fall to around 30 percent.”