According to the World Health Organisation’s guidelines, basic diagnosis and treatment should be available on the local level, whereas more complicated procedures should be centralized or managed at the national level. Strong cooperation between various healthcare specialists is a prerequisite of effective treatment.

“Highly specialized treatments require more complex technology and better knowledge, which can be used more cost-efficiently at the national level.”

Surgery, radiotherapy and chemotherapy are the most used methods for treatment and they are often used in combination. Cancer treatment can only be performed with sufficient tools and by specially trained personnel. Healthcare workers at higher and middle level must assess the treatment process and guide subsequent treatment and follow-up. Team members are responsible for the clinical management, according to national guidelines. All relevant professionals have to be presented in the team, including radiotherapists, surgeons, oncologists, gynaecologists, pathologists, haematologists etc. The therapeutic decision depends primarily on the diagnosis and the stage of the cancer, on the type of treatment required, on the availability of suitable infrastructure and in addition, the well-trained and experienced specialists (WHO, 2008).

As it turns out, (de)centralization is not a major factor in the quality of cancer treatment. Both approaches can work well under a national cancer strategy with sufficient quality control, personnel, equipment and accessibility. There are two different paths that could improve the quality of cancer treatment in Estonia:

  • The first would further centralize the current system and eliminate some of its inefficiencies by including more specialists in the decision-making process. On the other hand, a more centralized system might lack accessibility.
  • The alternative path proposed by the author is one of decentralization. A network-based approach would have greater accessibility, ot the other there is a risk of becoming too costly and fragmented. Such a system would only work if the roles of all parties were clearly defined by a central institution.