Profession, administration and patients in the Croatian Cancer Week: "From Zero To Hero"

Profession, administration and patients in the Croatian Cancer Week: "From Zero To Hero" - How can Croatia "jump" the gap in oncology care? We are reporting information from the event organized by Health Hub (www.healthhub.hr).

With a view to encouraging continuous quality dialogue and finding constructive solutions based on the best practices of global health policies, the regional health think tank Health Hub organized a special Health Hub Policy Coffee with partners at the Peppers Coffee & Wine Bar in Zagreb on the occasion of World Cancer Day and the Croatian Cancer Week on the topic: "From Zero To Hero" - How can Croatia "jump" the gap in oncology care?

The following contributed constructively to the panel: prim. dr. sc. Vera Katalinić Janković (special advisor to the Minister of Health of the Republic of Croatia), asst. dr. sc. Krunoslav Capak (director of the Croatian National Institute of Public Health), prof. dr. sc. Stjepko Pleština (President of the Croatian Society of Internal Oncology HLZ and Head of the Oncology Clinic, KBC Zagreb), Prof. Dr. Sc. Marko Jakopović (Head of the Department of Lung and Mediastinal Tumors, Clinic for Pulmonary Diseases Jordanovac, KBC Zagreb), M. Sc. Dražen Jurković (Director of the Croatian Healthcare Employers' Association), Prof. Dr. Sc. Damir Eljuga (President of the Croatian League Against Cancer), Dr. Sc. Davor Kust (Oncologist and Editor of Onkologija.net, Anova Polyclinic, KBC Sestre milosrednice), Prof. Ivica Belina (President of the Coalition of Healthcare Associations), and Dr. Miloš Ičević (Business Unit Director Oncology Balkans, AstraZeneca).

In support of the #ForEqualAccess toOncologyCare mission, the panel discussed what we can do to overcome and "close" the gap in oncology care and put an end to inequalities in access to innovations and treatment in accordance with the most modern guidelines. Great emphasis was placed on the organization and strategy of oncology care management in institutions across Croatia, and not only on additional financing of oncology care.

In addition to the announced reform measures and strengthening of health literacy and national preventive examinations, Croatia has adopted the Strategic Framework against Cancer by 2030, which envisages the creation of a national digital oncology network, the creation of an oncology patient registry, the strengthening of primary and secondary prevention, and improving access to modern radiotherapy. Oncology care in Croatia is fragmented and lacks a coordinated structure. This problem has been recognized and addressed by the National Strategic Framework for the Fight against Cancer, which plans to establish an oncology care network to improve coordination between all oncology centers in the country, along with the creation of centers of excellence and stimulating multidisciplinary patient-centered care. Rural areas also have less access to early detection and treatment options, and although progress has been made in the organization of palliative care, further improvements are needed, it was concluded at the "coffee with a mission".

The topic of financing later lines of therapy (3rd line of treatment) in oncology care was also raised, especially in metastatic patients, because later lines of treatment allow them to prolong survival while maintaining a quality of life and work capacity. During the networking coffee, patient representatives also raised the issue of putting drugs on the list only after funding has been approved in at least 10 EU countries, which is certainly not in favor of oncology patients, given that our WAIT indicators for waiting for innovative therapies are already up to 1000 days for some indications compared to some countries that very quickly have new oncology therapies available through insurance. According to The European Cancer Pulse, Croatia has 32% of new oncology drugs approved by the European Medicines Agency in the status of insurance reimbursement (by indication), while Germany, for example, has as much as 100%.

Recently, within the framework of the European Cancer Inequalities Registry initiative, The Country Cancer Profile for Croatia was presented, which provides reliable data on cancer prevention and care, while identifying trends, differences and inequalities between member states and the European region. Although compared to other European countries, Croatia is a country with a medium-high incidence of malignant diseases, its mortality rates are among the highest in Europe. According to estimates by the Joint Research Centre of the European Commission (JRC), we are in second place among men and sixth among women in terms of total cancer mortality. One in three people in Croatia will be diagnosed with some form of cancer during their lifetime. At the same time, survival is increasing for many countries, and progress in the diagnosis and treatment of malignant diseases has led to a decrease in mortality and an increasing number of people who survive for many years after a cancer diagnosis. It is estimated that there are over 170,000 people in Croatia who have been diagnosed with a malignant disease at some point in their lives, of whom 100,000 have been diagnosed more than five years ago, according to the Croatian Institute of Public Health.

Although direct cancer treatment costs per capita are significantly lower than in other EU countries, in 2018 cancer treatment costs amounted to 7% of total healthcare expenditure in Croatia, while the EU average was 6%. Let us consider that the allocation for healthcare in Croatia is 7.9% while the EU average is 10.9% (2020). However, on the other hand, productivity loss due to cancer morbidity accounted for 44% of cancer costs in Croatia – a share that is more than three times higher than the EU average (13%). Also, 26% of total cancer expenditure in Croatia is for healthcare expenditure (including medicines), while the EU average is 49%.

It was concluded that we all recognize the power of collective action and that each of us has the ability to make a difference, big or small, and that together we can make real progress in reducing the global impact of cancer – this is exactly the mission of World Cancer Day!