Context
Historically, cancer has been the second cause of death in Romania, except for 2021 when it was surpassed by respiratory diseases due to COVID-19 pandemic (INSP-CNSISP, 2022). Lung cancer is the most frequent cause of cancer death (3.9% of all deaths in 2020), followed by colorectal cancer (2.5%) and breast cancer (1.4%). Mortality rates for all cancers have seen an increasing trend in recent years (OECD, 2021). While cancer incidence is lower in Romania compared to the EU average, cancer mortality is higher, reflecting weaknesses in cancer diagnosis and treatment (OECD, 2021). The situation is expected to worsen, in part due to the COVID-19 pandemic, which affected both the diagnosis and treatment of cancer patients, and in part due to the high impact of risk factors, such as unhealthy diet, tobacco and alcohol consumption, and air pollution. These factors contribute to Romania’s poor performance among the EU countries in terms of both amenable mortality (the highest rate in the EU at 250 per 100,000 population vs. the EU27 average of 111), and preventable mortality (second highest, after Hungary, at 95 per 100,000 population vs. the EU27 average of 55) in 2019 (as calculated by the European Observatory for Health Systems and Policies based on WHO data).
Impetus for the reform
A few months after the release of the Europe’s Beating Cancer Plan in February 2021, the Romanian Parliament appointed a working group charged with the development of a National Plan for Beating Cancer (Camera Deputaților, 2022). To support these efforts, a dedicated online platform “Împreună învingem cancerul” [Together beat the cancer] (https://cancer-plan.ro) was created by the Romanian Association of International Medicines Producers (ARPIM) as a dialogue and public debate forum for professionals, patients’ associations and the media.
The National Plan for Beating Cancer was finalized in January 2022, voted through by the Senate (September 2022) and the Deputies Chamber (October 2022) and on 2 November 2022 the President of Romania promulgated the Law thereby officially approving this Plan (Raportul de Garda.ro, 2022).
Content of the reform
The National Plan for Beating Cancer will be implemented during 2023–2026. Its main objective is to define the patient pathway in order to ensure an integrated, multidisciplinary approach. Specific objectives include the establishment of a health innovation fund to offer early access to the best therapies; developing supporting services for cancer patients such as nutrition advice, psychological support and palliative services; developing a prevention strategy and monitoring risk factors; developing a National Cancer Registry linked to the European Network of Cancer Registries; periodical updating of the clinical guidelines and treatment protocols; and introducing a tumor board in cancer care (to review patient’s condition and discuss treatment options) and personalized medicine.
The National Plan for Beating Cancer is financed by the Ministry of Health. The Plan has a dedicated annual budget that amounts to 20% of the total budget for national health programmes. The health innovation fund will be set up and financed by the Ministry of Finance (Parlamentul României, 2022).