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Key lessons on the role of clinical guidelines in enhancing quality of cancer care: Robust clinical guidelines are a cornerstone of high-quality cancer care, helping to ensure that screening, diagnosis and treatment are consistent, effective and evidence-based. To maximize their impact, such guidelines should
However, challenges such as building professional consensus, navigating digital integration and addressing gaps in institutional support can impede broad and lasting implementation. |
The development and implementation of clinical standards and guidelines are key to improving cancer care quality across Europe
Clinical standards and guidelines ensure that care is consistent, high-quality and firmly rooted in the best available evidence (Baldeh, 2020). Ideally, clinical guidelines are developed by multidisciplinary expert panels, including clinicians, epidemiologists, researchers and patient representatives, and are updated regularly to reflect the evolving scientific landscape. Equally important, these guidelines should be transparent, accessible and open to feedback from both healthcare professionals and the broader scientific and patient communities.
Making clinical guidelines publicly accessible is essential for strengthening accountability, supporting equitable care delivery and fostering ongoing professional development. These guidelines serve as a foundation for healthcare providers. By adapting them to the individual needs of each patient, taking into account factors such as overall health, personal preferences and the specific cancer diagnosis, they ensure that care remains both evidence-based and tailored to the patient’s needs. Although clinical guidelines are typically developed or adapted at the national level, their relevance often transcends borders, offering a valuable basis for international cooperation and shared learning.
In this spirit, the European Commission’s Europe’s Beating Cancer Plan (EBCP, 2021) explicitly supports the identification and dissemination of best practices, including clinical guidelines and standards. By facilitating the exchange of these resources, EBCP encourages their implementation and adaptation across different national contexts, including in countries outside the EU.
Recent experiences in Austria and Bulgaria offer two compelling examples of how structured, evidence-based standards can help drive improvements in cancer care. These cases demonstrate not only the feasibility of embedding guidelines into clinical routines, but also the strategic value of transparency, collaboration and public accessibility in achieving better outcomes for patients.
In Austria, fragmented collaboration among hospitals in the Upper Austrian region led to the formation of the Upper Austrian Tumour Centre. This initiative brought together 14 regional hospitals into a cohesive network with the shared goal of standardizing care delivery. A central element of this reform was the creation of a joint clinical tumour registry to support data sharing and care coordination, particularly during patient transitions. Over the years, this collaborative structure has produced nearly 60 clinical guidelines, developed by more than 350 experts and updated annually. The process, driven by voluntary professional engagement, exemplifies how strong local ownership and interdisciplinary cooperation can underpin sustained quality improvement.
Bulgaria addressed similar gaps in care consistency by launching the MORE e-Guidelines platform, developed by the Bulgarian Joint Cancer Network (BJCN) in collaboration with BGO Software. This national digital platform provides a transparent, systematic framework for developing and continuously updating multidisciplinary oncology guidelines. Built on the GRADE (grading of recommendations assessment, development and evaluation) framework and organized using the PICO (population, intervention, comparator, outcome) question methodology, the platform enables expert panels to generate clear, evidence-based recommendations spanning the entire continuum of care. The collaborative nature of the platform facilitates consensus-building while offering real-time updates based on emerging evidence. The platform is increasingly integrated into daily clinical practice, particularly in multidisciplinary team meetings.
Digital integration and strong governance as enablers of standardized cancer care
Both Austria and Bulgaria demonstrate how clinical standards, whether regionally (e.g., Austria) or nationally (e.g., Bulgaria) implemented, can be embedded into digital tools that foster transparency, coordination and consistency in cancer care. Both websites provide up-to-date information on the management of certain cancer types, starting from prevention and diagnosis to treatment and follow-up. They are easily accessible for healthcare professionals and provide information in the respective national languages. Developed on the basis of the latest scientific evidence, expert consensus and clinical best practices, these guidelines can be expected to facilitate the provision of optimal, evidence-based cancer care.
In both cases, strong leadership and an evidence-based culture played critical roles in ensuring successful adoption (Governance). Austria benefited from the support of hospital operators, who incorporated the tumour centre into budget planning processes, strengthening the initiative’s long-term sustainability (Financing). Meanwhile, Bulgaria’s alignment with broader European policy goals, such as integrated care and best practice harmonization, lent additional legitimacy and encouraged buy-in from national stakeholders.
The role of technology partners also proved crucial in both contexts. In Austria, collaboration with IT specialists ensured that clinical needs were well integrated into digital platforms. In Bulgaria, technical design was tailored to support structured, iterative development of national oncology guidelines, highlighting the value of adaptable, user-centered design in clinical informatics.
Overcoming resistance and governance gaps is crucial for the implementation of digital guidelines
Despite their successes, both countries faced challenges in implementation. Reaching consensus across institutions and specialties required time-consuming deliberation. Ensuring the platform’s long-term sustainability also demands continuous technical support and expert engagement to maintain relevance and accuracy. In Bulgaria, some clinicians, particularly senior professionals, were reluctant to transition from paper-based manuals to digital tools, requiring targeted training and sustained advocacy.
Another challenge in Bulgaria was the lack of formal institutional recognition from the Ministry of Health and the Bulgarian Medical Association, particularly concerning their role in overseeing continuous medical education in oncology (Governance). This highlights a broader governance gap that can undermine otherwise successful digital health initiatives.
Several key lessons emerge from using tailored guidelines to improve quality of cancer care
Cancer care guidelines are a vital element of contemporary oncology, providing a structured, evidence-informed framework grounded in the latest research and expert consensus. Their use helps ensure that patients receive care that is both clinically effective and tailored to their specific circumstances. Austria’s regional network has shown that shared governance, clinical collaboration, and financial integration can help improve equity, quality and efficiency in cancer care. Bulgaria’s experience illustrates how structured, digital platforms can support clinical consensus and enable widespread use of evidence-based guidelines, even in a national context.
Both initiatives highlight that strong leadership, interprofessional collaboration and policy alignment are critical to implementing sustainable, high-quality oncology services and to improve equity. They further underscore the value of standards and digital tools in addressing variability in cancer care and improving transparency and accessibility to information. While the use of national languages ensures that guidelines are closely attuned to local contexts and clinical practice, it also poses limitations for broader international knowledge exchange, due to language barriers. However, these platforms are primarily designed to strengthen cancer care at the national or regional level. Their context-specific orientation enables the development of guidelines that are not only evidence-based but also adaptable to local healthcare systems, thereby increasing their relevance, acceptance and impact in clinical decision-making in specific regions.
For more information
Austria’s tumour centre: https://www.tumorzentrum.at
MORÉ e-guidelines: https://app-eguidelines.more-darzalas.com/home
References
Baldeh, T., Saz-Parkinson, Z., Muti, P. et al. Development and use of health outcome descriptors: a guideline development case study. Health Qual Life Outcomes 18, 167 (2020). https://doi.org/10.1186/s12955-020-01338-8
European Commission. (2021). Europe’s Beating Cancer Plan – Communication from the Commission to the European Parliament and the Council.
