Analyses

From diagnosis to recovery, healthcare professionals play a central role in cancer care – delivering treatment and offering support and guidance through complex care pathways.

Recognizing this, the Europe’s Beating Cancer Plan places strong emphasis on strengthening the healthcare workforce, highlighting that high-quality cancer care requires a high-quality workforce (European Commission, 2021). This vision calls for greater integration of healthcare professionals into all aspects of cancer care, particularly within multidisciplinary teams and personalized medicine approaches.

Experiences from Belgium, Ireland, Malta and Croatia demonstrate how actively involving healthcare professionals has helped overcome persistent barriers in cancer care delivery regarding:

• Difficulties in implementing targeted screening progammes due to limited data access and privacy constraints: In Belgium, although robust population health management data exists, strict data protection regulations limit its usability. As a result, targeted cancer screening invitations often fail to reach the intended population, hindering effective screening implementation.
• Delays in care and risk of complications on account of limited treatment capacity and emergency care overcrowding: In Ireland, patients undergoing systemic anti-cancer therapy (SACT) often face delays in receiving urgent care due to overcrowded emergency departments and insufficient capacity in haematology-oncology units. This not only increases the risk of complications but also places additional stress on already stretched services.
• Discontinuity of patient care because of fragmented care coordination and weak navigation systems: Malta experiences delays throughout the cancer care continuum – from referral to diagnosis and treatment – largely due to poor coordination among multidisciplinary teams and limited support for patients navigating the system. These gaps hinder timely care and reduce overall efficiency.
• High lung cancer burden: In Croatia, the high prevalence of smoking and corresponding incidence of lung cancer have strained the healthcare system. Although the country launched a Lung Cancer Screening (LCS) programme in response, it still faces the broader challenge of addressing high-risk behaviours while scaling up early detection and prevention efforts.

Healthcare professional engagement integrated into national cancer care strategies

All four countries embedded healthcare professional engagement within broader cancer care strategies (see Box 1), reflecting varying national priorities.

Across all initiatives, a clear commonality is the active and strategic inclusion of healthcare professionals in the development and delivery of cancer care services. Rather than being limited to frontline implementation, these professionals are involved early in the process, helping to shape care pathways, digital tools and patient engagement strategies.

GPs play a crucial role in identifying at-risk populations, facilitating early detection (e.g., Belgium and Croatia), and referring patients through digital platforms (e.g., Malta). Nurses are central to many initiatives, leading patient navigation systems (e.g., Malta), running specialized clinics (e.g., Ireland and Malta), conducting triage through validated tools (e.g., Ireland), and even delivering home-based treatments (e.g., Malta). These expanded roles reflect a growing recognition of their expertise and the value they bring to personalized, coordinated care.

To enable greater involvement of healthcare professionals, countries have prioritized workforce training and capacity-building. In Ireland, the implementation of the UKONS triage tool was supported by nationwide training for CNS, while Malta invested in training outreach nurses to deliver cancer care in patients’ homes. These efforts demonstrate how targeted nurse training can not only enhance the quality of care but also improve continuity and personalization. Both countries showcase how nurse-led, accessible services can strengthen the patient experience. e.g., Ireland’s AHOS, ensuring rapid response and follow-up via CNS-led telephone triage at each SACT centre, and Malta’s Nurse Navigation System and nurse-led clinics, which offer expert advice and person-centred support.

All initiatives are characterized by interdisciplinary collaboration, with healthcare professionals working alongside policymakers, IT developers, and public health institutions to co-design effective, patient-centred systems. Importantly, their involvement is not ad hoc but embedded in broader national strategies, ensuring continuity, accountability and long-term impact.

Funding and governmental support were key facilitating factors

The effective involvement of healthcare professionals in improving cancer care was supported by several critical enablers. Foremost among these was adequate funding, which ensured the sustainability of programmes and services (Financing). In Malta, financial backing came directly from government sources, while in Croatia, the Health Insurance Fund played a central role. Additionally, Croatia introduced financial incentives for GPs who referred eligible patients to the national LCS programme, further encouraging professional engagement.

Another essential factor was strong governmental support embedded within comprehensive national health strategies (Governance). In Ireland, Malta and Croatia, these strategies provided a clear framework, while also fostering collaboration across sectors. For example, Ireland benefitted from international collaboration, particularly with the United Kingdom, which facilitated the adoption of the UKONS validated triage tool used in the SOS telephone hotline.

Technology integration also emerged as a significant enabler (Resources). The interaction between GPs and databases proved to be helpful in targeting individuals for screening (e.g., Belgium). Likewise, Ireland’s use of digital triage tools and video consultations enhanced service accessibility and streamlined urgent care delivery, while Malta’s approach in directly involving GPs through the launch of an online fast-track e-referral system enabled quicker access to hospital consultations.

Furthermore, countries recognized the importance of dedicated leadership roles in managing service quality and development (Governance). Malta appointed a Quality Assurance Manager to oversee performance standards, while Ireland designated an Assistant Director of Nursing specifically to drive the national implementation of its oncology nursing services.

Workforce shortages remain a main barrier for full integration

Despite these advancements, several barriers hindered the full integration and effectiveness of healthcare professionals in cancer care delivery. A major challenge across countries was the shortage of healthcare workers (Workforce). This limitation affected service availability and quality, with Ireland, for instance, reporting restricted operational hours in the SACT centres due to insufficient staffing. Though the COVID-19 pandemic contributed to accelerating the uptake of Malta’s various initiatives, the shortages of key health professionals – such as nurses, pharmacists, psychologists and others – hindered the effective expansion of services and highlight the urgent need for improved integration of digital tools.

However, this can present another obstacle if the new technology and digital innovation encounter resistance. This was the case in Malta, where some healthcare professionals initially showed reluctance to adopt new technologies and digital tools (Service delivery). However, this seems to be a decreasing issue.

It is also important to highlight that although involving GPs in Belgium has improved the targeting of patients for cancer screening, broader implementation remains constrained by strict data protection regulations that limit access to the cancer registry. Unless these regulatory barriers are addressed, the full potential of such initiatives may not be realized.

Healthcare professionals as drivers of patient-centred cancer care across Europe

Across Europe, countries have adopted varied strategies to improve cancer care by integrating healthcare professionals into broader national programmes with some countries emphasizing GP engagement for early detection, and others focusing on training and promoting nurse-led, personalized services to improve care continuity and accessibility. Through these initiatives, healthcare professionals are not only positioned as service providers but as key architects of a more responsive, efficient and patient-centred cancer care system.

Overall, while national strategies and targeted professional engagement lay a solid foundation for progress in cancer care, addressing workforce capacity and ensuring wider digital adoption remain critical for sustaining and expanding these improvements.