Case Studies

Cancer care varies significantly across Slovenian hospitals. To address this, Slovenia’s National Cancer Control Program (NCCP) initiated an establishment of specific clinical registries to monitor care quality and outcomes for the country’s five most prevalent cancers: malignant melanoma, breast, colorectal, prostate and lung cancers. Together, these cancers account for approximately 60% of cancer cases in Slovenia.

The NCCP established five multidisciplinary expert groups, each focused on a specific cancer type, to develop a set of quality indicators for registry data collection. These groups will monitor the data and quality indicator’s report provided by the Slovenian cancer registry and ultimately propose actions for improvement.

The primary objective of this initiative is to acquire insight into processes that occur along the cancer pathway, allowing for a better understanding of the factors that influence care quality and results. While the results of analyses of cancer registry data may help to address patient inequalities related to geographical access, as patients often seek care at the nearest hospital, and also to health literacy and socio-economic status, the initiative also aims to enhance the quality of care by improving efficiency of the care pathway through informed action planning. 

The Clinical Registry of Skin Melanoma (KrMel), established in 2017, was the first of the five planned clinical registries. KrMel records all cases of invasive and in situ skin melanoma (classified as C43 and D03 according to ICD-10) from 2016 onwards. Compared to the Slovenian population-based cancer registry, KrMel collects more comprehensive data, including detailed information on disease type and diagnostic procedures from pathologists and dermatologists. Additionally, data from oncologists, radiation therapists and surgeons provide further insights on treatment details and patient responses, ensuring a richer dataset for monitoring and improving care quality (Onko-i.si, n.d.). 

By the end of 2024, the development of four other registries has reached the stage where sets of quality indicators have been developed. Data collection processes for breast and colorectal cancer registries has started in 2023, for prostate cancer registry in 2025. Overall, the creation of these specific cancer registries aimed to improve the quality and equity of cancer care through streamlining healthcare pathways.

Enablers: National consensus among experts and policymakers (Governance), enabled by the mandate of the NCCP; allocation of financing towards this action; developed human resources for data collection and analysis and tailored IT solutions (Resources), which leverage the Slovenian Cancer Registry’s 70-year tradition and the legal framework for data collection. 

Barriers: The resource development for the national consensus required effort, negotiation and time (Resources); limited interoperability of the data systems between all hospitals and the registry, and the workforce recruitment are currently stalling some processes in data collection and analysis. 

Lessons learned: Achieving consensus among experts and policymakers is crucial to support successful implementation. Public health authorities can play an essential role in this process, as can the general public, including patient representatives. The establishment of multidisciplinary expert groups has also shown additional value beyond their role in monitoring outcomes for the clinical registries. These groups provide a platform for broader networking and collaboration among stakeholders.