Državni Program Obvladovanja Raka 2022–2026

Objectives

Slovenia’s National Cancer Control Programme (DPOR) 2022–2026 provides a comprehensive, nationally adapted framework for reducing the cancer burden, ensuring equitable access to high-quality services and improving the quality of life of people with cancer.[1]Its overarching goals are to slow the rise in cancer incidence, improve survival and strengthen rehabilitation and palliative care throughout the cancer pathway.[1][2]The programme covers prevention, screening, diagnosis, treatment, rehabilitation, palliative care, research, education, digital connectivity and monitoring of cancer burden and care quality.[3][4]

• Reduce preventable cancer by addressing tobacco use, harmful alcohol consumption, unhealthy diet, physical inactivity, overweight, excessive sun exposure, environmental and occupational carcinogens, radiation and cancer-related infections.[5][6][7]
• Strengthen primary prevention through the European Code Against Cancer, vaccination against human papillomavirus and hepatitis B, infection prevention, public education and action across government sectors and society.[8][9][5]
• Maintain and improve organised screening through the Zora cervical-cancer, Dora breast-cancer and Svit colorectal-cancer programmes, while preparing evidence-based expansion, including a proposed lung-cancer screening programme.[10][11]
• Ensure timely, equitable and evidence-based diagnosis and treatment from suspicion of cancer onwards, using multidisciplinary treatment planning, appropriate referral pathways, modern diagnostic capacity and current clinical guidelines.[12][13]
• Increase net five-year survival by 3% in 2022–2026 compared with 2017–2021, while aiming to improve outcomes through earlier diagnosis and consistently high-quality treatment.[14][5]
• Improve quality of life through comprehensive rehabilitation from diagnosis onwards, addressing physical, psychological, social, vocational, nutritional and long-term treatment needs.[15][16][17]
• Provide people with incurable cancer with accessible, needs-based palliative care at all times, alongside support for relatives, workforce education, quality assurance and systemic financing.[18][19][20]
• Strengthen research, innovation, molecular diagnostics, cancer registries, clinical registries, education and international cooperation, including alignment with Europe’s Beating Cancer Plan and European cancer-research initiatives.[21][22][23][24]
• Monitor progress through age-standardised incidence, mortality, prevalence, survival, stage at diagnosis and quality-of-care measures, including nationally established quality-of-life indicators.[25][14][26]

Implementation

DPOR is implemented as a five-year, cross-sectoral programme of detailed objectives, measures, deadlines and named leads across primary, secondary and tertiary healthcare.[3][1]The Ministry of Health holds responsibility for submitting the programme to government, monitoring implementation and supporting coordination, while the Institute of Oncology Ljubljana coordinates and manages delivery.[27]Implementation combines nationally organised services, provider networks, clinical guidance, digital information systems, registries, workforce development, patient participation and cooperation with civil society.[15][28][29]

• Coordinate programme delivery through a ministerially appointed DPOR coordinator and deputy, supported by administrative and communications functions, the DPOR Expert Council, the Supervisory Board and thematic expert groups.[27][30][31]
• Use the Supervisory Board to review annual implementation reports, oversee strategic and detailed objectives, and adopt improvement measures where progress diverges from planned objectives.[32]
• Assign the Ministry of Health, the Institute of Oncology Ljubljana, the National Institute of Public Health, the Health Insurance Institute of Slovenia, healthcare providers, professional bodies, municipalities and non-governmental organisations roles in implementation according to the relevant action area.[33][28][27]
• Deliver prevention through legislation, national strategies, public-health programmes, primary healthcare, health-promotion centres, vaccination, workplace and environmental action, inspection and targeted communication.[8][34][35][36]
• Operate national screening programmes centrally under European quality guidance and national legislation, supported by screening steering structures, registry data, quality assurance, central invitations and targeted action to reduce participation inequalities.[10][37][38]
• Organise diagnosis and treatment through multidisciplinary councils, the very urgent referral pathway, guideline-based care, strengthened imaging and pathology capacity, molecular diagnostics, electronic referrals and interoperable e-Health records.[12][39][40][41]
• Establish and monitor an oncology provider network, including referral institutions and standards for staffing, premises and professional capability, with annual cancer-treatment reporting from 2025.[28]
• Develop rehabilitation through a national expert group and coordinator, progressive financing in public institutions, specialist training, patient referral and network-wide monitoring.[17][42]
• Expand palliative care through coordinated basic and specialist services, hospital and mobile teams, regional provision, round-the-clock telephone support, patient diaries, education centres and national quality indicators.[18][19][20]
• Modernise the Cancer Registry of the Republic of Slovenia and clinical registries to provide timely national data, annual provider-level quality reports, feedback on deviations, and monitoring of treatment timeliness, guideline adherence, complications and survival.[26][43][44]
• Involve patients, families, patient organisations and civil society in programme development, implementation, advocacy, awareness, screening promotion, rehabilitation, palliative care and research planning.[29][45][46]
• Maintain continuity of cancer care during emergencies by adapting services safely and applying lessons from the COVID-19 pandemic to preserve diagnosis, treatment and screening.[47][14]

Monitoring & Evaluation

Monitoring is built around the Cancer Registry of the Republic of Slovenia, clinical registries and programme governance. It covers cancer burden, quality of care, implementation progress and corrective action, although several areas lack fully specified evaluation methods or enforcement arrangements.[26][43][30][32]

• Track incidence, mortality, prevalence and survival nationally, with registry indicators available with a reporting delay of up to one year.[26][43]
• Monitor age-standardised incidence from a 2022 baseline, targeting a continuing 0.3% annual decline among men and no more than 1% annual growth among women; assess net five-year survival against a target of 3% improvement in 2022–2026 compared with 2017–2021.[14][5]
• Measure diagnosis and treatment quality through clinical registries, including time from diagnosis to treatment, adherence to guidelines, provider activity, complications and survival.[43]
• Establish reporting for the five most common cancers by the end of 2023 and produce national and provider-level annual quality reports by the end of 2025, with agreed indicators reviewed by multidisciplinary expert groups.[44]
• Prepare response reports identifying care deviations and improvement measures, and present them to the DPOR Supervisory Board and cancer-treatment provider group for further action.[48]
• Use the DPOR coordinator and deputy to prepare annual implementation reports; require the Expert Council to report annually on detailed objectives, programme-quality indicators and response reports for common cancers.[30][31]
• Require the Supervisory Board to review annual reports, oversee strategic and detailed objectives, and adopt improvement measures where performance deviates from plan.[32]
• Publish annual reports, council activities and meeting minutes through DPOR governance arrangements; the Expert Council meets three to four times a year and the Supervisory Council meets annually.[15]
• Monitor screening through programme-specific coverage, participation, quality and incidence measures, including the Zora coverage objective of 72–75% and Dora participation above 75%.[10][37][49]
• Track Svit quality indicators continuously, undertake improvement actions, and assess by 2024 whether active follow-up after polypectomy should be introduced for people at high risk.[38]
• Develop national rehabilitation indicators and data-collection methods by the end of 2025, followed by regular monitoring across the rehabilitation network by the end of 2026.[42]
• Develop palliative-care quality indicators by 2023 and establish quality oversight of all providers by 2026.[20]
• Establish a childhood cancer clinical registry and late-effects module by the end of 2023, integrating them into routine national follow-up by the end of 2025.[44]
• Use electronic reporting, sample and workflow traceability, structured pathology and cytology reports, and transmission to e-Health and legally defined data collections to support quality assurance and accountability.[39][40][50]

The plan assigns responsibilities and deadlines to the Ministry of Health, Institute of Oncology Ljubljana, Cancer Registry, National Institute of Public Health, Health Insurance Institute of Slovenia, screening bodies and provider institutions.[28][42][26][27]Several operational areas, including rehabilitation, palliative care, prevention and diagnostics, do not specify comprehensive indicator sets, reporting cycles, independent evaluation methods or formal sanctions beyond these arrangements.[51][52][12][40]

Costing & Financing

Costing evidence is limited. The plan identifies expenditure for cancer screening and selected treatment services in 2020, while most strategic actions specify resource needs or financing intentions without quantified budgets, funding gaps or economic assumptions.[53][54][55][20]

• Record 2020 spending for the Zora, Dora and Svit screening programmes, inpatient cancer treatment, outpatient radiotherapy and outpatient systemic oncology treatment using data from the Health Insurance Institute of Slovenia.[53][54]
• Cover modern cancer treatment through compulsory health insurance, while requiring stable ongoing Health Insurance Institute financing for guideline-based haematology diagnostic and therapeutic services during 2022–2026.[56][55]
• Finance comprehensive rehabilitation progressively through public healthcare institutions from 2023 to 2026 in accordance with the general agreement.[17]
• Provide state-budget funding for DPOR coordination and continue state-budget support for cancer-related non-governmental organisation activities, although no monetary allocations are specified.[45][27]
• Secure systematic financing for palliative care and use possible joint applications for European funding for rehabilitation clinical research.[42][19]
• Fund the work of the national European Union Cancer Mission hub manager from European funds.[24]
• Guarantee financing for molecular-diagnostics research, without specifying its amount, source or delivery mechanism.[41]
• Identify qualitative resource needs for staffing, training, facilities, equipment, digital systems, pathology capacity, rehabilitation services and palliative-care teams.[51][52][40][23]

The costing chapter excludes a comprehensive analysis because cancer care spans multiple healthcare levels and payment models and also involves research and education outside its scope.[53]The source does not provide a dedicated overall DPOR budget, future financing commitments, quantified funding gap, resource-allocation formula or broader economic assumptions.[53][54]