Državni Program Obvladovanja Raka 2022–2026

Objectives

Slovenia’s State Cancer Control Programme (DPOR) 2022–2026 is a national framework for comprehensive cancer control, building on the 2010–2015 and 2017–2021 programmes and aligned with Europe’s Beating Cancer Plan. Its overarching goals are to slow the increase in cancer incidence, improve survival, and improve the quality of life of people with cancer through rehabilitation and palliative care.[1][2][3][4]

• Reduce preventable cancer risk through action on tobacco, harmful alcohol use, unhealthy diet, physical inactivity, overweight and obesity, excessive sun exposure, environmental and occupational carcinogens, radiation, and cancer-related infections.[5][4][6][7][8]
• Strengthen primary prevention through health promotion, legislation, primary healthcare, vaccination, infection control and application of the European Code Against Cancer.[9][8][10]
• Maintain and improve organised screening for cervical, breast and colorectal cancer through the Zora, Dora and Svit programmes, while assessing new evidence-based programmes, including organised lung-cancer screening.[11][12][13]
• Improve earlier diagnosis, equitable access and quality of treatment through multidisciplinary care, updated clinical guidance, modern diagnostics, surgery, systemic therapies, radiotherapy, molecular diagnostics and integrated electronic health records.[14][15][16][17]
• Expand comprehensive rehabilitation from diagnosis onwards, addressing medical, psychological, social, functional and vocational needs, and provide timely palliative care across Slovenia.[18][19][20][21][22]
• Strengthen cancer research, education, public awareness, patient participation, cancer registration and monitoring of the burden of disease and care quality.[23][24][25][26]

The programme sets explicit strategic outcome ambitions: maintain a declining age-standardised incidence trend among men and reduce the annual increase among women to 1%; improve net five-year survival by 3% in 2022–2026 compared with 2017–2021; and develop national quality-of-life indicators during the programme period.[4]It also seeks survival above the European average and a 10% improvement for patients diagnosed in 2017–2021 compared with those diagnosed in 2007–2011.[27]

Specific prevention targets include reducing smoking among people aged 15 and over from 23% in 2019 to 17.5% in 2026, reducing weekly smoking among 15-year-olds from 9% to 7%, achieving at least 80% human papillomavirus vaccination coverage among girls aged 11–12, and increasing Svit participation to 70% by the end of 2026.[6][8][28]

Implementation

Delivery is based on coordinated action across healthcare, government sectors and civil society, reflecting the fact that cancer risks and outcomes extend beyond the health system.[1][4]The Ministry of Health owns the programme and is responsible for adoption, implementation and monitoring, while the Institute of Oncology Ljubljana manages operational coordination.[2][29]Each detailed objective is intended to have measures, deadlines and named leads.[1]

• Coordinate implementation through a DPOR coordinator and deputy, administrative and communications support, a Professional Council, a Supervisory Board, thematic expert groups and area coordinators.[30][31][32]
• Use the Supervisory Board, chaired by the Ministry of Health State Secretary, to review implementation, annual reports and corrective action where objectives are not achieved.[31]
• Use the Professional Council to coordinate detailed objectives, prepare annual implementation and response reports, and include screening leaders, primary care, multidisciplinary groups, genetics, rehabilitation, palliative care, research, education and the Slovenian Cancer Registry.[31][32]
• Deliver prevention through legislation, public-health programmes, primary care, health-promotion and health-education centres, vaccination, research, regulatory measures and cross-sectoral action.[9][33][34][10]
• Operate centralised screening programmes under national regulation, with the screening-programmes steering committee overseeing existing programmes and the State Commission for Screening Programmes assessing proposals for new national programmes.[12][13]
• Organise cancer care across primary, secondary and tertiary levels, supported by provider networks, regional referral arrangements, multidisciplinary councils, specialised reference centres and clinical registries.[23][35][36][37]
• Engage patients, families, non-governmental organisations and civil society in prevention, screening, education, advocacy, research, rehabilitation, palliative care and strategic planning.[38][39][29]

Monitoring combines population cancer surveillance with service-quality oversight. The Registry of Cancer of the Republic of Slovenia, located at the Institute of Oncology Ljubljana, is the principal source for incidence, prevalence and survival data, while active registration and connection with e-Health are intended to make national indicators available with a delay of no more than one year.[26][40][41]Clinical registries for common cancers are intended to assess timeliness from diagnosis to treatment, compliance with guidelines, provider caseload, complications and survival, with annual reports and improvement responses.[18][36][40]

Operational measures include strengthening diagnostic capacity and pathology information systems, standardising electronic referrals and reports, expanding molecular diagnostics, ensuring central sterile preparation of anticancer medicines, developing specialist workforce capacity, and improving access to modern medicines and treatments.[16][42][43][44][45]Rehabilitation and palliative-care implementation includes multidisciplinary pathways, national coordination, specialist and mobile teams, education, service definition and quality indicators.[46][22][47][48]

The supplied material identifies resource needs and several financing mechanisms, including compulsory health-insurance coverage for cancer treatment, state-budget resources for programme coordination, Ministry of Health co-financing of selected prevention and civil-society activities, and European funding for the national Mission on Cancer hub.[18][39][29][24]However, it does not provide an overall programme budget, costed implementation plan, funding-gap assessment or quantified allocations.[1][2][4]

Monitoring & Evaluation

The programme combines outcome monitoring, service-quality measurement, registry-based surveillance and formal governance. Its core outcomes are cancer incidence, survival and quality of life, with national monitoring intended to cover the cancer burden and quality of care.[1][23]Strategic targets include a continuing 0.3% annual decline in age-standardised incidence among men, reducing the annual increase among women to 1%, and improving net five-year survival by 3% in 2022–2026 compared with 2017–2021.[4]

• Monitor incidence, mortality, prevalence and survival through the Cancer Registry of the Republic of Slovenia, with updated national burden indicators intended to be available within one year.[26][40][41]
• Measure survival against the European average and the earlier objective of a 10% improvement for patients diagnosed in 2017–2021 compared with 2007–2011.[27]
• Track screening participation, quality and outcomes across Zora, Dora and Svit, including targets of 72–75% three-year cervical-screening coverage, participation above 75% for Dora, and 70% Svit participation by the end of 2026.[49][50][28]
• Monitor preventive targets for tobacco, alcohol and vaccination, including reducing adult smoking to 17.5% by 2026, achieving at least 80% human papillomavirus vaccination among girls aged 11–12, and maintaining childhood hepatitis B vaccination at approximately 90%.[6][33][8]
• Use clinical registries for breast, colorectal, lung, prostate and cutaneous melanoma cancers to assess timeliness from diagnosis to treatment, guideline conformity, provider caseload, complications, survival, equity and treatment quality.[18][36][40]
• Prepare annual clinical-registry reports at national and provider level, followed by response reports from disease-specific expert groups identifying deviations and improvement measures.[36][41]
• Develop national rehabilitation indicators and data-collection methods by the end of 2025, then introduce regular monitoring across the rehabilitation network by the end of 2026.[46]
• Develop palliative-care quality indicators by 2023 and establish quality control for all cancer palliative-care providers by 2026.[48]
• Monitor hereditary cancer services through mandatory reporting by genetic-testing providers, a national register and annual reports.[51]

Accountability is centred on the Ministry of Health, which monitors implementation, and the Institute of Oncology Ljubljana, which coordinates and manages the programme.[29][30]The Professional Council prepares annual implementation reports and quality-indicator reporting, while the Supervisory Board reviews progress at least annually and adopts corrective measures where objectives are not achieved.[31][32]Annual cancer-provider network reports are to be prepared by the cancer registry and reviewed from 2025 onwards.[35]Numerous actions also assign named leads and deadlines, including ministries, public-health bodies, insurance bodies, professional groups and treatment providers.[34][44][52]However, several areas do not specify complete indicator definitions, reporting formats, independent evaluation arrangements, sanctions or a consolidated surveillance timetable.[3][16][30]

Costing & Financing

The supplied material identifies substantial resource needs and several financing mechanisms, but does not provide an overall costed implementation plan, programme budget, funding-gap estimate or economic assumptions for the 2022–2026 National Cancer Control Programme.[1][2][4]Cancer treatment is fully covered by compulsory health insurance, and the Health Insurance Institute of Slovenia is repeatedly identified in arrangements for screening, medicines, specialised services and stable financing.[18][11][53]

• Finance cancer treatment through compulsory health insurance, including ongoing stable financing of guideline-based diagnostic and therapeutic haematological oncology services during 2022–2026.[18][53]
• Provide resources for staffing, diagnostic and treatment equipment, digital systems, pathology and molecular-diagnostics capacity, rehabilitation, palliative-care services and provider-network development.[23][43][54][48]
• Require adequate finance, staff, equipment, software and premises for the Dora breast-screening network, while requiring projected costs to accompany proposed policy changes.[50][55]
• Link payment for colposcopy to submission of a colposcopy report through the Zora information system, without specifying a payment amount.[56]
• Co-finance tobacco-reduction and harmful-alcohol-use programmes through the Ministry of Health, with no stated allocations or financing shares.[6][33]
• Support progressive introduction of comprehensive cancer rehabilitation through public healthcare institutions in accordance with the general agreement from 2023 to the end of 2026.[57]
• Provide stable financing for rehabilitation staff and premises for haemato-oncological patients, and finance renovation or acquisition of appropriate facilities at University Medical Centre Maribor.[58][59]
• Fund national programme coordination from the state budget and continue seeking state-budget support for cancer-related health-promotion programmes delivered through public calls.[39][29]
• Use European funds for the coordinator of the national Mission on Cancer hub and identify possible joint European funding applications for rehabilitation research.[21][24]
• Mobilise charitable, donation, sponsorship, membership-fee and personal-income-tax contributions through patient organisations and foundations, including a 2021 campaign that raised more than 850,000 euros for a CAR-T-cell treatment device.[60][61]

Resource requirements are explicit but largely unquantified. They include mobile palliative teams, specialist posts, pharmacy personnel, nurses, premises, scanners, servers, information systems, tissue banks, clinical registries, research support, advanced transplantation and cellular-therapy capacity.[62][44][53][40]The source identifies no monetary values for most activities, no national financing envelope, no allocation between institutions, and no quantified funding gap.[7][28][25]