Comparative analysis of the access to health-care services and breast cancer therapy in 10 Eastern European countries

Abstract

Aim: The aim of this study is to compare the differences in breast cancer therapy, health-care service practices, and their availability in ten European countries—Albania, Bosnia and Herzegovina, Bulgaria, Kosovo, Montenegro, Republic of North Macedonia, Croatia, Romania, Slovenia, and Republic of Serbia. Methods: An inquire survey was conducted among oncologists in the participating countries. The questionnaire was of qualitative character and focused on several key areas as screening practices, diagnosing, treatment, and health-care procedures utilization. The results were processed through comparative and percentage analysis. Results: All of the observed countries have national registries for breast cancer, but only in five, a mechanism of controlled action of early detection is implemented. Ninety percent of the countries have implemented in the national guidelines the European Society of Medical Oncology recommendations, while National Comprehensive Cancer Network is considered in only 50%. In all countries, digital mammography is a universal diagnostic method. Pathohistological analysis, including HER2 receptor expression and determination of the level of progesterone and estrogen receptors, is routinely performed in all countries prior to therapy. Some differences are observed in terms of FISH/CISH methods, determination of Ki-67 volume, and prognostic molecular assays. Trastuzumab is used as neo-adjuvant therapy in HER2-positive disease in all countries, while in Bosnia and Herzegovina and Croatia, only pertuzumab is used. Psychological support is integrated into the professional guidelines for treatment and monitoring in Bosnia and Herzegovina, Bulgaria, and Serbia. Conclusions: The international guidelines should be followed strictly, and some improvements in the health policies should be made in order to decrease the differences and inequalities in the availability of the breast cancer (BC) health services in the Central and Eastern European countries.

Pilot Study on the Incidence of Breast Cancer Among the Population of the North East Region of Bulgaria

“…Our study confirmed that hormone therapy dominated chemotherapy which is similar to other publications [12,13,14]. In other studies, hormone therapy is an efficient and cost-effective alternative of chemotherapy treatment strategies [15,16]. The prescribed treatment protocols were in accordance with those approved in the respective pharmacotherapeutic guideline for oncology diseases available in Bulgaria in 2019.…”

Triple negative breast cancer in Bulgaria: epidemiological data and treatment patterns based on real world evidence and patient registries

“…In the recent years, we also observed an improvement in the diagnostic methods and therapy, as well as an improved patients access to novel therapies. This real-life study showed also that the assigned therapeutic regimes followed the pharmaco-therapeutic guidelines for oncology and were compliant with the recommendations of NCCN and ESMO, and confirmed the results of a previously conducted study comparing the treatment practices and access to health care services of breast cancer patients in Central and Eastern Europe [26]. The main type of therapy in TNBC is the cytostatic chemotherapy and, as there is still no unified standard therapeutic scheme, it is recommended for most of the schemes to be platinum-based with the addition of paclitaxel.…”

Pharmacotherapeutic Patterns and Patients’ Access to Pharmacotherapy for Some Rare Diseases in Bulgaria – A Pilot Comparative Study

“…To the best of our knowledge, this is one of the few studies which attempt to analyze the Bulgarian RDs patients’ access to therapy applying a set of instruments: direct comparison between the pharmacotherapeutic guidelines on national and international level; assessing the time of inclusion and receiving reimbursement status after marketing authorization in the EU; analyzing the availability of national standards for initiation and continuing of treatment. One other study has evaluated the time between market and patients’ access to breast cancer therapy and compliance with international guidelines ( Dimitrova et al, 2020 ). The results show that most of the therapies are covered with public finances and the average time from marketing authorization to market and patients’ access is 1–2 years on average.…”

“…The results show that most of the therapies are covered with public finances and the average time from marketing authorization to market and patients’ access is 1–2 years on average. It also showed that there is a need for stricter compliance and regular updates of national to the international guidelines ( Dimitrova et al, 2020 ). Further studies are planned aimed at more detailed and deeper analysis and comparison covering other rare diseases.…”