ZAGREB, 31 May (Hina) - Cancer survival rates have significantly improved in Croatia in recent years, according to a report by the European Commission (EC) and the Organisation for Economic Co-operation and Development (OECD), which says the gap in the quality of cancer care in Croatia compared to the rest of the EU is narrowing.
Since 2023, the OECD and EC have been publishing country-specific reports on the state of cancer care, including for Croatia. This year's report shows, for the first time, positive trends for Croatia in five-year survival rates and reduced mortality for eight cancer types.
Compared with patients diagnosed between 2011 and 2015, five-year survival in the 2016-2020 period increased for eight cancer types - lung, breast, prostate, melanoma, colorectal, pancreatic, stomach, and ovarian cancer. A negative trend was recorded for cervical cancer, with a one-percentage-point drop in survival.
These figures confirm that investment in oncology is yielding results, although Croatia still has among the highest cancer incidence and mortality rates in the EU, as well as a low share of direct investment in treatment compared to the European average.
The report notes that childhood acute lymphoblastic leukaemia in Croatia has an exceptionally high survival rate of 94%. Prostate cancer patients have a five-year survival rate of 90%, breast cancer 84%, and melanoma 82%.
On the other hand, survival rates for more aggressive cancer types remain significantly lower: cervical cancer has a survival rate of 61%, colorectal cancer 54%, and lung cancer just 15%. Pancreatic cancer has the lowest survival rate at 8%.
However, compared to patients diagnosed between 2011 and 2015, five-year survival increased for all eight cancer types, except cervical cancer, which recorded a one-percentage-point decrease.
The greatest improvements were seen in prostate cancer and childhood acute lymphoblastic leukaemia, where survival increased by seven percentage points, followed by melanoma (5 pp), lung cancer (4 pp), colorectal cancer (3 pp), breast cancer (3 pp), and pancreatic cancer (2 pp).
Fifth highest estimated cancer incidence rate in EU
The estimated cancer incidence rate in Croatia in 2022 was 638.3 cases per 100,000 inhabitants, which is 12% higher than the EU average of 571.5 cases per 100,000 inhabitants.
Furthermore, Croatia has the fifth highest estimated incidence among EU countries plus Norway and Iceland. Only Norway, Denmark, Ireland, and the Netherlands have higher rates.
Men in Croatia are significantly more at risk. The incidence rate for men in 2022 was estimated at 802 cases per 100,000 inhabitants, which is 17% above the EU average. The incidence rate for women in 2022 was 529 cases per 100,000 inhabitants, compared to the EU average of 488 cases per 100,000, marking an 8% difference.
In Croatian men, the highest incidence of new cancer cases was recorded for prostate cancer, accounting for 21%, while the EU average is at 23%. This is followed by colorectal cancer (17%) and lung cancer.
Among women in Croatia, the highest incidence is breast cancer (26%), which is lower than the EU average of 30%. This is followed by colorectal cancer (13%) and lung cancer (9%), with rates similar to the EU average.
In 2021, Croatia recorded the second highest cancer mortality rate among European countries, just behind Hungary. Cancer mortality rates are declining at the same pace as in countries with comparable economies, but more slowly than the EU average.
The significant rise in cancer prevalence poses a major public health concern and is the main reason behind the establishment of Croatia's National Strategic Framework Against Cancer for the period up to 2030. Nearly two percent of Croatia's population received a cancer diagnosis in the past five years, according to data from 2022.
Performance in tackling risk factors improved, but more can be done
In 2021, Croatia allocated 4% of its total healthcare expenditure to preventive care, which is below the EU average of 6%.
It has improved its breast and cervical cancer screening rates, which are now above the EU average, but colorectal cancer screening rates remain low. HPV vaccination coverage in Croatia has increased, but overall remains systematically low. A thorough and continuous public health strategy is needed to reduce health risks associated with HPV.
The quality of cancer treatment in Croatia is lower than in other EU member states, but the gap is narrowing.
There are major differences in the distribution of cancer-related costs in Croatia compared to the rest of Europe.
Loss of productivity due to illness accounts for 44% of cancer-related costs in Croatia, which is three times higher than the EU average. About 26% of total cancer expenditure in Croatia goes to healthcare (including medication), while the EU average is 49%. The report suggests that this significant difference is due to late-stage diagnosis, unequal access to innovative therapies, and the fact that most healthcare costs are lost to reduced productivity caused by premature death, illness-related absences, and long-term disability among working-age patients.
A recent report by the Swedish Institute for Health Economics also analysed cancer care from an economic perspective and examined how much EU countries invest in cancer treatment.
Healthcare spending on cancer treatment varies by nearly a factor of three across countries.
Croatia ranks near the bottom in terms of direct spending on cancer, including medical equipment, drugs, and healthcare staff, with €130 per capita, compared to over €400 per capita in Germany. However, when it comes to indirect cancer-related costs, the situation is reversed. Croatia leads Europe in spending on lost productivity due to high mortality, sick leave, and disability resulting from the disease
Croatia has enough oncologists
The report also states that in 2023, Croatia had 376 oncology specialists, or nine specialists per 100,000 inhabitants, which is sufficient for current needs. Significant progress has been made in nursing care for oncology patients, including the launch of the first international academy and plans for specialisation and advanced roles in cancer treatment. Croatia is promoting high-quality cancer care through the extensive introduction of biosimilar medicines.
As for palliative care, in 2023, 52 coordinators were appointed and 41 mobile teams established in 30 health centres across all counties. Between 2023 and 2050, the number of depression cases related to cancer is expected to rise in Croatia, but the reduction in life expectancy is expected to be smaller than the EU average.
