Dear customer, we are sorry but your browser doesn't support all necessary features for good site view. Please switch to one of the modern browsers (Chrome, Safari, Firefox).

Care Delivery


16/6/2021 | 10 minutes to read

Copy link

Screening and Early Detection

 The Czech Republic is one of the top countries in the index when it comes to immunisation as a form of prevention of some types of cancer. The country has a national HPV vaccination programme and a hepatitis B vaccination programme for infants; 97% of one-year olds received the three doses of the vaccine in 2019 according to WHO data. However, there are some challenges in maintaining these accomplishments. "In terms of HPV vaccination, unfortunately, it has been dropping; 10 years ago rates were 75% of 13-year olds, while now the rate is 60%, and we would like to have at least 80% vaccination rates,” notes Mrs Cibulova. “We organise awareness campaigns, but there is still misinformation about different side effects such as autism, which we have to explain.”

The country also obtains full marks on an indicator measuring the development of screening and early detection. National screening programmes are in place for cervical cancer and breast cancer. There is also availability of services like mammography, faecal occult blood test or faecal immunological test, and bowel cancer screening (by exam or colonoscopy) at the public primary healthcare level. According to Dr Prausová, “the Czech Republic is extraordinary in this sense, because the screening programmes are free; patients don't have to pay.”

ICP assessment of selected preventive actions, Czech Republic

National HPV vaccination programme Nationale screening programme for cervical cancer National screening programme for breast cancer Availability of mammography or clinical breast exam (CBE) Availability of faecal occult blood text or feacul immunological test Availability of bowel cancer screening by exam or colonoscopy
Score 0-1 Score 0-1 Score 0-1 Score 0-2 Score 0-1 Score 0-1
1 1 1 2 1 1

Note: A higher score means better performance

Source: ICP

Mrs Cibulova notes further areas of progress such as the introduction of HPV DNA testing (covered twice in a woman’s life by health insurance) and BRCA1 or BRCA2 mutations genetic testing (follow up available for women who have the mutation). “Every patient with ovarian cancer should be tested for BRCA1/2, not only to choose the right treatment, but also that family members can find out if they have inherited the mutation and can undergo prophylactic surgery,” she adds.

The results of these efforts are showing. “We now catch more tumours in time, the first clinical stages are treatable and more advanced stages can be slowed down, and we can improve both the quality and the length of life,” notes Dr Prausová. According to Mrs Cibulova: “mortality in cervical cancer has dropped by 16% in the last 10 years and this is probably related to well functioning cervical screening.

Some challenges however persist. Professor Bartunkova mentions delays: “based on experience from my hospital, when you receive an invitation for screening, you might get an appointment in about half a year.” Mrs Cibulova notes: “we have very good screening organised here for three cancer types, breast, cervical and colorectal cancer; they work very well, but there is still a group of around 40% of people who do not show up.

 The role of doctors in promoting adoption is highlighted by Dr Prausová: “We actively encourage patients to take part in the screening programmes, we collaborate with GPs, and we evaluate the results regularly, to see if the programmes have an effect on the prevalence and treatment outcomes of these diagnoses.” Mr Špecián calls for more awareness raising on prevention by the government: “we feel that much is left to the charities and the private sector, and less is being done by the Ministry of Health.

Service Availability

The country is second in the group of 29 countries on the assessment of service availability and workforce. There is availability of radiotherapy in the public health system and the country has the highest density of radiation oncologists, above Italy and Germany. The country has a weaker performance on an indicator measuring the capacity of radiotherapy equipment to meet patient need, based on which the country ranks 12th.[1] It is 5th among the 29 countries examined in terms of clinical oncologists per 1,000 population.

Availability of medicines included in the WHO essential cancer drug list is observed in the public health sector (cisplatin, fluorouracil, docetaxel, imatinib, rituximab and trastuzumab).[2] These cancer medicines are registered with the State Institute for Drug Control (SIDC) and thus are fully reimbursed by health insurance companies.[3] [4] In the Czech Republic, participation in the health insurance system is mandatory.[5] Dr Prausová notes there have been improvements in the approval of new expensive treatments in recent years, with the time it takes to reach patients being reduced. “We have greatly improved access to costly treatment methods of malign cancers, because we have been able to successfully agree on the terms with insurance companies,” she adds.

Furthermore, the country is developing manufacturing capacity. “For the first time in the Czech Republic, there is a biotech company developing anticancer drugs.” Notes Professor Bartunkova.

Thanks to the presence of Complex Oncology Centres (COCs), cancer care is deemed to be high quality in the country overall. But there are still some gaps to close in the care continuum. Professor Bartunkova notes: “Sometimes it takes months before people reach the COC and are properly diagnosed; so, this is a long timeline before reaching specialised care.”

Another area for improvement is follow-up care, for instance, for childhood cancer survivors. “Care is very well functioning until patients get to the age of 18, then there is no systematic plan on when and where to take care of childhood cancer survivors and to follow long-term toxicity of chemotherapy, or other treatments,” notes Professor Bartunkova.

Regarding palliative care, the ICP confirms that oral morphine is generally available in the public health system, while there is availability of community or home-based palliative care in the public health system. According to Mrs Cibulova, the development of palliative care services is still work in progress, although with improvements in the last years. “To name a successful example worth following at the General faculty hospital in Prague, we had the first palliative clinic established just last month,” she adds. Professor Bartunkova notes: “I see from the patients’ side that when they stopped the treatment, continuing care is not as good as specialised care. For example, hospice care, supportive care, it is very difficult to get some care on a long-term basis.

Care Standards

The Czech Republic ranks 18th among the 29 countries based on an indicator measuring the development of clinical guidelines. There are evidence-based national guidelines for the management of major NCDs through a primary care approach. However, the study identified specific guidelines for only some priority cancers considered (breast, lung, prostate and colorectal cancer). The Czech Institute for Health Information and Statistics published clinical guidelines for the early stages of colorectal cancer in June 2019. In February 2020, it published clinical guidelines for the prevention, detection and treatment of prostate cancer. The Czech guidelines have been adapted from the German guidelines and guidelines for lung cancer are currently being prepared.[6] [7] [8] Mrs Cibulova adds: “for gynaecological cancers, we have very good guidelines from the European Society of Gynaecological Oncology (ESGO) which have been endorsed and are broadly used in the Czech Republic.“

Professor Bartunkova notes that the use of guidelines is common, even if relying on international guidelines and not always local ones. “Every oncological society uses international guidelines, people are really using guidelines; why develop a national guideline when there is a good international one?” she notes. Mr Špecián agrees: “From my perspective, it is not necessarily a good thing to have our own guidelines and create everything from the beginning. Because it is costly, requires financing, and the clinical landscape is evolving, so it needs a lot of updating.” 

The ICP assessment takes a slightly different view, and scores countries according to their use of national guidelines. The reason for this is the ICP’s focus on the need for validity and applicability, through guidelines that are tailored to specific population profiles and healthcare settings, in a local language that facilitates widespread use. “There is no mechanism to translate guidelines and to adopt them to local circumstances”, notes Dr Dolezal, referring to the situation in the Czech Republic. “The point is that every physician encountering oncology patients knows what to do.” It is possible to adapt guidelines if the evidence base is clear though, through the use of guideline adaptation tools such as ADAPTE and AGREE.

Lastly, regarding the development of patient-centred care, the country’s performance is also assessed as low (ranked 12th). In the Czech Republic, there is a network of 18 Complex Oncological Centres, which aim to provide patients with coordinated care of multidisciplinary teams, comprising of clinical oncologists, radiotherapists, diagnosticians, surgeons, nutritional specialists, psychologists and social workers.[9] [10] Mrs Cibulova notes however: “it depends in which hospital patients are treated, and not everybody has access to services such as supportive therapy, nutritionist care, physiotherapy, palliative care, psychological care.” Mr Špecián agrees: “there are issues with the availability of psychotherapy for patients who were successfully treated, and of additional support, for example nutrition counselling.”

There are also views that lack of coordination through the health system is a barrier for patient-centred care approaches. “Very often the patient is moving from one physician to another, not being properly coordinated according to clinical guidelines,” notes Dr Dolezal. “Problems with coordination of treatment may end up with delays of treatment and access to curative technologies.”  Mrs Cibulova is of a similar view: “The care here still is not patient-centred, revolving around the patient, making everything possible so that the patient feels safe though the journey, knows exactly what to do, has everything under the same roof.” Furthermore, no national clinical guidelines for long term follow up, rehabilitation and return to work were identified.

Bringing patients to the centre of health debates, there are cancer patient support organisations and they have been involved in cancer policy development and decision making. The website of the Czech Oncological Society lists 17 patients' organisations.[11] There is also a patients' board that functions as part of the Czech Department of Healthcare, and which includes 25 members, representing various conditions, including cancer. The board has regular meetings with the Department of Healthcare officials, and serves as an advisory body, issuing public statements on matters of legislation concerning patients and patient care.[12] “We are gaining strength, but we are not yet where we strive to be: we do not have patients sitting in ethical committees yet,” notes Mrs Cibulova.“I would like to see patients having a say together withHCPs and other experts for example regarding the information consent: Is it understandable? Is it easy enough to read for an average patient? We have to work locally on incorporating patients‘ opinions and experience into clinical trials.” Mr Špecián notes: “Historically, we have less civil society than in western Europe. And it is still evolving.”


[1] Calculated by the EIU based on the number of radiotherapy machines available (including linear accelerators and Cobalt-60 from public and private sectors), divided by the number of radiotherapy machines required.

[2] Based on information from a public hospital in the capital.

[3] The State Institute for Drug Control. (Státní ústav pro kontrolu léčiv). Available from:

[4] VZP, 10 + 1 questions about health insurance reimbursements for seriously ill patients according to Section 16 (10 + 1 otázek a odpovědí týkajících se úhrady zdravotní péče pro těžce nemocné pacienty dle paragrafu 16), 2017. Available from:

[5] Health Insurance Bureau (Kancelář zdravotního pojištění), Health insurance system in CZ, 2016. Available from:

[6] Clinical Advisory Guidelines for the Timely Detection, Diagnostics and Treatment of Various Stadiums of Prostate Cancer (Klinické doporučené postupy pro časnou detekci, diagnostiku a léčbu jednotlivých stádií karcinomu prostaty), 2020. Available from:

[7] Unfinished Clinical Guidelines: Lung Cancer. (Rozpracovné klinické postupy: Karcinom plic). Available from:

[8] Clinical Advisory Guidelines for Early Stages of Colorectal Cancer - Clinical Stages 1 and 2 - Diagnostics and Treatment (Klinické doporučené postupy pro časný kolorektální karcinom - klinická stádia 1 a 2 - diagnostika a léčba), 2019. Available from:

[9], The doctor and the multidisciplinary team (Lékař a multidisciplinární tým). Available from:

[10], Treatment: the multidisciplinary team. (Léčba: multidisciplinární tým). Available from:

[11], The Czech Oncological Society: Patients' Organisations. (Česká onkologická společnost: pacientské organizace). Available from:

[12] Ministry of Health, Patients' Organisations and the Patients' Board. Available from:

Share on social networks

Share on social networks


Copy link