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.   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.  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. 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. “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.”