Romania

Cancer Centers

The “Prof. Dr. Ion Chiricuta” Institute of Oncology

Healthcare System

The Romanian healthcare system operates under a social health insurance model, aiming for universal coverage. However, in practice, it covered 89% of the population as of 2017. The system is governed by the Ministry of Health and administered by the National Health Insurance House (NHIH). Both these bodies are represented locally through district public health authorities and district health insurance houses (DHIHs).

The healthcare system is financed from four main sources: national health insurance funds, the state budget, local budgets, and out-of-pocket (OOP) payments. OOP payments include direct payments for private services, co-payments for medicines, and potentially sizable informal payments.

The benefits provided by this system encompass a range of services. Primary care is provided by family physicians, who play a gatekeeper role, although direct access to specialists is possible for certain conditions. Specialist consultations, hospital care, and emergency services are provided by a network of various providers, such as outpatient departments, polyclinics, and specialized medical centers, but access can be uneven, with rural areas facing more challenges than urban areas.

To be eligible for these benefits, individuals must contribute to the national health insurance fund, a mandate that applies to employees, employers, and the self-employed. Certain groups like students, pensioners, and unemployed individuals receive state-funded health insurance.

Data management has been digitalized with the creation of national electronic systems for medical prescriptions and the insured. Hospitals and clinics are obliged to maintain patient records and are transitioning to Electronic Health Records (EHRs). The system faces challenges, including data standardization and interoperability across different healthcare providers.

Administrative or Claims Data

Database: Mortality by cause of death

[1] [2]

Sponsor, manager or home institution: National Institute of Statistics (Institutul Naţional de Statistică).

Primary purpose: Registry the number of deaths for statistics purposes.

Type of information: Commune; City; Municipality; Date; Number of the document from the civil status register; Code SIRUTA; Personal numeric code; Name and surname; Sex; Number of children born alive during life (for women only); Date of death; Date of birth; Marital status; Date of birth of the surviving spouse; Employee; Level of education; Citizenship; Ethnicity; Domicile; Place of death; Country where he died; Country where he was born; Causes of death; Antecedent causes; The initial morbid state; Other important morbid conditions; Manner of death; Status of the autopsy.

Available type of information: Deceased by causes of death; Macro-regions, Development regions and counties; Gender; Deceased with usual residence in Romania.

Source of Information: Death statistical bulletins made by the civil registry.

Data level: Patient-level.

Available data level: Regional and national level.

Number of Records: Unknown.

Date Range: 1990 onwards.

Cancer Areas of Interest: Unknown.

Open data access: Partially publicly available. To find statistics about death, on the domain page, go to the topic [3] "A.2 VITAL STATISTICS" > "DEATH", then choose the indicator you want to see. Instructions to request data for restricted content [4].

Information/Contact for data request: Contact information [5].

Database: Diagnosis Related Group (DRG)

[6]

Sponsor, manager or home institution: National Institute of Health Services Management.

Primary purpose: Characterize the hospital's patient care in order to evaluate the results, increase efficiency, and administrate the hospital's financing system. Classifies the patients simultaneously by type of pathology and cost of care.

Type of information: Type of information - DRG Romania.

Available type of information: Available type of information - DRG Romania.

Source of Information: Hospitals and ambulatory care reports.

Data level: Patient-level.

Available data level: National, regional, and hospital levels.

Number of Records: Unknown.

Date Range: 2002 onwards.

Cancer Areas of Interest: Cancer areas of interest - DRG Romania.

Open data access: Partially publicly available. Medical and pediatric oncology data information [7]. The quarterly indicators for evaluating the activity of hospitals [8]. Instructions to request data for restricted content [9].

Information/Contact for data request: Contact information [10].

Registries

Database: National Registry of Childhood Cancer (RNCCR)

[11]

Sponsor, manager or home institution: Daruieste Aripi Association and Romanian Society of Pediatric Onco-Hematology.

Type of information: The information contained in the registry follows the recommendations of ENCR [12]. Furthermore, it includes clinical data and the newest pediatric cancer staging system recommended by the Toronto Consensus [13]. Data refers to people aged between 0 and 14 years. The variables available to be registered by the sources in the database are: CNP; Name; First name; Date of birth; Age; Sex; County; City; Address; Date of cancer diagnosis; Explication (reason for registering the diagnosis: hospitalization, death, biopsy, etc.); Date of clinical onset; Date of relapse; Reason for reporting; Registration base (data source); Tumor location; Topographical code; Laterality. Histopathological/cytological examination: Behavior; Morphological code; Degree; Cod ICC3 primary; Cod ICC3 category; Cod ICC3 subcategory. Toronto staging: diagnostic class; level 1; level 2. TNM staging for solid tumors not included in Toronto staging: Stadium type; TNM classification. Treatment: Stadium type; TNM classification; Surgery date; Chemotherapy; Radiotherapy; Hormone therapy; Immunotherapy; Other treatments; Transplant; Diagnostic class; Therapeutic protocol; Another therapeutic protocol; Treatment abroad; Type of treatment abroad; Tara; end of therapy date; Response to treatment; Refusal; Reason for refusal; Abandon; Dropout reason). Tracking: Aate of last contact; Status; The last doctor; Death; The main cause; Secondary cause.

Source of information: Reports from pediatric oncologic centers.

Data level: Patient-level.

Date range: 2009 onwards.

Data access: Partially publicly available [14]. Instructions to request data for restricted content [15].

Cancer areas of interest: Unknown.

Information/contact for data request: Contact information [16].

Database: North-West Regional Cancer Registry

[17]

Sponsor, manager or home institution: Oncological Institute of Cluj (IOCN).

Primary purpose: Register the cases of cancer in the counties of Cluj, Bihor, Maramureş, Bistrita Năsăud, Sălaj, and Satu Mare to maintain epidemiological surveillance.

Type of information: The variables available to be registered by the sources in the database are: CNP; Name; First name; Date of birth; Age; Sex; County; City; Address; Date of cancer diagnosis; Explication (reason for registering the diagnosis: hospitalization, death, biopsy, etc.); Date of clinical onset; Date of relapse; Reason for reporting; Registration base (data source); Tumor location; Topographical code; Laterality. Histopathological / cytological examination: Date of examination and result; Tumor location; Topographical code; Laterality, Behavior, Morphological code, Differentiation degree, Stage type, TNM classification. Also informs if the cancer was detected by screening and if it is an interval cancer. Treatment: Type of treatment, Date of initiation. Informs if there was a refusal to the treatment. Tracking: Date of last contact, Name of the last doctor consulted, Date of death, Main cause and secondary cause of death.

Available type of information: Number of new cases of cancer; Region; Type of cancer; Year; Sex; Annual incidence by 100.000 inhabitants; Sexual rate (M/F) of new cases of cancer; Percentage distribution of new cases of cancer; Age group; Number of deaths by cancer; Crude rate of mortality by 100.000 inhabitants; Standardized mortality rate by 100.000 inhabitants (related to the world population).

Source of Information: Pathology, hematology and immunology laboratories, outpatients offices, and oncology departments from private and public national cancer centers; Also receives information from death certificates, screening units and other registries.

Data level: Patient-level.

Available data level: Regional-level.

Number of Records: Unknown.

Date Range: Regarding the county of Cluj, information is available from 2000 onwards. There is data about other counties from 2008 onwards.

Cancer Areas of Interest: Cancer areas of interest [18]. Some specific cancer locations are excluded [19].

Open data access: Partially publicly available [20]. Instructions to request data for restricted content [21].

Information/Contact for data request: Contact information [22].

Clinical Practices Guidelines

IOCN Guideline

Sponsor, manager or home institution: The Oncology Institute “Prof.Dr. Ion Chiricuță”; The Ministery of Health.

Primary purpose: To offer guidance to healthcare professionals in Romania, ensuring standardized and evidence-based care for pediatric oncology patients, and improving long-term survival through updated and reviewed strategies.

Type of information: Epidemiology, screening, diagnosis, treatments and follow up of various types of cancer in children's and adolescents.

Access to information: Access information [23].

Cancer-related Patient Associations and Resources

Compilation: ESMO Patient Guides

Sponsor, manager or home institution: European Society for Medical Oncology.

Primary purpose: To translate complex medical language into understandable information for patients.

Available guides: Adverse Reactions of Immunotherapy; Survival; CML; Colorectal Cancer; Endometrial Cancer; LAM; Follicular Lymphoma; Non-Small Cell Lung Cancer; Breast Cancer.

Type of information: Information on each guide varies for each cancer type. Generally, guides provide definitions, explanations of causes, diagnosis, treatment, treatment options, care after treatment, among others.

Access to information: List of guides [24].

Latest Policymaking Initiatives

Report: IOCN

Sponsor, manager or home institution: Institutul Oncologic Prof. Dr. Ion Chiricuta; RCC Nord-vest României.

Primary purpose: To provide data on cancer incidence and mortality, and serve as an essential tool for oncologists, public health researchers, healthcare services, and policymakers in their efforts to combat cancer in Romania.

Type of information: Cancer incidence and mortality trends; Cancer prevalence.

Data level: Regional level.

Access to information: Access Information [25].

Report: Ministry of Health

Sponsor, manager or home institution: Ministerul Sănătății.

Primary purpose: To establish an integrated system of prevention and care for people with cancer, ensuring equal access to personalized, high-quality, and comprehensive services, including early diagnosis, support to combat suffering, and improved survival rates through innovative approaches.

Type of information: Cancer incidence, prevalence, mortality; Risk factors; Distribution of new cancer cases; Estimated percentage changes in cancer; Incidence of cancer in children; Distribution of the number of palliative care beds; Percentage of people who had a breast, cervical and colorectal screenings; No. of hospitalization episodes.

Data level: National and regional level.

Access to information: Access Information [26].

Report: EU Country Cancer Profile 2023

Sponsor, manager or home institution: OECD and European Commission.

Primary purpose: To provide reliable data on cancer prevention and care, identifying trends, disparities, and inequalities among EU Member States and regions to guide interventions under Europe's Beating Cancer Plan.

Type of information: National cancer burden; Cancer incidence and mortality; Risk factors for cancer; Early detection programs (screenings); Cancer care performance, The impact of COVID-19 on cancer care.

Data level: National level.

Access to information: Access Information [27].

Quality of Life and Palliative Care Research

List of Articles: Quality of Life [28] and Palliative Care [29].