Delivering High Value Cancer Care

European Cancer Inequalities Registry Analytical Report

Report

2 February 2026

1. Assessment and recommendations

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Abstract

The global burden of cancer continues to rise, with incidence increasing – particularly among younger populations – even as survival rates improve thanks to advances in early detection and effective treatment. This dual trend leads to more people living with cancer, highlighting better performance in cancer care systems, while posing a growing challenge due to the need for increased investments. Given the fiscal constraints facing EU countries, it is critical to assess whether the cancer care delivered represents high value for both health systems and patients. This chapter highlights the key findings and main recommendations of the report, outlining policy directions to deliver high value cancer care, including faster access to care; evidence‑based and efficient care; and people‑centred approaches.

In Brief

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New OECD analysis shows an increase in cancer incidence, especially among young women

In 2024, there were an estimated 2.7 million cancer cases diagnosed in the EU (representing 5.1 new cancer diagnoses per minute), according to European Cancer Information System (ECIS). From 2000 to 2022, age‑standardised cancer incidence rose by 10% among women and 2% among men across EU countries. Cancer mortality dropped, across almost all main sites, by 18% in women and 26% in men between 2000 and 2023, and remained higher among men in all EU27 countries, Iceland and Norway (hereinafter referred to as “EU+2 countries” in this chapter). Concerningly, cancer diagnoses among younger people (ages 15‑49) have increased more widely among women, driven mostly by thyroid (+120%), skin melanoma (+48%), breast (+16%), and colorectal (+10%) cancers. Among men, skin melanoma (+50%), testicular (+38%) and colorectal (+12%) cancers have also risen. This means that a growing number of people – particularly younger women – are living with a cancer diagnosis that requires treatment and monitoring, placing sustained pressure on health and social care services.

Faster access to cancer care is key to meet the growing demand for care and improve health outcomes

Delays in access to cancer care can occur at any stage of the care pathway, from a person’s first contact with the health system through diagnosis and treatment, leading to poorer health outcomes and higher costs for the health system.

Infographic 1.1. Delays in access to cancer care occur at all stages of the care pathway
Copy link to Infographic 1.1. Delays in access to cancer care occur at all stages of the care pathway

To ensure people seek care, it is essential to prioritise health literacy, targeted awareness campaigns, and the removal of financial barriers. Evidence from the EU shows that financial burden remains a major obstacle, with 16% of cancer patients postponing or forgoing some care, most frequently medication and doctors’ appointments. To ensure equitable access, policy action is required to modernise care delivery systems, including expanding innovative and cost-effective screening modalities, streamlining diagnostic pathways, strengthening community-based and digital solutions, and establishing strong monitoring systems. Interventions to ensure continued access to innovative oncology drugs are equally critical, as oncology clinical trial starts have fallen by 22% in the European Economic Area since 2021. Furthermore, while patients in four larger countries (Germany, France, Italy, Spain) benefit from access to a large share of oncology clinical trials, those in smaller or Central and Eastern European countries have limited opportunities for participation. The EU Clinical Trials Regulation, the ACT EU initiative, and the promotion of decentralised and digital trial models are key policy instruments to promote oncology trial initiation.

Interventions to ensure quality, efficient cancer care are needed to achieve better value for money

Setting and monitoring quality standards is a key step to deliver effective cancer care, yet only 12 EU+2 countries report mechanisms to monitor compliance with cancer clinical guidelines. Risk-stratified cancer screening approaches, including based on genetic mutations (14 EU+2 countries), lifestyle factors like smoking (13 EU+2 countries) or HPV vaccination status (9 EU+2 countries) support high-value care by allocating diagnostic resources more efficiently among those at highest risk of cancer. However, potential cancer overdiagnosis – particularly relevant for thyroid and prostate cancers, as evidenced by empirical findings – has adverse effects on quality of life and wastes limited healthcare resources. As such, updating screening guidelines to target those at highest risk and to improve diagnostic accuracy, as well as adopting evidence‑based clinical guidelines to harmonise treatment, are important to reduce potentially harmful and unnecessary care. Clinician-led efforts such as Choosing Wisely recommendations against low-value care are a valuable approach in this regard. Policies to shift care from inpatient to outpatient settings, such as payment reforms that encourage day surgery or adoption of hospital-at-home models, further enhance efficiency. The Nordic countries are leaders: in 2023/24, between a quarter to half of mastectomies in Denmark, Finland, Norway and Sweden were performed as day surgeries. With medicines consuming a growing share of cancer spending, countries are promoting high-value cancer care via health technology assessments, use of biosimilars, reduction of medication waste, and optimising dosage for cancer medications.

Primary healthcare systems are not centred enough around the needs of cancer patients

OECD’s PaRIS data show that primary healthcare patients with cancer are one‑third less likely to report good to excellent health than those without cancer, with wide disparities between countries (20% in Portugal compared to 60% in Iceland) and population groups (30% lower among the less educated). Strengthening people‑centred care, such as self-management and co‑ordinated care, would enhance the quality of life and outcomes for people living with cancer. Yet fewer than one‑third of people with cancer in the EU11 experience high people‑centred care. Personalised cancer care plans and structured medication reviews must be consistently utilised to simplify complex treatment choices and reflect patients’ values and preferences. These practices can be further enhanced by co‑ordinated care pathways and patient navigation support (Denmark and France), after-hours continuity (Germany and Ireland), and digital health tools (Greece and Sweden). Policy must also extend beyond medical treatment to address well-being and quality of life, with early and community-based palliative care integrated into services (such as in Norway’s Orkal Model). Fertility preservation, sexual health, psychological care, and lifestyle counselling need consistent provision across EU countries, while survivorship programmes must be scaled up to meet the long-term needs of cancer survivors. Beyond health, cancer also has major economic impact: SHARE data reveal that a diagnosis reduces employment likelihood by 14% in EU countries, highlighting the need for labour market and workplace reintegration policies. Mechanisms such as extended sick leave, structured return-to-work policies and the “Right to be forgotten” are vital to prevent financial toxicity and ensure equity for people with cancer.

1.1. The burden of cancer continues to grow, driven by higher incidence, improving survival and rising rates of early-onset cancers among women

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Cancer incidence remains higher among men than women

According to the European Cancer Information System (ECIS), more than five people are estimated to have been diagnosed with cancer every minute across the 27 EU countries in 2024, corresponding to 2.7 million cancer diagnoses. In age‑standardised terms, cancer incidence in 2024 is estimated at 547 per 100 000 population across EU countries for both sexes, with 471 cases per 100 000 women and 650 cases per 100 000 men.

Estimated age‑standardised incidence rates are higher among men in every EU+2 country, by 38% on average in the EU. Gender gaps in estimated age‑standardised incidence rates are the largest in the Baltic countries, namely Estonia, Latvia and Lithuania. By contrast, the lowest estimated gender gaps are in Cyprus, Denmark, Malta, the Netherlands and Sweden.

Overall, ECIS estimated that by 2040, there will be 3.2 million cancer cases in the EU – an increase of half a million cases (18%) as compared to ECIS’ previous 2022 estimates.

Crude cancer incidence has risen by about 30% over the last two decades

By collecting and harmonising cancer registry data from 24 EU countries, along with Iceland, Norway as well as other OECD countries, the new OECD analysis shows that the crude incidence of cancer has increased by about 30% among both men and women in the EU between 2000 to 2022. When the effect of the ageing population is removed, the trend is more modest. The age‑standardised cancer incidence rate rose by 10% in women (from 431 to 474 per 100 000), while increasing slightly by 2% in men (from 661 to 674 per 100 000) over the same period (Figure 1.1).

Analysing the evolution of age‑standardised incidence by cancer site reveals that the key drivers of the overall increase among women are breast cancer (+12%) and lung cancer (+52%) (Figure 1.1). The rise in breast cancer is driven by a combination of demographic changes, reproductive patterns (with later and fewer pregnancies), lifestyle habits and metabolic and hormonal factors. Most of the rise in lung cancer among women is explained by a rise in tobacco smoking (where increases in smoking among women started and peaked in more recent birth cohorts as compared men), but also exposure to outdoor and indoor air pollution (OECD/European Commission, 2025[1]). Increases in cancer incidence also relate to improved screening, diagnostic and cancer registration practices.

By contrast, the limited increase in male cancer incidence rates can be explained by a large reduction in the incidence of lung cancer (‑20%) and stomach cancer (‑34%), which more than offset an increase in prostate (+14%) and skin melanoma (+90%) cancers. A gradual decline in men’s smoking rates have likely contributed to this overall trend (OECD/European Commission, 2025[1]).

Figure 1.1. Since 2000, cancer incidence has increased faster among women than men in the EU
Copy link to Figure 1.1. Since 2000, cancer incidence has increased faster among women than men in the EU

Age‑standardised cancer incidence rate per 100 000 population by cancer site, all ages, EU average

Younger populations are increasingly affected by cancer, shifting cancer care needs and affecting well-being for many years to come

Incidence of early-onset cancer – defined as cancer cases occurring among young adults aged between 15 and 49, has risen faster among women than men. Increased incidence among younger women was observed in 22 of the 24 EU countries with available data, compared to half of 24 EU countries for younger men.

From 2000 to 2022, the age‑standardised cancer incidence among younger adults increased by 22.8 per 100 000 women, from 143.8 to 166.6 per 100 000 women (+16%), while remaining stable at 97.0 per 100 000 for men on average across 24 EU countries (Figure 1.2). The most significant drivers of increased cancer incidence among younger women are thyroid cancer (+9.9 per 100 000 women), breast cancer (+8.7 per 100 000), skin melanoma (+4.2) and colorectal cancer (+0.8). A notable decrease of 2.2 per 100 000 women in cervical cancer is likely related to human papillomavirus (HPV) vaccination initiatives.

As for men, testicular cancer is the largest contributor to the rise in age‑standardised incidence between 2000 and 2022, with an increase of 3.7 per 100 000 men on average across EU countries. The incidence rate of skin melanoma among young men has also risen by 2.9 per 100 000 and by 1.0 per 100 000 for colorectal cancer. Among EU+2 countries, Croatia, France, Poland, the Netherlands and the Nordic countries saw a significant increase in colorectal cancer incidence among the younger population, whereas Czechia, Italy and Spain registered a decline.

Figure 1.2. Among women, the rise in early-onset cancer is driven by thyroid, breast, skin melanoma and colorectal cancers
Copy link to Figure 1.2. Among women, the rise in early-onset cancer is driven by thyroid, breast, skin melanoma and colorectal cancers

Change in age‑standardised cancer incidence rates per 100 000 among those aged 15 to 49, EU average, 2000-2022

These findings are consistent with previous literature showing the rise in early-onset cancer as a global, multi-cancer phenomenon. In the United States, incidence among those aged 15‑39 rose by nearly 30% between 1973 and 2015, with notable increases in kidney, thyroid, and colorectal cancers (Scott et al., 2020[3]), and a faster rise among women under 50 (Shiels et al., 2025[4]). Similar patterns appear in Europe: in the United Kingdom, cancer incidence increased more in young women (27%) than men (9%) from 1993-2019 (Hamilton et al., 2022[5]), while in France, rates rose from 2000-14 before declining slightly from 2015, with testicular, breast, thyroid, and melanoma cancers most affected (Desandes et al., 2025[6]).

In other OECD countries, trends in the cancer incidence among younger populations are similar to those in the EU+2 countries. However, the age‑standardised incidence of colorectal cancer among the younger population has increased faster for both sexes in Australia, Canada, Chile, Korea, New Zealand, Türkiye, the United Kingdom and the United States.

The rising incidence of early-onset breast, colorectal, skin melanoma and testicular cancers requires that diagnostic cancer care, treatment and supportive services be adapted to the growing number of people living with cancer for an extended period. A people‑centred approach for individuals living with cancer is becoming increasingly important – not only to help them understand and manage their prognosis, but also to foster their social and economic well-being.

Although the underlying causes of rising early-onset cancer require further study, three main factors likely play a role. The first is a genuine increase in the number of early-onset cases due to heightened risk exposures among younger generations. Shifts in metabolic and lifestyle factors and early-life environments – such as obesity, diet, physical inactivity, reproductive patterns and microbiome – are linked to higher cancer incidence in the younger population (Díaz-Gay et al., 2025[7]; Wang et al., 2025[8]). Second, expanded healthcare access and improved diagnostic technologies have increased opportunities for earlier detection among younger populations (Ladabaum et al., 2020[9]; Issa and Noureddine, 2017[10]). Lastly, broader use of diagnostic imaging and testing may have contributed to incidental and overdiagnosis of some cancers, particularly for slow-growing thyroid and prostate cancers (Richman and Gross, 2025[11]; Jiang et al., 2025[12]).

[Cancer] affected me a great deal. I was sad and depressed and treatment for [side effects] and my cancer took all my time. Losing my job due to my cancer was really tough and my individual financial situation was terrible…I lost many friends due to their fear of meeting me and they did not know how to handle [the] “new” me.

Margareta, diagnosed with Non-Hodgkin´s lymphoma at age 49

Cancer is the second largest cause of death in the EU, while cancer mortality rates fell on average by 18% in women and 26% in men from 2000 to 2023

Cancer accounts for 23% of deaths in EU countries, with an age‑standardised mortality rate of 208 per 100 000 population as of 2023, remaining the second most significant cause of mortality over the last decade (after cardiovascular disease). Due to advances in cancer detection and treatment, however, cancer mortality has dropped by 18% among women and 26% among men across EU countries between 2000 and 2023. Cancer mortality has declined across almost all main sites (Figure 1.3). For women, improvements chiefly stem from lower colorectal, breast and stomach cancer mortality. For men, gains are driven by reduced lung, colorectal, stomach and prostate cancer mortality.

Figure 1.3. Mortality rates fell across almost all main cancer sites, particularly for male lung cancer and female colorectal cancer
Copy link to Figure 1.3. Mortality rates fell across almost all main cancer sites, particularly for male lung cancer and female colorectal cancer

Age‑standardised cancer mortality rate per 100 000, by cancer site, EU average

Substantial reductions in cancer mortality were observed for women in Denmark, Czechia, Ireland and Hungary, and for men in Belgium, Czechia, Hungary and Luxembourg. While mortality rates were consistently higher among men than women in both 2000 and 2023 in all EU+2 countries, gender gaps in mortality rates narrowed during this period. Beyond gender disparities, socio-economic inequalities in mortality remain a cause for concern (see Box 1.1).

Box 1.1. Monitoring socio-economic inequalities in cancer outcomes is crucial to addressing the root causes of disparities

Copy link to Box 1.1. Monitoring socio-economic inequalities in cancer outcomes is crucial to addressing the root causes of disparities

Growing evidence in EU+2 countries indicates that the pattern of cancer incidence and cancer mortality significantly differs by socio-economic status (SES). Inequalities arising from income, education, occupation, and other social factors have been well documented (Conway et al., 2019[13]).

For cancer incidence, the meta‑analysis by Mihor et al. (2020[14]) covering EU countries shows that lower SES among adults is associated with higher risk of lung, stomach, cervical and pancreatic cancers, while adults with higher SES have higher risk of breast, thyroid, skin melanoma and prostate cancers. A scoping review of cancer inequalities by Li et al. (2024[15]) also highlights that people from lower SES backgrounds are at higher risk of lung cancer, but have a lower incidence of breast cancer.
The EU Cancer Inequalities Registry country factsheets 2015‑2019 demonstrate differences in cancer mortality between those with primary education and those with tertiary education (EC/IARC/Erasmus MC, 2025[16]). Overall, estimated cancer mortality rates are consistently higher among people with a lower level of education, for both sexes (except for women in Slovenia, Spain and France). Across EU countries, men with a low level of education face an 83% higher cancer mortality rate than highly educated men, while women with a low level of education are 31% more likely to die from cancer than highly educated women (Figure 1.4).
While it is key to monitor cancer inequalities, the majority of European cancer registries lack SES information on registrants or linkage to a database where such information is stored. Less than half of EU+2 countries enable linkages to SES data to monitor socio-economic inequalities, limiting monitoring of socio‑economic inequalities in the cancer burden.

Figure 1.4. Cancer mortality rates are higher among individuals with lower levels of education, for both women and men
Copy link to Figure 1.4. Cancer mortality rates are higher among individuals with lower levels of education, for both women and men

Estimated age‑standardised mortality rate per 100 000 (2015‑2019), ages 40‑70, by education, EU27 average

Improving survival, coupled with higher cancer incidence, has increased the number of people who have ever been diagnosed with cancer

Lower cancer mortality rates are a consequence of higher survival rates, which stem from improved access to early detection and diagnosis (see Chapter 3), as well as progress in cancer treatments including more effective surgical procedures, medicines, and radiotherapy technologies (see Chapter 4). Five‑year cancer survival has improved across most EU+2 countries, reflecting these advances.

Lung cancer, historically among the lowest-survival cancers, showed the greatest progress among the main sites. Improvements were reported in all 17 EU+2 countries with trend data, particularly in Denmark, Finland, Iceland, Norway and Sweden – all of which saw lung cancer survival increases of eight or more percentage points (p.p.) over the latest decade. Colorectal cancer survival has also improved steadily across all countries, coinciding with the roll-out and expansion of population-based screening programmes. Breast cancer continues to achieve among the highest survival rates – typically above 80% – with moderate increases observed even in countries where screening participation has declined.

The combination of increasing cancer incidence and improving survival rates results in higher cancer prevalence. As highlighted by De Angelis et al. (2024[17]), the share of the EU population living with and beyond cancer grew by 24% between 2010 and 2020, reaching 5% of both women and men. This suggests that cancer diagnostics, treatment and supportive services must meet the needs of a growing number of people living with cancer (Chapter 5).

Health expenditures on cancer in the EU have doubled over time and range from 4% to 8% of health spending in 2023

According to a 2025 report by the Swedish Institute for Health Economics, cancer spending ranged from about 4% of total health expenditure in the Nordic countries (Denmark, Iceland, Finland and Norway) to about 8% in France, Germany and the Central European countries of Bulgaria, Lithuania, Poland and Romania (Manzano et al., 2025[18]), with an average of almost 7% in the EU. On a per-capita basis, this is equivalent to EUR 268 – ranging from EUR 130 in Croatia and Hungary to more than EUR 390 in Luxembourg and Germany (Figure 1.5).

Figure 1.5. In 2023, the EU devoted 7% of health expenditures to cancer, equivalent to EUR 268 per capita
Copy link to Figure 1.5. In 2023, the EU devoted 7% of health expenditures to cancer, equivalent to EUR 268 per capita

After adjusting for inflation, it is estimated that the direct real costs of cancer in the EU more than doubled from EUR 54 billion in 1995 to EUR 120 billion in 2023 (Monzano et al., 2025[19]). Estimated health expenditures on cancer increased more quickly in the Central European countries than in other countries between 1993 and 2023, leading to some convergence in cancer spending between countries.

According to OECD projections, effective management of the disease will entail considerable financial costs, placing substantial pressure on healthcare systems globally. Driven by population ageing alone – assuming cancer incidence and survival rates remain constant across age groups – the cancer burden is projected to raise average per capita cancer-related health expenditure in EU countries by 59% and in OECD countries by 67% between 2023 and 2050 (OECD, 2024[20]). The costs of cancer on the economy collectively reverberate widely; reduced productivity and hours worked due to cancer are anticipated to reduce the labour supply by 1.1 million full-time workers in EU countries through 2050, at a loss of EUR PPP 49 billion per year. For OECD countries as a whole, the cancer burden through 2050 equates to a loss of 3.1 million workers and EUR PPP 163 billion (OECD, 2024[20]).

The increased spending on cancer care, combined with the substantial economic burden of cancer, calls for assessing how cancer services are delivered, with a stronger focus on value – namely, whether current investments are achieving the best possible outcomes. At a time of fiscal pressure and competing government priorities spanning defence, social welfare and economic growth – alongside capacity and workforce limitations in the health system itself – emphasis must be placed on ensuring high-value cancer care that contributes to the health and quality of life of people in EU countries. This report identifies key levers to improve value for money for patients and healthcare systems: faster access, evidence‑based and efficient care that ensures optimal health outcomes; and people‑centred approaches that reflect individuals’ needs and preferences.

1.2. Faster access to accurate and appropriate cancer diagnosis and treatment is key to control cancer and related cost

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Delays in access to cancer diagnosis and services occur at all stages of the cancer care pathway, pointing to significant unmet needs

Population-based screening programmes do not equally benefit eligible populations

Detecting cancer early (typically stage I‑II) improves survival, reduces treatment costs, and continues to inform care by characterising tumour biology and monitoring progression (Crosby et al., 2022[21]). Population-based cancer screening is an effective intervention to detect cancer early, by finding abnormalities associated with cancer in asymptomatic individuals. A recent population-based cohort study shows that breast cancer screening significantly reduces the likelihood of advanced tumour stages at diagnosis and breast cancer mortality over a 25‑year period (Ma et al., 2025[22]). All but three EU+2 countries have population-based screening for breast cancer, with Bulgaria, Lithuania and Romania instead relying only on non-population-based screening. Three-quarters of EU+2 countries have established population-based screening programmes for cervical and colorectal cancer. However, uptake of screening varies across countries and population groups, with important implications for timely contact with healthcare services. Breast cancer screening rates vary five‑fold between EU countries (from 15% in Greece to 83% in Denmark and Sweden) and cervical cancer screening rates vary 13‑fold (from 6% in Romania to 78% in Sweden). Colorectal cancer screening rates are typically lower than for other cancers, and had an eight‑fold variation (from 9% in Hungary and 74% in Finland).

Socio‑economic inequalities in screening uptake also persist across EU+2 countries. People with high education levels on average have a 25‑p.p. higher probability of having had a mammogram in the previous two years than those with low education, with an 8 p.p. gap found for colorectal cancer screening (Figure 1.6).

Figure 1.6. Participation in cancer screening programmes is consistently higher among people with high education levels
Copy link to Figure 1.6. Participation in cancer screening programmes is consistently higher among people with high education levels

Delays in access represent missed opportunities for early-stage cancer diagnosis

Early diagnosis relies on patients seeking care promptly when symptoms emerge, primary care providers spotting red flags and making appropriate referrals, and specialists completing stepwise tests such as imaging and pathology to confirm the disease. The new OECD analysis reveals that between 2018 and 2023, the share of breast cancer cases diagnoses at early stage among screening-relevant ages (women aged 50‑64) averaged 56% across 10 EU countries with available data, and varied from 42% in Latvia to 66% in Norway. Early-stage diagnosis of cervical cancer in females aged 15‑49 years averaged 62%, ranging from 37% in Latvia to 85% in Iceland. Among EU+2 countries, the share of early cervical cancer diagnoses exceeded 60% in nine EU+2 countries (Belgium, Czechia, Estonia, Iceland, Ireland, the Netherlands, Norway, Slovenia and Sweden). In contrast, the share of colorectal cancer cases diagnosed at an early stage is lower, ranging from 16% in Latvia to 33% in Luxembourg, with an EU average of 22%. These lower rates are partly due to the fact that colorectal polyps removed during colonoscopy screening (a key early detection and treatment mechanism) are generally not recorded in cancer registries.

Rates of emergency diagnoses for lung and colorectal cancers also signal delays in early stage of cancer diagnosis. Across all age groups, between about 15%‑40% of patients with colorectal cancer are diagnosed via emergency presentation in six EU countries. Among those aged 50‑69 years (the screening age eligible population), the share of colorectal cancers diagnosed through emergency presentation ranges from 8% in Luxembourg to 29% in Belgium (Figure 1.7). Compared to younger or older populations, the screening eligible population consistently reports the lowest proportion of emergency diagnoses of colon cancer. Ireland and Luxembourg report the largest age gap in emergency diagnoses, where the proportion among the screening-age population is half that among those aged 15‑49 years. This gap highlights the importance and impact of colorectal cancer screening programmes. Indeed, younger patients with colorectal cancer tend to be diagnosed at a later stage and are more likely to present as an emergency, due to more aggressive cancer, not being eligible for screening, and atypical or unsuspected symptoms of colorectal cancer.

Figure 1.7. The proportion of colon cancers diagnosed by emergency presentation is much lower in the screening eligible population aged 50‑69 years
Copy link to Figure 1.7. The proportion of colon cancers diagnosed by emergency presentation is much lower in the screening eligible population aged 50‑69 years

Variation in time to treatment highlights gaps in access to cancer care, having adverse impact on cancer survival

Once cancer is confirmed through tissue diagnosis, starting treatment quickly is essential. Shorter time to cancer treatment initiation is associated with lower mortality and is particularly critical for certain cancer types (Neal et al., 2015[24]). A meta‑analysis found that for every four‑week delay in cancer treatment, the risk of death increases by around 10% (Hanna et al., 2020[25]). However, it is important to note many countries require or recommend the use of multidisciplinary teams (MDTs), which can slightly increase the time to start of treatment but help to improve health outcomes.

The OECD data collection shows that there are major cross-country differences with regard to timeliness of treatment initiation. Four EU+2 countries (Belgium, Denmark, Ireland and Norway) reported that at least 60% of people diagnosed with colorectal cancer began treatment within 30 days of diagnosis. Denmark (83%), Norway (71%) and Belgium (61%) lead with the highest share of people treated within 30 days for female breast cancer. Five EU+2 countries (Belgium, Denmark, Estonia, the Netherlands and Norway) met the 50% threshold for treatment initiation within 30 days of tissue diagnosis for lung cancer, suggesting more efficient care pathways in these countries.

There are some indications of a persistent negative impact of the COVID‑19 pandemic on some measures of timeliness of diagnosis and care. There is an upward trend in emergency diagnoses of cancer in some EU countries (Croatia, Denmark, and Ireland) when comparing the proportion before versus after the COVID‑19 pandemic (between 2018 and 2023), particularly for lung cancer. Similarly, the share of cervical cancers diagnosed at an early stage decreased by 7 p.p. or more before and after the pandemic among five EU+2 countries (Iceland, Latvia, the Netherlands, Norway and Sweden), although no consistent time trends were seen for breast and colorectal cancer. In addition, the share of breast cancer patients treated within 30 days of diagnosis fell across all countries, with Estonia and the Netherlands particularly affected for both breast and colorectal cancer.

Delays in access to cancer care can be addressed at all three stages of the cancer care pathway: screening and first interaction with health systems (delay 1), diagnosis (delay 2) and treatment (delay 3), through several overarching levers: providing information, changing behaviour, redesigning care delivery, and increasing care capacity (Table 1.1).

Table 1.1. Providing information, changing behaviours, redesigning delivery and increasing care capacity are key levers to address delays in the cancer care pathway
Copy link to Table 1.1. Providing information, changing behaviours, redesigning delivery and increasing care capacity are key levers to address delays in the cancer care pathway

Delays	Main challenge	Policy lever	Country examples
Delay 1: Screening & first interaction	Low health literacy, and limited awareness	Changing behaviours - culturally tailored communications and health literacy initiatives.	IE: Runs awareness campaigns on cancer risk factors and early signs, including at schools. FR: Simplified screening information materials for people with disabilities. LT: School and workplace information sessions.
Barriers to screening participation	Redesigning delivery – adapting screening delivery modes.	FR: Pharmacists distribute colorectal screening kits. IE: Access Officers support vulnerable groups. CZ: Distributing self-sampling kits for HPV testing
Delay 2: Diagnosis	Lack of primary care physicians’ knowledge of cancer symptoms	Changing behaviours – training materials for primary healthcare.	EE: Decision-support tool for primary care physicians and nurses within clinical software IE: GP training on early symptom recognition.
Delayed referral, fragmented co‑ordination	Redesigning delivery – fast‑track pathways and rapid diagnostic clinics.	DK: Cancer Patient Pathways with national time targets. SE: Diagnostic pathways with real-time monitoring. NL: Early Diagnostic Clinics provide same‑day results
Delay 3: Treatment	Fragmented co‑ordination	Redesigning delivery– treatment pathways, protocols, and data exchanges.	SE: 31 cancer‑specific care pathways with waiting time targets. NO: Standardised care pathways monitor intervals between diagnosis and treatment.
Workforce shortages	Increasing care capacity – workforce development	AT: Oncology and community nurse roles BE, CZ: Specialised oncology nurse training NL: Forecasting tools to plan future workforce needs.
Unequal radiotherapy capacity and ageing equipment	Increasing care capacity – investment in radiotherapy infrastructure.	FR: Shared procurement initiative for radiotherapy equipment, leading to the purchase of 40 particle accelerators. IE: Uses national governance structures to co‑ordinate investment in radiotherapy as well as expansion of public facilities. DE, IT: Provide domestic particle‑beam therapy capacity.
Delays 1‑3	Financial burden on individuals	Changing behaviours – eliminating financial barriers	RO: Provides free transport for vulnerable groups in colorectal cancer screening pilot. LV: Removed co-pays for follow-up testing after screening. PT: Eliminated user charges for cancer-related services.
Fragmented data flows, limited interoperability	Providing information – digital tools and monitoring systems	SI: Runs real-time dashboards to track patient intervals. NO: Measures diagnostic intervals from first presentation to referral. SE: Publishes timeliness indicators.

Changing behaviours and providing information promote timely access to cancer care

Culturally tailored communication, supported by community engagement, is essential for overcoming barriers and ensuring inclusive cancer care

Health literacy – the ability to understand and use health information – is vital for cancer decision making, as participation in cancer screening programmes and seeking care when experiencing cancer symptoms are influenced by awareness, attitudes, beliefs and ability to navigate relevant health information. Adequate health literacy increases participation in breast, cervical, and colorectal cancer screening (Baccolini et al., 2022[26]) and constitutes an important factor in recognition of symptom seriousness.

Virtually all countries now have initiatives to improve public health literacy regarding early cancer symptoms and screening benefits through awareness campaigns or culturally tailored communication, often involving patient organisations. In addition, 14 EU+2 countries have initiatives that involve collaboration with schools, universities, or employers (e.g. occupational health collaborations or workplace‑based screening awareness programmes) to raise health literacy regarding early cancer symptoms and promote screening participation. In Ireland for example, the Marie Keating Foundation delivers a Schools Cancer Awareness Programme to around 10 000 secondary students annually with National Cancer Control Programme support, including education about cancer risk reduction and early signs and symptoms.

Eliminating financial barriers at all stages of the cancer pathway

Ensuring equitable access to cancer care requires removing financial barriers at every stage – from screening and diagnosis to cancer treatment. Most EU+2 countries provide free cancer screenings to encourage participation; however, even minor charges, such as Iceland’s arrival fee of ISK 500 (EUR 3.3) which applies to any medical visit (including breast or cervical cancer screening) may deter individuals from attending. Evidence from other OECD countries, such as Japan, indicates that lowering cost barriers significantly increases screening uptake, while the affordability of follow-up diagnostics is equally critical, as patients may forgo screening or not act on positive screening tests if they cannot afford subsequent care. Beyond screening, diagnostic testing continues to impose significant out-of-pocket costs on patients as reported in the OECD Policy Survey on High-Value Cancer Care by Greece, Hungary, Italy, Latvia, Portugal and Spain. Some countries, however, have taken proactive measures to strengthen financial protections in recent years. Latvia removed co-payments for follow-up diagnostic examinations after screening in 2022, while Estonia provides free follow-up tests for positive screening results.

At the same time, financial hardship continues to undermine access to cancer treatment, with cost-related delays and care avoidance leading to poorer health outcomes. A 2025 EU-wide survey found that 16% of cancer patients postponed or avoided care due to financial constraints, with the highest rates in Greece (47%) and Bulgaria (38%) (Vancoppenolle et al., 2025[27]). The most commonly delayed or avoided services were doctor visits and buying medicines, though treatments such as chemotherapy, radiotherapy and surgery were rarely skipped. To ensure cost does not present a barrier to treatment and to enable equal access, 22 EU+2 countries have implemented mechanisms to ensure low or no co-payments for cancer treatment, and many have expanded reimbursement schemes for low-income groups or cover ancillary expenses such as transportation, childcare, and accommodation. Belgium offers a good example, providing enhanced reimbursements for low-income people and full coverage once an annual spending cap is reached, along with partial transport reimbursement.

Primary healthcare education on cancer and decision support tools help overcome knowledge gaps

Developing training and teaching materials on early cancer signs and up-to-date investigation processes, as well as strengthening the use of electronic health records can shorten the time between a patient’s first presentation with cancer symptoms in primary healthcare and their referral to secondary care (Harris et al., 2019[28]). These often include brief e‑modules, interactive referral checklists, and audit-and-feedback exercises. In 2025, seven EU+2 countries offer dedicated training campaigns on cancer to primary care physicians. At the EU level, the Cancer Prevention Europe programme provides multilingual learning modules covering cancer prevention and control to enhance primary healthcare knowledge on prevention, early signs and referral principles, for which European Union of Medical Specialists accreditation applies.

Use of clinical decision support tools also help primary healthcare providers recognise potential cancer signs and symptoms, directing referrals to specialist services or testing. Pilots show impact: for example, in England such tools prompted referrals that would not have occurred in about 20% of cases. Estonia implements a decision support tool for family physicians and nurses that is integrated into clinical software. It generates recommendations and reminders based on patient data such as diagnoses, medications, tests and treatments from the past five years (Estonian Health Insurance Fund, 2025[29]).

Better information on timeliness is required to address delays in access to cancer care

A well-developed cancer data infrastructure is essential to monitor the timeliness, continuity, and co‑ordination of cancer care across the patient pathway. This requires comprehensive cancer registries linked to administrative and mortality databases, supported by unique patient identifiers to ensure interoperability between healthcare providers. However, major data gaps persist in monitoring screening outcomes and diagnostic timeliness. Among EU+2 countries, only a handful systematically track false negatives, link screening and diagnostic data, or measure interval cancers arising between screens – key indicators of early detection performance. Monitoring the time between suspicion, diagnosis, and treatment also remains uneven, with only Denmark, Norway and the Netherlands assessing all steps in the pathway from primary healthcare to treatment.

At the same time, advances in health information systems are improving countries’ ability to promote transparency and support quality improvement. Twelve EU+2 countries now use timeliness data for public reporting in order to support individuals in making informed decisions about provider choice; and nine EU+2 countries use it to support quality improvement initiatives (including in Lithuania, Slovenia and Sweden).

A key policy direction to strengthen cancer care performance is to prioritise developing interoperable data systems that enable end-to‑end monitoring of cancer care pathways and screening outcomes. Linking registries and screening, as well as diagnostic data is crucial to identify bottlenecks and evaluate programme effectiveness. Expanding disaggregated monitoring by key population and provider characteristics and using digital tools for real-time reporting and provider feedback are key areas for consideration to identify unmet needs and ensure timely and co‑ordinated cancer care for all.

Redesigning care delivery can prevent delays in timely access to cancer diagnosis and treatment

Adapting cancer screening delivery modes to the needs of individuals increases uptake among the target population

There are various approaches to increase screening uptake by adapting the delivery model. These policies range from deploying mobile screening units (19 EU+2 countries), distributing self-sampling kits for colorectal cancer screening (20 EU+2 countries) and for cervical cancer screening (12 EU+2 countries), and increasing the role of primary care physicians (11 EU+2 countries) and of pharmacists (seven EU+2). Some of these strategies have already proven effective in increasing participation among the target population. In Ireland for example, there was increased uptake of colorectal screening among first-time invitees when a home test kit was sent directly along with a reminder letter, rather than requiring that individuals request a kit (Health Service Executive, 2025[30]). This approach was effective even among people living in lower socio-economic areas.

Fast-track pathways and rapid diagnostic clinics address waiting times and diagnostic delays

Many patients with non-specific symptoms like fatigue or weight loss face delays in cancer diagnosis due to unclear referral criteria. Fast-track referral pathways help standardise access to specialists and speed up diagnostic tests. These services provide direct access to comprehensive diagnostic and support tools, often supported by national waiting time targets. As of 2025, 18 EU+2 countries have fast-track diagnostic pathways for suspected cancer. Denmark introduced its Cancer Packages which are standardised and time‑defined pathways that organise a pre‑planned sequence of investigations, multidisciplinary decisions, treatments and follow-up. A recent retrospective observational study in Denmark shows improved survival rates for high-grade soft-tissue sarcoma following the introduction of its cancer patient pathway (Thorn et al., 2024[31]).

Alongside pathways for patients with site‑specific symptoms, rapid cancer diagnostic centres are being developed in several countries to provide early diagnostic services for patients. Instead of being referred to multiple specialists, these patients are offered a co‑ordinated, multidisciplinary assessment at a single centre, combining multiple steps in the diagnostic pathway. Rapid diagnostic centres have been established in nine EU+2 countries. Ireland has implemented rapid access clinics for breast, lung and prostate cancers, supported by performance monitoring and feedback mechanisms.

I had to navigate between multiple specialists and tests on my own, with little guidance. The process felt slow and uncoordinated, prolonging the time from the first consultation to the final diagnosis. I felt unsupported in understanding what to expect next, and the absence of psychosocial assistance made the waiting period even more stressful.

Maria, 52 years old, endometrial cancer

Structured treatment pathways and protocols with defined time benchmarks address the fragmentation and co‑ordination issues that impede access to care

Treatment pathways are also essential policy tools that reduce delays in cancer care by standardising and co‑ordinating every step, from a cancer diagnosis to treatment. They help to align primary healthcare, diagnostic services and oncology teams around clear timelines and responsibilities, thereby reducing fragmentation and poor co‑ordination.

As of 2025, at least 17 EU+2 countries have developed cancer care pathways, with many embedding clear time benchmarks that should be met. Among them, Sweden stands out with its highly systematised 31 cancer patient pathways for the most common cancers, implemented across 21 regional health authorities, with evidence of success in ensuring more timely, equitable, and quality-assured access to cancer care. By 2023, 83% of people with a history of cancer were managed within one of these pathways (OECD/European Commission, 2025[32]). Recently, France piloted accelerated co‑ordinated cancer care pathways in seven hospitals for cancers with poor prognosis.

Increasing care capacity is necessary to meet the growing demand for cancer treatment

Training reforms, workforce planning tools and new professional roles in cancer care

Access to cancer care is frequently hindered by shortages and unequal distribution of specialised healthcare professionals. Among countries where a more comparable definition was feasible, the number of physicians classified as medical, clinical, or radiation oncologists averaged 7.6 per 1 000 estimated incident cancer cases, ranging from 11.6 in Czechia to 2.9 in Bulgaria (where data on radiation oncologists was not available).

Many EU+2 countries already face workforce shortages in the health sector, including in cancer care, due to an ageing workforce, heavy workloads, and burnout intensified by the COVID‑19 pandemic. A 2024 European Cancer Organisation survey shows that 1 in 12 cancer professionals plan to leave the field within five years, 19% report high burnout, and 77% work overtime (European Cancer Organisation, 2024[33]). Urgent policies are thus needed to improve working conditions and reduce administrative burden. Building a sustainable cancer workforce requires stronger workforce planning tools, alongside recruitment, retention, and innovation in workforce roles. Such approaches already take place in Austria, Czechia and the Netherlands (Table 1.1).

The projected 25% increase in radiation therapy demand necessitates investments in radiotherapy workforce and equipment

Recent projections estimate a 25% rise in the global demand for radiotherapy services between 2022 and 2050, reaching 2.4 million cancer patients in the EU (Zhu et al., 2024[34]). Correspondingly, the workforce demand for radiotherapy is projected to increase by a quarter, by almost 6 300 new professionals (almost 2 000 radiation oncologists, 1 100 medical physicists, and 3 200 radiation technicians), resulting in a need for close to 31 000 professionals by 2050.

At the same time, linear accelerators (LINACs) are the most common machines used for external beam radiotherapy, making up to almost 80% of all radiotherapy equipment in EU countries. According to recent projections, EU countries on average would need to invest EUR 504 million in LINACs to meet expected utilisation demand in 2045 (Moraes et al., 2025[35]). This corresponds to an average investment of EUR 31 per capita. Substantial variability exists across EU+2 countries, ranging from EUR 47 per capita in Cyprus to EUR 15 per capita in Norway, reflecting differences in current capacity, equipment replacement needs, infrastructure development, and human resources. Across 16 EU+2 countries, efforts are already underway to improve access to radiation therapy through targeted investments, new payment models, and innovative techniques like hypofractionation.

Infographic 1.2. Investments in radiotherapy equipment and workforce are required to meet future demand in the EU
Copy link to Infographic 1.2. Investments in radiotherapy equipment and workforce are required to meet future demand in the EU

Harmonising EU regulations will help support and streamline implementation of clinical trials in EU countries

Europe’s regulatory environment has substantial administrative costs for initiation of clinical trials, and concerningly, oncology clinical trial starts have fallen by 22% in the European Economic Area since 2021. Furthermore, access to oncology clinical trials in Europe remains uneven, largely due to differences in market attractiveness, research capacity and regulatory complexity. Larger Western European countries such as France, Germany, Italy and Spain dominate the trial landscape, while smaller countries in Central and Southern Europe remain underrepresented. However, countries like Denmark, Belgium, Norway, the Netherlands and Austria host more trials relative to population size, demonstrating that agile regulation, strong institutional collaboration, and government-industry partnerships can help achieve relatively higher trial density.

To address these disparities, the EU Clinical Trials Regulation (2022) and the Clinical Trials Information System (CTIS) aim to streamline approvals, improve transparency, and reduce duplication of documentation across 30 European Economic Area countries. Complementary initiatives (like ACT EU and EU-X-CT) seek to integrate research into healthcare systems and facilitate cross-border trial participation.

1.3. Interventions to improve quality and efficiency are needed to achieve higher value for money

Copy link to 1.3. Interventions to improve quality and efficiency are needed to achieve higher value for money

Improving the effectiveness of evidence‑based cancer screening and diagnosis

Screening and early detection are key elements to ensure that cancer is identified at earlier stages, where outcomes are better and care is more efficient. Opportunities remain to make population-based screening programmes more effective via expanding evidence‑based screening programmes and reducing the risk of overdiagnosis and potential overtreatment.

Tailored or targeted cancer screening based on risk-stratification is a strategy for more cost-effective and efficient allocation of healthcare resources, maximising benefits while minimising harms to patients. Targeted screening approaches increase the likelihood of detecting cancer compared to using an identical approach to screening the full population, yielding an increased rate of early diagnosis relative to the resources allocated (O’Mahony, 2021[36]; Zheng et al., 2024[37]). As of 2025, countries are implementing risk-stratified approaches, taking into account lifestyle factors that affect cancer risk such as smoking (13 EU+2 countries), HPV vaccination status (9 EU+2 countries), and genetic mutations (14 EU+2 countries). Genetic testing for people with familial cancer history is, for example, publicly financed under certain conditions in countries such as Austria, Germany, Greece and Italy.

In line with the Council of the EU Recommendations, progress has also been made in piloting screening studies for lung, gastric, and prostate cancer. For lung cancer, 11 countries are involved in pilots in the EU SOLACE project on screening feasibility and cost-effectiveness (European Commission, 2023[38]). France, Portugal and Sweden have undertaken lung cancer screening pilots since 2023, while Croatia has a national screening programme in place since 2020 and Germany will begin national roll-out in 2026. Determining cost-effective population screening approaches will assist in reducing overdiagnosis and potential overtreatment of low-risk cancers. Under the EU PRAISE‑U initiative, four countries (Ireland, Lithuania, Poland and Spain) are piloting risk-stratified screening for prostate cancer. Cancer overdiagnosis leads to substantial direct healthcare costs as well as lost productivity, potential complications from unnecessary treatment, and psychological distress to patients. As of 2025, overdiagnosis of prostate cancer is recognised as a policy issue in 13 EU+2 countries, while for thyroid cancer, it is of concern in eight EU+2 countries.

Adoption of evidence‑based clinical guidelines for prostate cancer management are needed to harmonise practice and reduce potential overtreatment

Overdiagnosis of prostate cancer often affects older, asymptomatic men whose early-stage cancer would not impact their life expectancy. Among countries with available data, the share of early-stage prostate cancer diagnoses in men aged 75 and older ranges from 53% in the Netherlands to 81% in Luxembourg. The large variation reflects the lack of international consensus and differences in prostate cancer screening practices, and is indicative of overdiagnosis, leading to potential overtreatment. While prostatectomy is the main treatment for prostate cancer, it carries significant long-term side effects and may not be the most people‑centred option for many patients when alternatives such as chemoradiotherapy or active surveillance achieve similar survival outcomes (Noble et al., 2020[39]), (Hamdy et al., 2023[40]). Nonetheless, wide international variation in prostatectomy rates persist (Box 1.2). Overall, adoption of evidence‑based international clinical guidelines for prostate cancer management, such as those of the European Association of Urology (European Association of Urology, 2025[41]), are needed to harmonise practice and reduce the burden and costs of overdiagnosis and overtreatment. In line with this, the publication of national clinical guidelines for active surveillance of men diagnosed with prostate cancer to reduce the risk of overtreatment, such as in Ireland, sets a good example (Health Service Executive Ireland, 2025[42]), while the EU PRAISE‑U pilot will provide key input for future guidance on prostate cancer screening.

Box 1.2. Reliance on prostatectomy varies widely across countries, with no correlation with the number of prostate cancer cases

Copy link to Box 1.2. Reliance on prostatectomy varies widely across countries, with no correlation with the number of prostate cancer cases

OECD analyses show large variability in treatment patterns for prostate cancer across EU+2 countries, with little correlation between prostatectomy rates and incidence. Indeed, the share of prostatectomies to cancer cases varies more than 70‑fold, with Northern European countries reporting the lowest ratios and Western and Southern European countries the highest (Figure 1.8). Such unwarranted variation in medical practice, signalling either under- or over-utilisation of care, raises questions about efficiency.

Figure 1.8. EU+2 countries reported as much as a 70‑fold variation in the ratio of prostatectomy surgeries to prostate cancer cases
Copy link to Figure 1.8. EU+2 countries reported as much as a 70‑fold variation in the ratio of prostatectomy surgeries to prostate cancer cases

Countries that offer “watchful waiting” or alternative treatment options that have shown good results, such as active monitoring – reserving surgery for cases of clear need – may avoid overtreatment of prostate cancer, reducing harms to patient quality of life as well as health system expenditures.

Unwarranted variations in cancer care quality and outcomes must be tackled if cancer care systems are to deliver value

Age‑standardised mortality rates following colorectal cancer surgery range from 1.4% to 7.2% among EU+2 countries, indicating room for quality improvement

Differences in surgical approaches and outcomes across countries indicate room for further improvement in quality. For example, many patients with early-stage breast cancer are eligible for breast conservation surgery (partial mastectomy), which has similar or better survival outcomes to full mastectomy and is less invasive with lower risk of complications. About two‑thirds of mastectomies in the EU are partial, but this figure ranges from about 80% in Spain to about 50% or less in Romania and Poland. Such variation is too large to be explained solely by patient needs and preferences, indicating low-value care. The OECD data collection on cancer quality also found that age‑standardised 30‑day mortality rates following colorectal cancer surgery range from about 1.5% in Denmark and Norway to above 5% in Croatia and Czechia (Figure 1.9). Rates of 30‑day mortality are higher among men than women in most countries, likely reflecting higher prevalence of co-morbidities and behavioural risk factors among men alongside later stage of disease presentation.

Figure 1.9. 30‑day mortality rates after colorectal cancer surgery vary up to five‑fold among EU+2 countries
Copy link to Figure 1.9. 30‑day mortality rates after colorectal cancer surgery vary up to five‑fold among EU+2 countries

30‑day mortality rate after colorectal cancer surgery, age‑standardised, latest 3‑year average

Setting standards for ensuring high-quality cancer care is common across EU countries

To promote quality cancer care, countries set recommended or required quality standards for cancer care, such as structural requirements or minimum volume norms. Minimum volume norms promote better care quality as hospitals and surgeons with higher case volumes for complex cancer surgeries are associated with fewer complications for patients, lower postoperative mortality, and improved survival (Engdahl et al., 2023[44]; Baum et al., 2020[45]; Subramanian et al., 2022[46]; Huhta et al., 2022[47]). As of 2025, 19 EU+2 countries have set quality standards for cancer care in the form of structural requirements in areas such as equipment or personnel, while 17 countries have implemented minimum volume norms to ensure sufficient cases are treated to develop expertise (Table 1.2). However, several countries – Iceland, Latvia, Hungary and the Slovak Republic (where hospital reform including minimum volume norms is underway) do not currently set either structural or minimum volume norms for cancer care.

Table 1.2. Number of countries reporting cancer care standards and quality monitoring
Copy link to Table 1.2. Number of countries reporting cancer care standards and quality monitoring

Number of Countries	Standards	Quality monitoring
EU + 2	19	17	22	12
Other OECD Countries	4	4	3	2

Structural or minimum volume standards (Table 1.3) are often set for common cancers as well as for rare and paediatric cancers. In Czechia, minimum staffing and equipment standards and volume norms are set through accreditation of comprehensive cancer centres, while in Denmark, the Health Authority designates institutions that can provide specialised cancer treatment and defines minimum volumes by cancer type. In addition to national efforts, The EU Network of Comprehensive Cancer Centres is developing a harmonised organisational and quality framework for cancer centres.

Table 1.3. Minimum volume norms differ by cancer type: Examples from EU and other OECD countries
Copy link to Table 1.3. Minimum volume norms differ by cancer type: Examples from EU and other OECD countries

Yet less than half of EU+2 countries report mechanisms to monitor adherence to clinical guidelines

Even with standards in place, gaps between expectations and treatment in practice demonstrate the need for effective monitoring and enforcement. For example, in Italy, more than half of surgeries in 2022 for stomach, rectal and pancreatic cancer were performed in units that did not meet minimum volume thresholds. However, only 12 EU+2 countries report assessing adherence to clinical guidelines for treatment of cancers such as breast, prostate, colorectal and lung. Nonetheless, the OECD’s data collection revealed strong compliance (81% – 89%) among six of seven EU+2 countries in the share of women with HER2+ breast cancer receiving evidence‑based treatment.

Use of accreditation / certification mechanisms, reported by 22 EU+2 countries, ensure that an independent body assesses whether cancer centres meet required standards of quality and safety. Most EU countries rely on the international certification system of the Organisation of European Cancer Institutes (OECI) although several have national mechanisms instead (e.g. Germany) or in addition (e.g. Spain, the Netherlands). About one in four new cancer cases in the highest-income tercile EU+2 countries with OECI-certified centres are treated in such centres, compared with about one in ten in middle‑income and one in five in lower-income EU+2 countries. OECI centres are well-developed technologically, with almost all utilising digital tools for patient records, clinical guidelines, medication prescription, and data exchange.

Alongside accreditation / certification, many countries employ other tools to monitor the quality of cancer treatment providers. The two most common uses of quality monitoring processes are provider feedback for quality improvement and public reporting to promote transparency or patient choice. The Netherlands has a clinician-led national system for monitoring cancer care quality that provides hospitals with direct insights into treatment outcomes, enabling continuous care improvements. Belgium also monitors cancer care quality at the hospital level and uses feedback systems for improvement, publicly reporting aggregated quality metrics at the regional level.

Despite international consensus, few countries adopt and promote recommendations to reduce cancer diagnostics and treatments that are deemed low-value

Clinician-led initiatives, such as the global Choosing Wisely campaign, can foster alignment among physicians and support patient communication to reduce unnecessary health interventions. The OECD analysis finds that there are 20 Choosing Wisely recommendations on reducing low-value cancer care that are shared by two to ten EU+2 and OECD countries (Figure 1.10). This highlights substantial opportunities for other countries to widely adopt and promote these recommendations.

One of the most common recommendations – present in Austria, Italy, Norway and Sweden as well as six other OECD countries – is to avoid chemotherapy in advanced cancer when it is unlikely to benefit patients (Figure 1.10). In four out of seven EU+2 countries, 5% or more of patients age 70+ with low-survival cancer types (pancreatic, lung, or stomach) received chemotherapy in the last 30 days of life. As chemotherapy treatment at the end of life as often leads to greater toxicity, lower quality of life and higher healthcare costs without improving survival (Prigerson, Bao and Shah, 2015[56]; Bao et al., 2018[57]), the decision to pursue it must be clearly aligned with patient preferences and made via a shared, informed process with patients. The OECD data collection found that many countries are unable to provide data for this indicator, indicating gaps in monitoring end-of-life cancer care.

Figure 1.10. Top recommendations to reduce low-value cancer care from Choosing Wisely national initiatives
Copy link to Figure 1.10. Top recommendations to reduce low-value cancer care from Choosing Wisely national initiatives

Countries are shifting cancer away from the hospital to improve efficiency

To reduce pressure on inpatient capacity, enhance efficiency, and improve patient experience, EU+2 countries have sought to shift care away from the inpatient setting through strategies such as changes in payment methods to incentivise or require day surgeries, policy targets on share of day surgeries, national strategies promoting the expansion of day surgery units, and implementing hospital-at-home models (Kreutzberg et al., 2024[58]; Milstein and Schreyögg, 2024[59]; Dubas-Jakóbczyk et al., 2020[60]). The Nordic countries have been particularly active in shifting care to the outpatient setting with Denmark, Finland, Norway and Sweden performing about a quarter to half of mastectomies in 2023/24 in the day setting. In addition, Belgium, France, Ireland, Lithuania, Portugal and Spain have all noticeably increased the use of day mastectomies over the last decade, to between 5% and 13% of all such procedures.

In addition, Belgium, Denmark, France, Greece, Hungary, Iceland, Ireland, Lithuania, Poland, Portugal, Slovenia and Sweden report implementing hospital-at-home models for cancer care. These include initiatives such as hospital-supervised in-home chemotherapy, immunotherapy and targeted therapy delivery and personal infusion devices supported by patient training, alongside regulations designed to ensure safety, quality, and cost-neutrality for patients. These policies are also reflected in decreases in hospital cancer care, with colorectal cancer discharges per diagnosed case falling by 12% in the EU between 2012 and 2022, and lung cancer discharges declining by 24% (Figure 1.11).

Figure 1.11. Hospital discharges per cancer case have decreased by 12% for colorectal and 24% for lung cancer since 2012 in the EU
Copy link to Figure 1.11. Hospital discharges per cancer case have decreased by 12% for colorectal and 24% for lung cancer since 2012 in the EU

Hospital discharges per new cancer case, 2012 and 2022 (or nearest)

Box 1.3. Home hospitalisation for cancer care is progressing in several EU+2 countries

Copy link to Box 1.3. Home hospitalisation for cancer care is progressing in several EU+2 countries

Belgium: The possibility of home hospitalisation is discussed with the cancer patient and once approved, a detailed care plan is developed in collaboration with the hospital and home care teams. The hospital is responsible for the preparation, transport, and delivery of medications, and the collection of hazardous medical waste. The initiative is designed to be cost-neutral, including for patients, with an evaluation of the processes and costs planned.

France: Home hospitalisation for systemic cancer drug treatments is part of France’s 2021‑26 national roadmap. The model relies on close co‑ordination between hospitals, community health professionals, and families, supported by information-sharing systems. Injectable cancer drugs, including immunotherapies and targeted therapies can be administered at home if preparation, monitoring, and safety requirements are met. In 2023, nearly 210 000 days of home‑based care had been provided in France for cancer chemotherapy by 193 providers.

Greece: Greece’s “Oikothen” (“from home”) care programme, launched in June 2023 by one of the leading cancer hospitals in Athens, delivers cancer treatments directly to patients’ homes. By December 2024, 156 patients had benefited from the programme, improving patient well-being and relieving pressure on hospital resources. It has expanded to four additional hospitals, with plans underway to extend coverage to all major cities.

Poland: The National Institute of Oncology in Warsaw offers portable chemotherapy infusers as an alternative to inpatient care – deploying up to 10 000 devices annually. These infusers allow for the prolonged administration of chemotherapy at home and are primarily used in postoperative and palliative treatments for colon, gastric, and pancreatic cancers. Patients receive training on how to use the infuser safely at home and have access to telephone support from their treatment centre.

Alongside these policies, there has also been a reduction in length of hospital stay across the main cancer sites between 2013 and 2023 (ranging from an 11% reduction for skin cancer to a 25% reduction for prostate cancer in the EU on average). Collectively, these changes translate into an average 3.7% per year growth in hospital spending on cancer care between 2015 and 2023 among EU21 countries.

Efficient use of pharmaceuticals requires a multi-pronged approach entailing biosimilars, coverage reassessments, treatment optimisation and reduction of medication waste

Given increased spending on cancer medicines as a share of cancer spending, countries are pursuing various approaches to promote high-value pharmaceutical care. A main policy is to encourage substitution via biosimilars, or medicines that are highly similar to already approved biologic treatments. Compared to other therapeutic areas, there has been good adoption of biosimilars in oncology. However, use of oncology biosimilars varies across EU+2 countries, from 55% of treatment volume in Bulgaria to 96% in Denmark in 2023 (Figure 1.12), where centralised tendering systems have supported rapid uptake. In the EU on average, list price reductions for oncology biologics following biosimilar market entry averaged 33%; however, they were almost negligible in Austria (1%) compared to very substantial (66%) in Poland. Larger price decreases following introduction of biosimilars into a national market is associated with larger increases in treatment volumes.

Figure 1.12. Oncology biosimilars account for about 80% of treatment volumes for drugs with available biosimilars in the EU, with price decreases of 33% in these markets
Copy link to Figure 1.12. Oncology biosimilars account for about 80% of treatment volumes for drugs with available biosimilars in the EU, with price decreases of 33% in these markets

With the quick pace of expensive new cancer drugs coming to market, countries seeking to promote high-value cancer care must also implement mechanisms for pricing and coverage reassessment. Learnings from countries such as France, Germany, Italy and Spain on time‑limited or outcome‑based reimbursement for expensive CAR-T cell therapies can provide examples in this process. In parallel, treatment optimisation – i.e. finding the right dose and schedule to achieve meaningful therapeutic benefit while lowering risks from adverse events – should be a continued priority both before and after market approval of a medicine. Optimisation via post-marketing studies can provide opportunities to reduce dose levels or frequency, thus lowering spending on drugs and treatment of side effects while improving patient quality of life. In parallel, strategies such as adjusting packaging sizes, vial sharing, and improved prescribing practices can help reduce cancer medicine waste. However, regulatory, reimbursement, or operational changes may be needed to support these processes, and safety must be ensured.

Innovation and new technologies are being deployed in cancer care

New technologies and digital infrastructure are being deployed or piloted across EU+2 and other OECD countries to enhance the efficiency and quality of cancer care from diagnosis to treatment. Countries have embraced technological innovations in national or regional programmes or pilots, including robotic-assisted cancer surgery (16 EU+2 countries), AI-assisted imaging in cancer screening to improve diagnostic efficiency and accuracy (10 EU+2 countries) and minimally invasive liquid biopsies to monitor treatment effectiveness or relapse (five EU+2 countries). A German study found that AI assisted double reading of mammography improved detection rates and led to economic savings, while a randomised trial is underway to test outcomes of employing AI in combination with radiologists for breast cancer screening in Norway. Interviews with OECD countries have also revealed use of AI-assisted imagery in lung (Portugal, Lithuania) and skin cancer (Germany, Portugal).

In parallel, the field of molecular diagnostics is rapidly evolving to better classify tumour types and guide optimal treatment decisions. Two of the main cancer types where next-generation sequencing (NGS) is more commonly used are in lung, followed by colorectal cancer. However, availability of small NGS panels (<50 genes) varies widely across EU countries. These are reported as always available in Denmark and Luxembourg for lung cancer (and usually/occasionally for colorectal cancer) and usually available in Austria, Belgium, Czechia, Finland, Iceland, Malta and the Netherlands for both cancer types. In Bulgaria, Estonia and Romania their use is largely limited to research.

Alongside new technologies, health data infrastructure is of growing importance. Data linkage, including via cancer registries, provides both clinical benefits to individual patients as well as a key mechanism for monitoring the quality and efficiency of cancer care systems. Indeed, 25 EU+2 countries responding to the OECD Policy Survey on High Value Cancer Care reported using cancer registries to monitor incidence, survival, stage, and other epidemiological trends, and many can also report on inequalities, although these are often limited to geographic or gender disparities. Eleven EU+2 countries report using cancer registries for research to improve timeliness of care and ten report utilising them to improve treatment or clinical guidelines, although a few countries such as Sweden use quality registries for this purpose as well. One of the challenges, however, is that there is a wide range in the quality and completeness of cancer registry data. Indeed, experience from the OECD data collection shows that data such as treatment information that is supposed to be included in registries is missing or incomplete for many cancer cases. Looking forward, countries must pursue continued progress in health infrastructure to support individual and population-level improvements in delivering high-value quality cancer care.

1.4. Primary healthcare systems are not centred enough around the needs of people living with cancer

Copy link to 1.4. Primary healthcare systems are not centred enough around the needs of people living with cancer

People with cancer are vulnerable, and in need of social care and support

Cancer patients can experience poorer physical and mental health than individuals with other chronic conditions, due to the complex interlink between the disease and its treatment. Chemotherapy, radiation therapy and surgery can cause fatigue, pain, nausea and loss of appetite, impairing mobility and independence. These symptoms can persist long after treatment, adversely impacting quality of life. Beyond the physical burden of a cancer diagnosis, patients may experience psychological distress, including anxiety, depression and fear of recurrence. This distress is exacerbated by uncertainty, changes in body image and disruption to daily life. Empirical studies based on the SHARE Survey confirm that cancer survivors report higher rates of physical limitations, higher levels of depressive symptoms, and lower subjective well-being (Bültmann, U., Hinzmann, D., & Hasselhorn, H. M., 2023[62]; Veiga, D., Peralta, M., Carvalho, L., Encantado, J., Teixeira, P. J., & Marques, A., 2025[63]).

The OECD PaRIS data examining primary care users above age 45 in 18 OECD countries further confirms these results. Patients with cancer are more vulnerable than other primary healthcare patients. They have worse physical health, well-being and social functioning. On average, only 44% of primary healthcare (PHC) users with a cancer diagnosis in the last five years rated their health as good, very good or excellent, compared to 66% for other primary healthcare users (Figure 1.13). In Italy, Portugal and Romania, less than three in ten PHC users living with cancer report a good health status compared to six in ten PHC users with cancer in Belgium, Iceland and Luxembourg. The gap between PHC users with and without cancer is the largest in Greece (30 p.p.), Portugal (27 p.p.) and Slovenia (26 p.p.), compared to Iceland (6 p.p.) and Norway (15 p.p.).

Figure 1.13. Cancer negatively affects people’s well-being and quality of life
Copy link to Figure 1.13. Cancer negatively affects people’s well-being and quality of life

Similar to patients without cancer, socio‑economic factors disadvantage people living with cancer

Socio‑economic factors – including income, education, and employment status – are key determinants of health, strongly influencing indicators such as life expectancy and self-reported measures of health (Figure 1.14). PaRIS data show that also among people with a cancer diagnosis, socio‑economic factors matter. There is a strong social gradient in patient-reported outcomes, with significant differences by education levels in well-being, general health and social functioning.

On average in the EU11 countries, among patients living with cancer, those with a low level of education are almost 30% less likely to report a good to excellent health status. Country-level variations are particularly striking. In Iceland and the Netherlands, there is virtually no gap between education groups, whereas countries such as Greece, Luxembourg, Portugal and Slovenia show disparities of more than 16 p.p. Other key dimensions of health, such as self-reported well-being and the PROMIS physical and mental health score, are consistently worse among cancer patients with lower levels of education.

Figure 1.14. People with cancer and low education face a double disadvantage that accumulates and compounds
Copy link to Figure 1.14. People with cancer and low education face a double disadvantage that accumulates and compounds

Share of primary care patients with cancer reporting good to excellent health, by education level

Evidence from PaRIS shows that education strongly shapes health outcomes in the general population, and these disparities persist among those with a cancer diagnosis. In practice, this means that cancer patients with lower education face a double disadvantage: they carry both the persistent health inequalities linked to limited education and the added physical and psychological burden of cancer. These disadvantages accumulate, amplifying vulnerabilities. For policymakers, this underscores the need to design cancer care and primary healthcare strategies that explicitly address social health inequalities, ensuring that lower-educated people are not left with disproportionately worse health trajectories.

While people‑centred care is associated with better health outcomes, less than a third of people with cancer report high levels of people‑centredness in the EU11

People‑centred care places individuals’ needs, preferences, and values at the core of healthcare decisions. It is especially critical for cancer patients who face complex pathways across multiple providers and services. A people‑centred approach ensures co‑ordination, continuity, and communication throughout the care journey. By empowering patients in decision making, it improves support, leading to better well-being and overall health outcomes.

PaRIS data show that in all countries, PHC users living with cancer who report higher levels of people‑centredness feel healthier and report better physical health scores than those who report lower people‑centredness. On average, there is about a four‑point difference on both the PROMIS physical and mental health scales between cancer patients reporting higher and lower level of person-centredness. An interesting finding is that cancer patients who report high levels of person-centredness show even better mental health than patients with other chronic conditions treated in primary care. In terms of physical health, high person-centredness places cancer patients on par with those with other chronic conditions, whereas cancer patients reporting low person-centredness fare significantly worse.

Overall, less than a third of people living with cancer report a high level of person-centred care in the EU11, ranging from 42% in Belgium to 16% in Greece (Figure 1.15). Sufficient consultation time, effective communication with the doctor, and the possibility to talk about health issues are all positively associated with person-centredness among people living with cancer – highlighting the importance of incorporating these attributes in cancer care services.

Figure 1.15. There is a more than a 2.5‑fold variation in the percentage of people reporting high person-centred care across countries
Copy link to Figure 1.15. There is a more than a 2.5‑fold variation in the percentage of people reporting high person-centred care across countries

Percentage of primary healthcare patients reporting high person-centredness (scores of 19 or over)

How a health care provider shares the information about cancer and speaks to a patient change everything, the tone, the language and approach. We always decided to go ahead with the advice of a doctor who explained the diagnosis and the options...

Rohini, 40 years old, rare and aggressive bile duct cancer

People‑centredness could be improved through more effective use of medical records, care co‑ordination processes and better patient engagement

While information continuity is a key component to effective care co‑ordination between health professionals, almost one‑third of PHC users living with cancer needed to repeat information that should have been in their health records (Figure 1.16). Having to repeatedly provide health information that should already be documented signals weak integration of care, insufficient data systems, and limited capacity to support smooth care transitions. The highest rates were observed in Greece and Italy, where more than half of PHC patients living with cancer reported that they needed to repeat health information that should have been available in their health records. By contrast, this applied to only one in six people living with cancer in Belgium, Czechia and Slovenia.

Figure 1.16. Almost a third of primary healthcare patients living with cancer had to repeat information that should be in their health records, while half reported not having a care plan
Copy link to Figure 1.16. Almost a third of primary healthcare patients living with cancer had to repeat information that should be in their health records, while half reported not having a care plan

When it comes to care co‑ordination processes, only half of people living with cancer in the EU11 report having a care plan (50%), varying more than six‑fold across countries from 12% in the Netherlands to 79% in Italy. Cancer care plans and medication reviews, tailored to an individual’s needs and preferences, translate complex medical decisions into clear, actionable roadmaps to guide patients and their care teams through cancer treatment. However, a quarter of cancer patients did not have a medication review in the last 12 months; ranging from less than 20% in Belgium and Czechia to almost 60% in Iceland and Slovenia. The impact of cancer care plans can be further enhanced by robust care co‑ordination and patient navigation protocols (such as in France, Denmark and Estonia), out-of-hours support (such as in Germany and Ireland), and the use of digital solutions (such as in Estonia, Greece and Sweden).

To further improve people‑centred care, there is also scope also to invest in co-production of health, involving patients in decision making and supporting them in self-management. In the EU11, just under three out of five PHC users living with cancer report being confident in managing their own health and two‑thirds say they receive enough support to manage their own health. For both indicators, Greece, Iceland and Romania perform relatively poorly, whereas Spain and Belgium reported consistently better scores – showcasing stronger policies supporting patient empowerment and engagement in their care.

For people living with cancer, the care pathway must extend beyond curative medical treatment to integrate wider health and social needs

Important actions are needed to expand the cancer care pathway beyond curative medical treatment to encompass broader social and health needs (Figure 1.17). Early integration of palliative care alongside curative treatment significantly improves the well-being of cancer patients and their caregivers. Nonetheless, while all EU+2 countries have palliative care structures, some countries including Bulgaria, Croatia, Cyprus, Greece, Latvia, Lithuania, Malta, Poland and the Slovak Republic rank lowest in advanced care planning related policies, which are key for early integration. Italy and Norway are among the most advanced in areas such as national strategies, recognition of palliative care and advanced care planning polices, but both still experience disparities in care accessibility and implementation. Italy’s 2023 National Oncological Plan seeks nationwide palliative care coverage by 2025, while Norway’s system offers comprehensive basic care but limited early specialist access. In other OECD countries, Japan provides a strong example with mandatory palliative care training, strong co‑ordination between hospital and home‑based services, and early integration into cancer care pathways. In addition, as many patients prefer to die at home, several countries – including Belgium, Poland and Slovenia – have expanded community-based palliative care, improving outcomes and reducing hospitalisations. However, effective home‑based care depends on robust support for primary healthcare providers and informal caregivers, with education, equipment access, and caregiver leave entitlements playing crucial roles.

Comprehensive, people‑centred cancer care also requires integrating fertility preservation, sexual health, mental health support, and survivorship planning into care pathways. Fertility preservation is recognised as a key component of equitable cancer care, given that treatments often cause infertility in both men and women. Evidence from countries such as France, Germany, the Netherlands, Nordic countries, Poland, and Slovenia shows that statutory health insurance can successfully cover sperm or egg banking, ensuring accessibility for patients. However, sexual health support for cancer patients remains underdeveloped across much of the EU. Denmark and Austria offer good policy examples – Denmark includes sexual function assessments in cancer survivorship guidelines, while Austria’s Comprehensive Cancer Centre in Vienna runs a dedicated platform for addressing sexual health issues. Mental health and survivorship care are also gaining in importance but remain uneven across EU countries. Sixteen EU+2 countries report integrating psychological support into oncology pathways, combining early assessments, multidisciplinary collaboration, and Non-Governmental Organisations (NGOs) partnerships. Ireland provides a leading model, with national psycho‑oncology frameworks, community support centres, and funded survivorship programmes such as “Cancer Thriving and Surviving.” In addition, France’s legal framework ensures that most cancer patients referred for psychological care use it.

Figure 1.17. A people‑centred approach to cancer care is needed to meet the health, social and economic needs of people living with cancer
Copy link to Figure 1.17. A people‑centred approach to cancer care is needed to meet the health, social and economic needs of people living with cancer

Financial and employment protection also support the health and quality of life of patients and their caregivers. The OECD analysis show that the impact of cancer on employment outcomes is large and follows a geographic pattern. Based on the Survey on Healthy Ageing and Retirement in Europe (SHARE), a lower proportion of individuals with a cancer diagnosis are employed, and there is a large social gradient in disfavour of people with low education. On average, a cancer diagnosis reduces the likelihood of employment by 14%, after controlling for individual characteristics. The largest gaps in employment rates between individuals with a cancer diagnosis and those without are observed in Bulgaria, Cyprus, Czechia, Hungary and Ireland, calling for strengthening labour market policies and workplace reintegration support. Extended paid sick leave and return-to-work support are increasingly critical to safeguard employment and avoid financial toxicity (such as in Germany, the Netherlands and Sweden), particularly given the growing number of cancer cases among the younger population. Expanding legislation on the “Right to be Forgotten” beyond the nine EU+2 countries where it currently exists is also key to prevent discrimination and improve life opportunities.

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Cancer type	Country	Minimum volume norms
Breast	Italy and Spain	150 surgeries per cancer centre; 50 surgeries per surgeon
	Germany	100 surgeries per hospital
	France	70 surgeries per authorised facility
	Ireland and Slovenia	50 surgeries per surgeon
	Belgium	30 surgeries per surgeon; 125 new diagnoses per co‑ordinating breast clinic & 60 per satellite clinic
Gynaecological	France	20 surgeries for non-breast and ovarian gynaecological cancers, 20 complete cytoreductive surgeries for ovarian cancer per authorised facility
Gynaecological	Italy	20 cervical cancer surgeries, 20 ovarian cancer surgeries per unit
Thoracic	Italy	85 surgeries per unit
	Germany	75 treatments per hospital
	France	40 surgeries per authorised facility
Urological	France	30 surgeries for urological cancers per authorised facility
Urological	Italy	30 prostate cancer surgeries per unit
Visceral and digestive	Italy	50 colon cancer surgeries, 30 pancreatic cancer surgeries, 25 rectal cancer surgeries, 20 stomach cancer surgeries per unit
	France	30 surgeries for visceral and digestive cancers with organ minimums: oesophagus and gastroesophageal junction (5), stomach cancer (5), liver cancer (5), pancreatic cancer (5), rectal cancer (5)
	England	10 rectal cancer surgeries per hospital, 5 per surgeon

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