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Economic and Financial Impacts of Cancer · Journal article
Healthcare · September 9, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a descriptive cross-sectional survey of 114 Bulgarian oncologists' perceptions of access to innovative therapies. Physicians reported moderate-to-high self-perceived knowledge and identified financial, regulatory, and HTA-related factors as principal barriers to access, but the study measures perception only and does not establish causal relationships or validate these barriers against objective data.
Cross-sectional web-based survey. Physicians involved in oncology care in Bulgaria (n=114); setting not explicitly specified but respondents include medical oncologists and physicians treating varying patient volumes.. n = 114. Bulgaria.
57.9% (95% CI: 48.7–66.6%) rated perceived timeliness of access as good or very good 68.4% (95% CI: 59.4–76.2%) reported encountering patients who sought treatment abroad due to perceived unavailability or poor accessibility of innovative therapies Self-perceived knowledge was higher among medical oncologists (adjusted p < 0.001) and physicians treating ≥100 cancer patients per month (adjusted p = 0.003)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and health system leaders in Bulgaria and similar healthcare contexts may use these physician-reported barriers (financial constraints, regulatory delays, HTA processes) to identify priorities for health system reform, but should recognize that these are perceptions rather than validated measurements of actual access determinants.
A descriptive cross-sectional survey of physician perceptions with no control group, experimental intervention, or clinical outcome; generates hypotheses about access barriers rather than testing them.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health system leaders in Bulgaria and similar healthcare contexts may use these physician-reported barriers (financial constraints, regulatory delays, HTA processes) to identify priorities for health system reform, but should recognize that these are perceptions rather than validated measurements of actual access determinants.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background/Objectives: Despite major advances in precision medicine, equitable and timely access to innovative oncology therapies remains challenging because of differences in reimbursement systems, health technology assessment (HTA), and healthcare organization. Physicians are well positioned to identify barriers affecting the implementation of these therapies in routine practice. This study evaluated Bulgarian physicians’ perceptions of innovative oncology therapies, assessed patient access, identified barriers to timely availability, and examined factors perceived as associated with these perceptions. Methods: A cross-sectional web-based survey was conducted between March and May 2025 among physicians involved in oncology care in Bulgaria. The questionnaire comprised six domains addressing professional characteristics, self-perceived knowledge, clinical implementation, perceptions of patient access, barriers to implementation, and policy priorities. Descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and multivariable ordinal logistic regression were used to analyze the data. Results: A total of 114 physicians participated. Respondents generally reported moderate-to-high levels of self-perceived knowledge regarding innovative oncology therapies. Self-perceived knowledge was higher among medical oncologists (adjusted p < 0.001) and physicians treating at least 100 patients with cancer per month (adjusted p = 0.003). Overall, 57.9% of respondents (95% CI: 48.7–66.6%) rated the perceived timeliness of access as good or very good, while 68.4% (95% CI: 59.4–76.2%) reported encountering patients who sought treatment abroad because innovative therapies were perceived as unavailable or insufficiently accessible in Bulgaria. Professional experience (aOR = 0.68, 95% CI: 0.50–0.93; p = 0.014) and higher monthly patient volume (aOR = 0.45, 95% CI: 0.21–0.96; p = 0.039) were independently associated with more favorable perceptions of access. Financial constraints, regulatory and HTA-related delays, and perceived delays in pharmaceutical-company submissions were the principal perceived barriers. Conclusions: Bulgarian oncology specialists demonstrate high self-reported professional readiness for innovative oncology therapies; however, the perceived timely patient access remains constrained primarily by financial, organizational, and reimbursement-related factors. Although, these findings reflect physicians’ perceptions and do not establish causal determinants of access, strengthening reimbursement pathways, HTA implementation, molecular diagnostic capacity, and clinical research infrastructure may improve equitable access to innovative oncology therapies within the evolving European HTA framework.
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