Mrs. Desislava Atanasova,


DR Cv. Raychinov,


Subject: Changes to Ordinance amending and supplementing Ordinance ? 40 of 2004 laying down the basic package of health services guaranteed by the NHIF budget (SG. 112 of 2004)


Of Medical Oncology Associations on Bulgarian and Bulgarian Association of Oncology

Dear Madam Minister, Honourable Dr. Raichinov, In order to improve the work in clinics of chemotherapy (medical oncology) and to improve the service of cancer patients with solid tumors undergoing drug treatment, we offer the following:

1. In paragraph 6 of that Ordinance, p. 3 to correct: “Systemic drug treatment of solid tumors in individuals over 18 years with a minimum hospital stay two days.” Reason for the requested change is the need to stay with duration no more than two days in patients undergoing long infusions of cisplatin or dexamethasone preparation the night before. This is the predominant number of patients treated with KP no 298.

2. We introduce a new clinical pathway No:298-A “Treatment of complications of anti-tumor therapy conducted in subjects over 18 years of solid tumors.” We are talking about a small number of patients who must be hospitalized for treatment of severe complications: febrile neutropenia, thrombocytopenia, anemia, pantsitopenii inflammatory complications, dehydration due to diarrhea grade 3-4, hypercalcemia, tumor lysis syndrome, etc. . Treatment of these patients is related to the use of expensive drugs: growth factors, parenteral antibiotics, parenteral nutrition. Minimum hospital stay for these patients was 7 days. Logically this clinical pathway is adequately costed

3. In paragraph 6, p. 4 – to Note 3 to add: “the value of cytostatics and analgesics are not included in the price of the KP”

4. Paragraph 10, Annex 11 – A comprehensive review and correct application. We offer an exemplary embodiment, created by our experts.

17.09.2012 Yours:

Ass. Dr. K.V.Timcheva,

Chairman of the Bulgarian Association of Medical Oncology


Dr. Borislav Dimitrov,

Vice-President of BAMO


Professor. Dr. Strashimir Karanov,

Chairman of the Bulgarian Association of Oncology