Rare cancers are defined by an annual incidence of fewer than 6 per 100,000. Bearing similarities to rare diseases, they are associated with substantial health inequalities due to diagnostic complexity and delayed access to innovative therapies. This situation is further aggravated in Southeastern European countries like Bulgaria, where limited public resources and expertise underscore the need for additional policy and translational research on rare cancers. This study aimed to explore the availability and access to orphan drugs for rare cancers in Bulgaria for the period of 2020–2023. We cross-compared data from both the European Union and national public sources to evaluate the number of available and accessible orphan drugs for rare cancers, the delay from market authorization to reimbursement, the dynamics of public expenditures, and regional disparities in access across the country. We juxtaposed the main characteristics of oncological and non-oncological orphan drugs as well. Only 15 out of 50 oncological orphan drugs that were authorized by the European Medicine Agency were accessible for rare cancer patients in Bulgaria. The median delay between market authorization and inclusion in the Bulgarian Positive Drug List was 760 days. The total expenditures for all orphan drugs for rare cancers amounted to EUR 74,353,493 from 2020 to 2023. The budgetary impact of this group rose from 0.24% to 3.77% of total public medicinal product expenditures for the study period. Rare cancer patients represent a vulnerable population that often faces limited to no access to treatment. We call for targeted European and national policies to address this major inequality.

Rare cancers, defined by an annual incidence of fewer than 6 per 100,000 cases, pose significant challenges due to their complexity, lack of expertise, and limited treatment options. In Bulgaria, these challenges are compounded by limited resources, fragmented care, and outdated policies. This study investigates policy stakeholder perspectives to identify gaps and propose policy alternatives for rare cancer care in Bulgaria, with implications for the broader European Union (EU) context. A grounded theory qualitative research design was employed to explore stakeholder insights. Eight key stakeholders, including policymakers, healthcare providers, patient advocates, and pharmaceutical representatives, participated in semi-structured interviews. Data was analyzed through thematic coding to map policy gaps and develop viable alternatives. Stakeholders highlighted significant gaps in funding, access to innovative therapies, and care organization. Four policy approaches emerged: Liberal, advocating for inclusivity and decentralized care; Conservative, emphasizing cost control and centralization; Balanced, integrating elements of both; and Status Quo, retaining the current system. While centered on Bulgaria, these findings address universal challenges in rare cancer care, offering a framework adaptable to other EU countries. Adopting tailored policies can reduce disparities, improve patient outcomes, and align national strategies with EU objectives, particularly under Europe's Beating Cancer Plan and the EU Cancer Mission.

Rare cancers, defined as those with an annual incidence of fewer than six cases per 100,000 individuals, are associated with significant health inequalities. This study aimed to assess the knowledge, attitudes, and perceptions of healthcare providers with expertise in rare cancers regarding the effectiveness of enacted or planned rare cancer policies across Europe. Between 25 March 2023 and 5 March 2024, we conducted an online survey targeting 738 healthcare providers affiliated with the European Reference Networks and the Organization of European Cancer Institutes, yielding 92 complete responses from 28 European countries (response rate: 12.5%). While a significant portion of respondents were unaware of their country’s legal definitions for rare cancers, 67.4% acknowledged that national cancer plans prioritized rare cancers. These plans received the highest ratings for their evidence-based interventions and monitoring efforts. The integration of rare cancer policies into broader oncology frameworks was the preferred policy model. National cancer registries were highly rated for confidentiality and validity but scored the lowest for cost-effectiveness. Government funding was deemed crucial for cancer screening programs. The disease burden and unmet health needs primarily influenced reimbursement decisions in the field of rare cancers. Respondents rated palliative care as more effective in adults with rare cancers compared to in children, particularly regarding symptom management. We confirmed significant variability in rare cancer policy evaluations across Europe, the necessity for a common EU-level definition for rare cancers, and a shift in reimbursement and policy framework models, highlighting the importance of policy integration and enhanced collaboration. However, given the limitations of the study, such as small sample size and possible unstudied confounding factors, we should interpret our findings with caution. A systematic policy review and multistakeholder assessment in the future could complement our results.

Background: Secretory immunoglobulin A (sIgA) plays a key role in oral and mucosal immunity, serving as a first-line defense against pathogens. Smoking is known to negatively affect immune function, but data on the impact of heated tobacco products such as IQOS^® on sIgA levels are limited. Objective: To assess and compare the effects of conventional cigarette smoking and IQOS^® use on the concentration of salivary sIgA in healthy individuals. Methods: A total of 200 participants were enrolled and divided into three groups: 60 non-smokers, 70 conventional cigarette smokers, and 70 IQOS^® users. Unstimulated whole saliva samples were collected and analyzed for sIgA concentration using ELISA method. Statistical analysis was performed using IBM SPSS Statistics 25. Results: Mean salivary sIgA levels were significantly lower in both cigarette smokers (246.03 μg/mL) and IQOS^® users (243.54 μg/mL) compared to non-smokers (380.74 μg/mL, p < 0.05). No significant difference was observed between cigarette smokers and IQOS^® users. A pronounced reduction in sIgA was seen in female users of both tobacco products, whereas male users did not show a statistically significant decline. Conclusions: Both cigarette smoking and IQOS^® use are associated with a significant decrease in salivary sIgA levels, particularly in females. The findings suggest that IQOS^® does not offer an immunological advantage over conventional smoking in terms of preserving mucosal immunity. Further studies are needed to confirm these findings and explore underlying mechanisms.

Background/Objectives: Oral health is a critical component of public health, yet disparities in access and financing remain significant. In Bulgaria, dental services are financed through the National Health Insurance Fund and patient co-payments, with coverage differing between children and adults. The aim of this study was to analyze the dynamics of health insurance payments and expenditures for dental care in Bulgaria over the period 2019–2025, with a focus on differences between age groups and the balance between public funding and patient contributions. Methods: A retrospective descriptive–analytical study was conducted using aggregated data from NHIF annual reports, national legislation, and secondary literature. Absolute expenditures (BGN) and relative shares (%) of dental services within total health insurance payments were examined for the period 2019–2025 (actual data). Key dental procedures analyzed included examinations, restorations, extractions, and treatment of pulpitis/periodontitis in children, as well as prosthetic rehabilitation in older adults. Descriptive statistics, trend analysis, and simple linear regression were applied to assess expenditure growth and predictability. Results: Total health insurance payments in Bulgaria nearly doubled between 2019 and 2025, increasing from 4.12 to 8.87 million BGN. Dental expenditures rose from 167,000 to 416,000 BGN, with the share of dental care rising modestly from 4.05% to 4.69%. For children, NHIF covered nearly all costs, with minimal or absent co-payments. Among adults, a co-financing model prevailed, with fixed patient contributions for basic services but full NHIF coverage for prosthetic rehabilitation in edentulous patients aged 65–69 years. Conclusions: Bulgaria’s dental care financing reflects a socially oriented model, with full coverage for children and mixed financing for adults. Strategic policy adjustments are needed to ensure sustainability, equity, and alignment with universal health coverage goals.

Introduction: Obstructive Sleep Apnea is one of the prevalent breathing sleep disorders, especially among the elderly population of the modern world. Obstructive sleep apnea is defined as the occurrence of five or more episodes of complete or partial upper airway obstructions per hour during sleep. Over the years, we have seen many different appliances that target treating patients with apnea syndrome.The result is that they all seem to deal with the problem at hand on a scale from mild to moderate OSA. Aim: The goal we set was to create a new design ofan adjustable dental appliance which will help patients with obstructive sleep apnea. Materials and Methods: Impressions of the mandible and maxilla were obtained to create the specific dental appliance. The special design of the appliance includes an adjustable metal bar that is placed frontally to the anterior upper teeth and can be adjusted to the different levels of mandibular advancement.Adam's clasps have been affixed to the first lower molars, and two occlusal splints to the occlusal surfaces of all lower teeth in order to secure the device in place. To prevent mouth opening during sleep, two barriers have been built into the vestibular surfaces of the upper premolars and molars. Conclusion: With the help of this innovative appliance design, dental professionals may now properly position and make necessary corrections in patients who suffer from obstructive sleep apnea and snoring.