Background <p>Cancer is the second leading cause of death in Romania, with gaps and inequities present across oncological care. Health and cancer literacy are widely acknowledged as drivers of equitable care, but they remain understudied in national policies. This study aims to assess the focus on health and cancer literacy in Romania and to co-develop policy recommendations to enhance their role in cancer care.</p> Methods <p>Desk research informed the agenda for two participatory workshops using a policy dialogue structure in Cluj-Napoca and Bucharest, Romania. A diverse group of Romanian key stakeholders engaged in identifying gaps, needs and role of health and cancer literacy, which informed the development of policy recommendations. These were later co-created with international and national experts.</p> Results <p>The process revealed inequities in service access, workforce distribution, communication, and institutional focus on health and cancer literacy. Seven final policy recommendations were developed: three directly addressing health and cancer literacy, focused on organizational health literacy, individual-targeted campaigns, and population-level health and cancer literacy assessment; four indirectly supporting health and cancer literacy through informal caregiver support, regulation of complementary therapies, legal protection against workplace discrimination, and reintegration pathways for cancer survivors.</p> Conclusion <p>This research is especially important to Romania since it co-developed policy recommendations on health and cancer literacy, an area that has received little attention in the fight for cancer equity. These recommendations can be used to open the discussion for similar gaps in other countries towards building literacy-related efforts in cancer care.</p>