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Your Brussels correspondent (1) reports on the
European Union’ s endorsement of the rights of
patients to seek treatment in another EU country where
they face “undue delay” in their own member state.
This legislation also has important implications for
NHS cancer patients experiencing unacceptable delays
for curative or palliative radiotherapy. There is limited
but compelling data that delay in delivery of radical
radiotherapy for lung cancer(2) and more recently of
postoperative radiotherapy after breast conserving
surgery (3) compromises survival. These delays reflect
shortage of radiotherapy capacity. Substantial
investment in new linear accelerators to reduce waiting
times for radiotherapy in the UK is already in progress.
However shortages of clinical oncologists, radiotherapy
radiographers and medical physicists may preclude
the maximum 4 week wait for curative radiotherapy
recommended by the Royal College of Radiologists (4)
being achieved for all patients.
To facilitate high quality crossborder cancer services
agreements are needed on evidence based best
practice, consent, confidentiality and clear lines of
medical responsibility along the whole pathway of
care.The application of teleconferencing, teleradiology
and telepathology to facilitate the process of
assessment, treatment and aftercare needs to be
explored.
Some EU countries already have bilateral
agreements. Patients in Denmark for example facing
delays in the delivery of cancer treatment beyond
national guidelines may choose to have their treatment
in Germany.Similar health care alliances need to be
reached between the UK and neighbouring EU
countries with greater radiotherapy capacity.
Most patients will still prefer to have their treatment
locally. However in keeping with the principles of equity
of access to care and transparency espoused by the
NHS, all cancer patients facing “undue delay” in
treatment need to be informed of access to
crossborder health care. If they choose to wait for
treatment in the UK, they might be asked to sign (as
Canadians patients offered treatment in the USA) a
waver accepting that delay may compromise the
outcome of treatment. Once target waiting times for
radiotherapy can be universally met, cross border
arrangements will no longer be needed.
References:
1.EU ministers support draft legislation for patients to
be treated abroad. BMJ 2002;325:138.
2. O'Rourke N, Edwards R . Lung cancer treatment
waiting times and tumour growth. Clin Oncol 2000; 12:
141-144.
3.Mikeljevic S, Haward B,Johnston C et al. Does
postoperative radiotherapy delay in breast cancer
patients matter? Clin Oncol; 2002;14,S44
4. Joint Council for Clinical Oncology. Reducing delays
in cancer treatment:some targets.Royal College of
Physicians, London, 1993
Competing interests:
None declared
Competing interests:
No competing interests
20 December 2002
Ian H kunkler
Consultant and Senior Lecturer in Clinical Oncology
University Dept of Clinical Onclogy, Western General Hospital, Crewe Road, Edinburgh,EH4 2 XU
Crossborder cancer services
Your Brussels correspondent (1) reports on the European Union’ s endorsement of the rights of patients to seek treatment in another EU country where they face “undue delay” in their own member state. This legislation also has important implications for NHS cancer patients experiencing unacceptable delays for curative or palliative radiotherapy. There is limited but compelling data that delay in delivery of radical radiotherapy for lung cancer(2) and more recently of postoperative radiotherapy after breast conserving surgery (3) compromises survival. These delays reflect shortage of radiotherapy capacity. Substantial investment in new linear accelerators to reduce waiting times for radiotherapy in the UK is already in progress. However shortages of clinical oncologists, radiotherapy radiographers and medical physicists may preclude the maximum 4 week wait for curative radiotherapy recommended by the Royal College of Radiologists (4) being achieved for all patients.
To facilitate high quality crossborder cancer services agreements are needed on evidence based best practice, consent, confidentiality and clear lines of medical responsibility along the whole pathway of care.The application of teleconferencing, teleradiology and telepathology to facilitate the process of assessment, treatment and aftercare needs to be explored.
Some EU countries already have bilateral agreements. Patients in Denmark for example facing delays in the delivery of cancer treatment beyond national guidelines may choose to have their treatment in Germany.Similar health care alliances need to be reached between the UK and neighbouring EU countries with greater radiotherapy capacity.
Most patients will still prefer to have their treatment locally. However in keeping with the principles of equity of access to care and transparency espoused by the NHS, all cancer patients facing “undue delay” in treatment need to be informed of access to crossborder health care. If they choose to wait for treatment in the UK, they might be asked to sign (as Canadians patients offered treatment in the USA) a waver accepting that delay may compromise the outcome of treatment. Once target waiting times for radiotherapy can be universally met, cross border arrangements will no longer be needed.
References:
1.EU ministers support draft legislation for patients to be treated abroad. BMJ 2002;325:138.
2. O'Rourke N, Edwards R . Lung cancer treatment waiting times and tumour growth. Clin Oncol 2000; 12: 141-144.
3.Mikeljevic S, Haward B,Johnston C et al. Does postoperative radiotherapy delay in breast cancer patients matter? Clin Oncol; 2002;14,S44
4. Joint Council for Clinical Oncology. Reducing delays in cancer treatment:some targets.Royal College of Physicians, London, 1993
Competing interests: None declared
Competing interests: No competing interests