few scrub nurses.The inevitable resultis long waiting lists.Spiliotissayshejusttoldapatient diagnosed with col-orectalcancertocomebackin45 days. Waiting times forradiotherapy are evenlonger, he says. In the fourmain cancer hospitals and nineother public hospitals with radio-therapyequipment,thewaitinglististhreetofourmonths.“Itisverydif-ficulttoproposeneoadjuvantchemoradiation forpatientswithrectalcan-cer with waiting timeslike that. So the patienthas to get this treatmentfromprivatepractice.”Supplies of essentialcancer medicines, includingTaxotere,Temodal,Avastin,HerceptinandMabthera,aredryingup,saysKathiApostolidis, a breast cancer andpatientsrightsadvocate.Shedescribesdriving around the hospitals andpharmacies of Athens for a friend, insearchofsuppliesofZometa(zoledronicacid for controlling bonemetastases). Pharmaceuti-calcompaniesareinsistingon advance payment fromhospitalsandpublichealthinsurance, she says, whilepharmacies are refusingto deliver medicines topatients on credit.She believes patientsare being held hostagein the battles between theMinistryofHealth,pharmaceu-ticalcompaniesandpharmacists.There are worries too thatfinancial concerns are leadingpatientstodelayvisitstoadoctor.“We have a problem that 15–20%of patients do not consult a physi-cian. We compared results from2007to2009,anditseemsthatweareseeingcancerpatientsatamoreadvanced stage than three years ago,thoughwedonothavestatisticallysig-nificantdataonthisasyet.”Iftrue,thiswould mean that not only are fewerstaff having to care for more patients,using fewer resources, but a higherproportion of patients are presentingwith cancers that are more com-plex, more expensive to treatand more likely to be fatal. While Greece isundoubtedlyatthesharpend of Europe’s debtcrisis, it is by nomeans alone. Withausterity the pre- vailing watch-word, public spending is being reinedin everywhere. Although countriessuch as Spain, Italy, Portugal and Ire-landareinthefrontline,countriessuchas France, Belgium, UK and theNetherlands are not far behind. EvenGermany, the strongest economy inEurope, has plans to cut public sectordebt by
80 bn by 2014.As healthcare accounts for a highproportion of public spending,and cancer accounts for asizeable chunk of healthcarespending – with its need forcomplex multidisciplinary approaches to care, heavy use of expensive imagingtechniques,andrelianceonsomeveryexpensivedrugs–cancerservices are under pressure as neverbefore.For patients, many of whom at thebest of times feel they have to fight forquickaccesstothebesttreatments,themost urgent question is to what extentthefinancialpressuresonEurope’scan-cerservicesareaffectingfrontlinecare.Inanefforttoanswerthatquestion,
askeditsEuropeanread-ersforfeedbackonhowtheEuropeandebt crisis is impacting on cancercare in their own countries. Ninety responses from 20 European memberstates suggest that there is a strongperceptionthatthedebtcrisisishavinga direct impact on patient care wellbeyondthecountriesfacingthetough-estcuts(seebox
).Drawingoncommentsappendedtothesurveyandoninterviewswithsomeoftherespon-dents reveals a patchy picture acrossEurope, but patterns are emerging.
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