No abstract

Centralisation of cancer services is ongoing in many countries due to the rapid increase of knowledge in oncology, the interdisciplinary of many cancer treatments and economic pressure. This study investigated whether cancer patients are willing to accept this additional burden. All patients who came in February 2012 for a consultation or an ambulant treatment were asked to answer to a survey. The questionnaire covered among other six questions whether the patients would be willing to travel more frequently or further away. These questions were split in two groups: one for a slightly more efficacious therapy and the other for a therapy with slightly fewer side effects. To travel more frequently is well accepted as a clear majority of patients say yes or rather yes to travel more frequently for a more efficacious therapy (67%) as for a therapy with fewer side effects (62%). To travel further away doesn't have a clear majority as 51% of the patients say yes or rather yes for a more efficacious therapy and 49% for a therapy with fewer side effects. General acceptance of travelling further away as a consequence of centralisation of oncology services cannot be assumed. Particularly elderly patients are reluctant to it and will require specific solutions. AbstractCentralisation of cancer services is ongoing in many countries due to the rapid increase of knowledge in oncology, the interdisciplinary of many cancer treatments and economic pressure. This study investigated whether cancer patients are willing to accept this additional burden. All patients who came in February 2012 for a consultation or an ambulant treatment were asked to answer to a survey. The questionnaire covered among other six questions whether the patients would be willing to travel more frequently or further away. These questions were split in two groups: one for a slightly more efficacious therapy and the other for a therapy with slightly fewer side effects. To travel more frequently is well accepted as a clear majority of patients say yes or rather yes to travel more frequently for a more efficacious therapy (67%) as for a therapy with fewer side effects (62%). To travel further away doesn't have a clear majority as 51% of the patients say yes or rather yes for a more efficacious therapy and 49% for a therapy with fewer side effects. General acceptance of travelling further away as a consequence of centralisation of oncology services cannot be assumed. Particularly elderly patients are reluctant to it and will require specific solutions.

Geographic disparities in access to cancer care have been reported for several countries. The distance between the place of residence and the cancer care centre can be one cause of these disparities. Solutions to surmount the barriers can be found if patients talk about this to their care professionals. We investigated whether patients in Valais talk with their physicians about difficulties to access cancer care. We interviewed five general practitioners and five medical oncologists in Valais with semi-structured interviews to identify difficulties patients are talking about. Medical oncologists were also interviewed on their habits to adapt chemotherapy to access problems of their patients. Cancer patients in Valais do talk about their access problems. Medical oncologists in Valais do take access problems into account when discussing therapeutic options with the patients and use the scope they have within their therapeutic options. In Valais the family of cancer patients play an important role in access to cancer care. Special offers are in place when social support is insufficient. Whether some socio-economic minorities do not use the solutions in place cannot be answered and should be investigated in further studies.

Purpose: Disparities in cancer treatment for geographical and socioeconomic reasons have been demonstrated in several countries. In Valais, a canton in Switzerland, to travel to one of the oncology wards can be time consuming, cost intensive and make support by relatives or external persons and institutions necessary. Method:We investigated which kind of support cancer patients in Valais need today to make a treatment possible, quantified it and identified subgroups with particular needs. All patients who came in February 2012 for a consultation or an ambulant therapy to one of the four centres of the "Département Valaisan d'Oncologie" or the unique private practice in the region were asked to answer to a questionnaire. Results were summarised and analysed. Results: 84% of the patients need support. 40% of the patients need two or more kinds of support. Kind and quantity of support depend on gender, age and distance. Cancer patients in Valais need support to make their treatments possible. Some subgroups have a complex pattern of support and need specific assistance as younger women or elderly patients. Conclusions:We demonstrate that cancer patients in Valais need social support to handle their treatment days and that their out of the pocket travel expenses increase rapidly with distance. The pattern of support needed varies according to patient characteristics as gender, age and distance to treatment centre.

Objective: Many patients describe travel to cancer treatment as inconvenient and a practical hardship and it may be perceived or experienced as a barrier to treatment. We investigated which impact cancer treatments has on the family of the patients, especially for the most frequent cancer type prostate, breast, colon and lung cancer.The aim was to identify groups of patients with an increased burden for the family.Method: All patients coming in February 2012 for chemotherapy to one of the four centres of the hospital or to the unique private practice were asked to answer a survey. The questionnaire covered items as gender, date of birth, living place, kind of cancer, kind of treatment and questions covering different aspects of the travel: how the patient travelled to the centre, how long the travel lasted, which kind of support was necessary to travel and who provided this support, whether the accompanying person had to absent herself from her workplace, whether the patient lives alone or not and how many journeys to health care providers the patients had in the last month were included in the analysis Results: 298 patients answered to all required questions (73%). 186 came accompanied, a vast majority by a member of the family and one out of four of the accompanying person had to leave the workplace. Help at home is almost exclusively provided by family members. Patients have several journeys to health care providers per month.Conclusions: The type of cancer has an impact on the support needed and must added to the previously published factors as age, gender and distance. The journey to the cancer treatment is not the unique journey to health care providers the patients have and increase the burden for the patient and the family.