Skip to main content
Top
Published in: Supportive Care in Cancer 3/2012

01-03-2012 | Original Article

Inequalities in access to cancer treatment: an analysis of cross-regional patient mobility in Greece

Authors: Kostas Athanasakis, Kyriakos Souliotis, Elias-John Kyriopoulos, Evangelia Loukidou, Persefoni Kritikou, John Kyriopoulos

Published in: Supportive Care in Cancer | Issue 3/2012

Login to get access

Abstract

Purpose

The quest of specialized oncology services represents an inelastic need for cancer patients that often leads to traveling in order to receive adequate care. The present survey assesses patient geographic mobility to access services for the prevention and treatment of neoplasmatic diseases in Greece, a country where the National Health System is characterized by severe misdistribution of oncology-specific resources.

Methods

Based on data from the National Statistical Service for 1999–2005 (last available), we estimated geographic mobility as the difference between oncology patients residing in a specific region and those receiving care in National Health System (NHS) facilities located in the region, for the ten administrative districts of Greece. Especially for Attica, we performed a sub-analysis according to cancer diagnosis.

Results

The most significant mobility is towards Attica, where patients receiving care within the region outnumber the patients actually residing by 48.9% annually, on average. Positive flows are also observed towards Macedonia (8.4%) and Epirus (7.8%). Negative flows are recorded in all remaining regions, the highest noticed in Sterea (−76.2%), Ionian Islands (−63.3%), Aegean Islands (−45.2%), and Thessaly (−37.3%). The largest flow towards Attica is for cases of malignant neoplasms of the skin, uterus, male genital organs, and for Hodgkin’s lymphomas.

Conclusions

Misallocation of oncology-specific resources creates “two-tier” cancer patients based on ability to pay for traveling/accommodation. The severity and the consequences of the disease necessitate a bold approach to resource allocation and the establishment of integrated patient support networks that ensure all cancer patients are offered equal opportunities to effective treatment.
Literature
1.
go back to reference World Health Organization (2001) The World Health Report 2001. WHO, Geneva World Health Organization (2001) The World Health Report 2001. WHO, Geneva
2.
go back to reference Ries LAG, Cl K, Hankey BF et al (1999) SEER cancer statistics review, 1973–1996. National Cancer Institute, Bethesda Ries LAG, Cl K, Hankey BF et al (1999) SEER cancer statistics review, 1973–1996. National Cancer Institute, Bethesda
4.
go back to reference Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML (2008) Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 100:888–897PubMedCrossRef Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML (2008) Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 100:888–897PubMedCrossRef
5.
6.
go back to reference Yabroff KR, Davis WW, Lamont EB, Fahey A, Topor M, Brown ML, Warren JL (2007) Patient time costs associated with cancer care. J Natl Cancer Inst 99:14–23PubMedCrossRef Yabroff KR, Davis WW, Lamont EB, Fahey A, Topor M, Brown ML, Warren JL (2007) Patient time costs associated with cancer care. J Natl Cancer Inst 99:14–23PubMedCrossRef
7.
go back to reference Yabroff KR, Warren JL, Knopf K, Davis WW, Brown ML (2005) Estimating patient time costs associated with colorectal cancer care. Med Care 43:640–648PubMedCrossRef Yabroff KR, Warren JL, Knopf K, Davis WW, Brown ML (2005) Estimating patient time costs associated with colorectal cancer care. Med Care 43:640–648PubMedCrossRef
8.
go back to reference Kessler LG, Ramsey SD (2007) The forest and the trees: the human costs of cancer. J Natl Cancer Inst 99:2–3PubMedCrossRef Kessler LG, Ramsey SD (2007) The forest and the trees: the human costs of cancer. J Natl Cancer Inst 99:2–3PubMedCrossRef
9.
go back to reference Lysdahl KB, Borretzen L (2007) Geographical variation in radiological services: a nationwide survey. BMC Health Serv Res 7:21PubMedCrossRef Lysdahl KB, Borretzen L (2007) Geographical variation in radiological services: a nationwide survey. BMC Health Serv Res 7:21PubMedCrossRef
10.
go back to reference Schweikhart SB, Smithdaniels VL (1993) Location and service mix decisions for a managed health-care network. Socio Econ Plann Sci 27:289–302CrossRef Schweikhart SB, Smithdaniels VL (1993) Location and service mix decisions for a managed health-care network. Socio Econ Plann Sci 27:289–302CrossRef
11.
go back to reference Jayaraman V, Srivastava R (1995) A service logistics model for simultaneous siting of facilities and multiple levels of equipment. Comput Oper Res 22:191–204CrossRef Jayaraman V, Srivastava R (1995) A service logistics model for simultaneous siting of facilities and multiple levels of equipment. Comput Oper Res 22:191–204CrossRef
12.
go back to reference Chiu LF (2003). Inequalities of access to cancer screening: a literature review. Cancer Screening Series No. 1, December. NHS Cancer Screening Programmes, Sheffield, UK Chiu LF (2003). Inequalities of access to cancer screening: a literature review. Cancer Screening Series No. 1, December. NHS Cancer Screening Programmes, Sheffield, UK
13.
go back to reference Souliotis K, Athanasakis K, Golna C, Papadopoulou C, Kyriopoulos J (2009) Availability and spatial contribution of oncology specific resources in Greece. Doc Greek Med 26:808–817 Souliotis K, Athanasakis K, Golna C, Papadopoulou C, Kyriopoulos J (2009) Availability and spatial contribution of oncology specific resources in Greece. Doc Greek Med 26:808–817
14.
go back to reference Souliotis K (2007) Economic inequalities and health policy. Papazisis Publishers, Athens Souliotis K (2007) Economic inequalities and health policy. Papazisis Publishers, Athens
15.
go back to reference Guidry JJ, Aday LA, Zhang D, Winn RJ (1997) Transportation as a barrier to cancer treatment. Cancer Pract 5:361–366PubMed Guidry JJ, Aday LA, Zhang D, Winn RJ (1997) Transportation as a barrier to cancer treatment. Cancer Pract 5:361–366PubMed
16.
go back to reference Giokas D (2001) Greek Hospitals: how well their resources are used. Omega 29:73–83CrossRef Giokas D (2001) Greek Hospitals: how well their resources are used. Omega 29:73–83CrossRef
17.
go back to reference Efstathiou N, Ameen J, Coll AM (2007) Healthcare providers’ priorities for cancer care: a Delphi study in Greece. Eur J Oncol Nurs 11:141–151PubMedCrossRef Efstathiou N, Ameen J, Coll AM (2007) Healthcare providers’ priorities for cancer care: a Delphi study in Greece. Eur J Oncol Nurs 11:141–151PubMedCrossRef
18.
go back to reference Organization for Economic Co-operation and Development (OECD)—Working Party on Social Policy, Human Resources for Health Care Systems (2002) Geographical imbalances of HRHC: size, determinants and policy responses. OECD, Paris Organization for Economic Co-operation and Development (OECD)—Working Party on Social Policy, Human Resources for Health Care Systems (2002) Geographical imbalances of HRHC: size, determinants and policy responses. OECD, Paris
19.
go back to reference Dussault G, Francescini MC (2006) Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health 4:12PubMedCrossRef Dussault G, Francescini MC (2006) Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health 4:12PubMedCrossRef
20.
go back to reference Souliotis K (2001) Approach of the social and regional inequalities in health in Greece. Topos 17:49–74 Souliotis K (2001) Approach of the social and regional inequalities in health in Greece. Topos 17:49–74
21.
go back to reference Tountas Y, Karnaki P, Pavi E, Souliotis K (2005) The “unexpected” growth of the private health sector in Greece. Health Policy 74(2):167–180PubMedCrossRef Tountas Y, Karnaki P, Pavi E, Souliotis K (2005) The “unexpected” growth of the private health sector in Greece. Health Policy 74(2):167–180PubMedCrossRef
22.
go back to reference Payne SN, Jarrett N, Jeffs D (2000) The impact of travel on cancer patients’ experience of treatment: a literature review. Eur J Cancer Care 9:197–203CrossRef Payne SN, Jarrett N, Jeffs D (2000) The impact of travel on cancer patients’ experience of treatment: a literature review. Eur J Cancer Care 9:197–203CrossRef
23.
go back to reference Fitch MI, Gray RE, Mcgowan T, Brunskill I, Steggles S, Sellick S, Bezjak A, McLeese D (2005) Τravelling for radiation cancer treatment: patient satisfaction. Can Oncol Nurs J 15:107–119PubMed Fitch MI, Gray RE, Mcgowan T, Brunskill I, Steggles S, Sellick S, Bezjak A, McLeese D (2005) Τravelling for radiation cancer treatment: patient satisfaction. Can Oncol Nurs J 15:107–119PubMed
24.
go back to reference Martin-McDonald K, Rogers-Clark C, Hegney D, McCarthy A, Pearce S (2003) Experiences of regional and rural people with cancer being treated with radiotherapy in a metropolitan centre. Int J Nurs Pract 9:176–182PubMedCrossRef Martin-McDonald K, Rogers-Clark C, Hegney D, McCarthy A, Pearce S (2003) Experiences of regional and rural people with cancer being treated with radiotherapy in a metropolitan centre. Int J Nurs Pract 9:176–182PubMedCrossRef
25.
go back to reference Hegney D, Pearce S, Rogers-Clark C, Martin-McDonald K, Buikstra E (2005) Close, but still too far. The experience of Australian people with cancer commuting from a regional to a capital city for radiotherapy treatment. Eur J Cancer Care Engl 14:75–82PubMedCrossRef Hegney D, Pearce S, Rogers-Clark C, Martin-McDonald K, Buikstra E (2005) Close, but still too far. The experience of Australian people with cancer commuting from a regional to a capital city for radiotherapy treatment. Eur J Cancer Care Engl 14:75–82PubMedCrossRef
26.
go back to reference Davis C, Girgis A, Williams P, Beeney L (1998) Needs assessment of rural and remote women travelling to the city for breast cancer treatment. Aust N Z J Public Health 22:525–527PubMedCrossRef Davis C, Girgis A, Williams P, Beeney L (1998) Needs assessment of rural and remote women travelling to the city for breast cancer treatment. Aust N Z J Public Health 22:525–527PubMedCrossRef
27.
go back to reference Rosato R, Sacerdote C, Pagano E, Di Cuonzo D, Baldi I, Bordon R, Ponti A, Bertetto O, Segnan N, Merletti F, Vineis P, Ciccone G (2009) Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population-based study in Northern Italy. Breast Cancer Res Treat 117:349–356PubMedCrossRef Rosato R, Sacerdote C, Pagano E, Di Cuonzo D, Baldi I, Bordon R, Ponti A, Bertetto O, Segnan N, Merletti F, Vineis P, Ciccone G (2009) Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population-based study in Northern Italy. Breast Cancer Res Treat 117:349–356PubMedCrossRef
28.
go back to reference Dejardin O, Remontet L, Bouvier AM, Danzon A, Trétarre B, Delafosse P, Molinié F, Maarouf N, Velten M, Sauleau EA, Bourdon-Raverdy N, Grosclaude P, Boutreux S, De Pouvourville G, Launoy G (2006) Socioeconomic and geographic determinants of survival of patients with digestive cancer in France. Br J Cancer 95:944–949PubMedCrossRef Dejardin O, Remontet L, Bouvier AM, Danzon A, Trétarre B, Delafosse P, Molinié F, Maarouf N, Velten M, Sauleau EA, Bourdon-Raverdy N, Grosclaude P, Boutreux S, De Pouvourville G, Launoy G (2006) Socioeconomic and geographic determinants of survival of patients with digestive cancer in France. Br J Cancer 95:944–949PubMedCrossRef
29.
go back to reference Jack RH, Gulliford MC, Ferguson J, Møller H (2003) Geographical inequalities in lung cancer management and survival in South East England: evidence of variation in access to oncology services? Br J Cancer 88:1025–1031PubMedCrossRef Jack RH, Gulliford MC, Ferguson J, Møller H (2003) Geographical inequalities in lung cancer management and survival in South East England: evidence of variation in access to oncology services? Br J Cancer 88:1025–1031PubMedCrossRef
30.
go back to reference Sariego J (2009) Patterns of breast cancer presentation in the United States: does geography matter? Am Surg 75:545–549PubMed Sariego J (2009) Patterns of breast cancer presentation in the United States: does geography matter? Am Surg 75:545–549PubMed
31.
go back to reference Sariego J (2008) Regional variation in breast cancer treatment throughout the United States. Am J Surg 196:572–574PubMedCrossRef Sariego J (2008) Regional variation in breast cancer treatment throughout the United States. Am J Surg 196:572–574PubMedCrossRef
32.
go back to reference Sowden A, Aletras V, Place M, Rice N, Eastwood A, Grilli R, Ferguson B, Posnett J, Sheldon T (1997) Volume of clinical activity in hospitals and healthcare outcomes, costs, and patient access. Qual Health Care 6:109–114PubMedCrossRef Sowden A, Aletras V, Place M, Rice N, Eastwood A, Grilli R, Ferguson B, Posnett J, Sheldon T (1997) Volume of clinical activity in hospitals and healthcare outcomes, costs, and patient access. Qual Health Care 6:109–114PubMedCrossRef
33.
go back to reference Bain NSC, Campbell NC, Ritchie LD, Cassidy J (2002) Striking the right balance in colorectal cancer care—a qualitative study of rural and urban patients. Farm Pract 19:369–374CrossRef Bain NSC, Campbell NC, Ritchie LD, Cassidy J (2002) Striking the right balance in colorectal cancer care—a qualitative study of rural and urban patients. Farm Pract 19:369–374CrossRef
34.
go back to reference Mandelblatt JS, Yabroff R, Kerner JF (1999) Equitable access to cancer services: a review to barriers to quality care. Cancer 86:2378–2390PubMedCrossRef Mandelblatt JS, Yabroff R, Kerner JF (1999) Equitable access to cancer services: a review to barriers to quality care. Cancer 86:2378–2390PubMedCrossRef
35.
go back to reference Blumenthal S (2002) The effects of socioeconomic status on health in rural and urban America. JAMA 287:109PubMedCrossRef Blumenthal S (2002) The effects of socioeconomic status on health in rural and urban America. JAMA 287:109PubMedCrossRef
Metadata
Title
Inequalities in access to cancer treatment: an analysis of cross-regional patient mobility in Greece
Authors
Kostas Athanasakis
Kyriakos Souliotis
Elias-John Kyriopoulos
Evangelia Loukidou
Persefoni Kritikou
John Kyriopoulos
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 3/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1093-0

Other articles of this Issue 3/2012

Supportive Care in Cancer 3/2012 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine