BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPE
work together to ensure sustainable and equitable access. Critical to this is the inclusion of patient
organisations to ensure that their voice is heard. However, five of the countries in our study do not
include a patient perspective in HTA decision making: Austria, Belgium, Norway, Spain and Sweden.The hub and spoke model can balance specialisation with
localisation
Whether to provide access that is local to patients or centralised within fewer, major medical centres
was a topic raise by many participants. Many countries face problems arising from inefficient care
delivered via fragmented systems.^12 Certainly, centralisation of cancer services into specialised
treatment hubs can help ensure that patients receive appropriate diagnostic and high-quality care.
However, the relative lack of access for those living at a distance from the specialised hub becomes
an issue—particularly in large and sparsely populated countries. Norway, for example, is exploring
how diagnostic and surgical services could be centralised while using improved telecommunication
services to decentralise treatment. This would allow patients to receive their treatment from locally
based clinicians who can be in contact with the centralised hub specialists. France has a similar system
of networks linking regional cancer facilities with designated centres of reference and centres of
competence.^12Stigma is common, but support for mental health is not
Being given a lung cancer diagnosis causes immense distress to the patient and his or her family. Not
only is it often considered a death sentence, patients also report a sense of stigma, associated with
the disease’s link to smoking.^63 Finnish smokers, for example, are often reluctant to bring themselves
forward for screening because they feel the shame of a disease that they have brought upon
themselves. Participants also spoke about the unconscious bias that some healthcare professionals
have towards lung cancer patients and treating them for a self-inflicted disease. Psychological
support—including problem-solving approaches, support group-based treatments and cognitive
behavioural therapy—can help lung cancer patients and their families from diagnosis through
treatment.^64
Too often, however, the psychological needs of cancer patients are not met. Many patients report
wanting to obtain mental health support for their families but are unable to access it. Patients who
have managed to get referred have reported being seen by professionals who either lacked a proper
understanding of cancer or were unable to provide the help that they and their families needed. Some
patients report that what help they did receive was inappropriate and hurtful.^65
Stigma has an impact beyond the emotional toll. For example, participants from the Netherlands
discussed how both health professionals and patients may question the use of expensive treatments
and whether the patient is deemed to be worthy of receiving it. Reducing negative attitudes and
fatalistic thinking, while promoting anti-smoking efforts, has been shown to help to reduce stigma at
a professional level and in society at large.18, 66 Indeed, participants from several countries—including
Finland and Norway—reported that their health systems are looking for ways to confront the stigma
and the barriers that it creates for people who are reluctant to take part in screening and early-
detection services.