BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPEPsychological support services should be included in lung cancer clinical guidelines. However, this
is only the case in six of our countries: Austria, Finland, France, the Netherlands, Norway and Sweden.
Of these countries, only three—Austria, Norway and Sweden—provide clear referral pathways. Getting
actual access to services remains an issue: for example, in the UK, psychological support is available at
the time of diagnosis but support throughout treatment varies and is often a casualty of insufficient
staffing.
Supportive and palliative care is often poorly organised
and initiated too late
WHO defines palliative care as “an approach that improves the quality of life of patients and their
families facing the problems associated with life-threatening illness through the prevention and relief
of suffering by means of early identification and impeccable assessment and treatment of pain and
other problems, physical, psychosocial and spiritual.”^67 Sometimes the term “supportive” care is used for
those services provided during the course of active treatment and “palliative” is reserved for end of life
care. We treat supportive and palliative care as one continuum.
Research has shown that a country ’s wealth does not always predict its ability to prioritise or
organise supportive and palliative care.^68 Indeed, we found that access is often insufficient simply
because a number of countries lack a suitable patient pathway. Despite supportive and palliative
care being mentioned in clinical guidelines produced in nine of our eleven countries, specific referral
pathways to these services are only provided in seven countries: Austria, Finland, France, the
Netherlands, Norway, Sweden and the UK. The lung cancer clinical guidelines used in Belgium and
Romania did not discuss supportive and palliative care at all.
Multidisciplinary teams need to be co-ordinated
Table 4: Number of medical and surgical specialists (per 100,000)
Austria Belgium Finland France Netherlands Norway Poland Romania Spain Sweden United Kingdom
Thoracic
surgeons
0.6 no data 2 0.7 0.9 1.0 1.4 1.6 1.7 1.4 1.5General
surgeons22.1 11.5 8.7 7.6 9.7 8.6 15.5 12.8 11.4 16.1 13.4
Pulmonologists 4.8 4.7 3.7 4.7 5.1 3.7 4.2 5.7 5.5 2.1 4.1
Oncologists no data 4 3.2 1.5 no data 4.2 5.7 3.1 3.9 5.7 3.8
Source: Eurostat. Data extracted May 2019.Lung cancer treatment requires the services of oncologists, pulmonologists, thoracic surgeons,
palliative care specialists and a host of nursing and allied health professional staff.^26 Provision varies
extensively across countries (Table 4). The delivery of care is a complicated business, with many
opportunities for co-ordination failure. Scarcity of specialist staff was reported by participants in
several countries. For example, it was said that the UK suffers from significant shortages in pathology
and radiology.