Thursday, 19 July 2012

Cancer Treatment in France; pros and cons

Following ex OU academic Jill Reynolds' previous posts 'what if I die before I get old' husband Dave continues Jill's story of her experience of cancer treatment in France.
The news in March that chemo treatment had reduced the size of Jill's secondary cancers gave us confidence that with more treatment we could enjoy summer at our house in France and pop down to Spain so Jill could practise her spanish.  The last blog 'European Union at work' expressed our frustrating experience of health system bureaucracies, but in mid April she started chemo in Narbonne.  We did not expect things to change so quickly. The nagging pain in her left hip quickly got worse.  In early April we'd got our bikes out for short rides and done vineyard walks of an hour or so; two weeks later she was on crutches and moving a few paces with difficulty.  When we'd asked 'specialists', in Oxford or Narbonne, if this was likely to be cancer spreading to her bones, they all said 'probably not; pancreatic cancer spreading to bones is rare, only 5-10% of cases'.  We had it x-rayed and went to see a 'rhumatalogist' Dr Brousson, an earnest man with a reputation for brusqueness.  He eyed Jill and her x-ray with the look of a gas engineer inspecting an obsolete boiler, and said;
'Hole here.  Very thin here, perhaps fissure.  Risk of fracture.  Perhaps try cement.  You walked in here with aid of one crutch?  Always use two.  Do not walk back down the corridor; take a wheelchair.  Put no weight on legs.  Come to hospital tomorrow for scans and tests.'
Whenever you go to any healthcare service they always ask for your 'carte vitale' with social security number first.  Having to explain 'we're not resident here, don't have carte vitale, but do have an international exchange agreement, form S2, I know you haven't heard of it, here's our number' became a little tedious but once you've got the paperwork sorted they do move.  None of this 'A secretary will get back to you in a week or so with a date for some other time' - they pick up the phone, talk to the scan unit, and say 'tomorrow'.
The news from the scans was not good.  Jill was one of the 5-10% whose cancer had spread to bones - hip and back.  So as 'cement' was obviously not an option a 10 day course of radiotherapy, reputed to be a good treatment for bone cancers, was arranged.  The treatment clinic in Beziers was modern and full of high tech robot things that targeted several places at once.  Although the actual treatment only takes a few minutes, we had a daily 70 mile round trip by taxi/ambulance which dominated the day.
We were told it takes up to 4 weeks for radiotherapy to take effect, so Jill put her feet up and waited; nothing changed.  At least she could enjoy a small vin rouge in our sunny garden. Everyone told us what a washout the english summer was so we could almost feel smug.  After 3 weeks there was a follow up and when we asked if, given more time, benefits from radiotherapy might still appear, Dr Mathieu gave a very gallic shrug and spread of hands.
The frustrating thing about pancreatic cancer is that for all the specialisms and high tech kit nobody understands how this disease works and what might happen.  It's not that they're bad, or lazy, they just don't know and can't tell you much.
If Jill's mobility was unlikely to allow her to do much, we thought of returning to the UK where we were confident of the end of life care given by McMillan nurses and the local hospice. But a week or so later Jill lost the use of her legs and ability to stand, so travel would evidently be difficult.  She now has 'soins palliatif a la maison' where local nurses come in twice a day to wash, change dressings etc and they're marvellous.  She even has a physio visit daily to give her foot massage 'pour le circulation' while we watch Bradley Wiggins on tv puffing up the Pyrenees a couple of hours from here on 'le tour'.
So what are the differences, the pros and cons of having treatment in France or staying in the UK?  As one might expect, they're both western european countries with similar educational traditions so the solutions will be similar.  In France there's a lot of 'up front' bureaucracy partly due to the network of public and private providers.  They react quicker; waiting times are much less or non existent, which is important when dealing with 'aggressive' cancers.  They spend about 20% more per person on healthcare -  a significant difference but not a massive one.  You can see plenty of opportunities for cost savings! In the UK the slowness that seems endemic in the admin is difficult to understand and so stressful. The support systems - both NHS and personal - are more intimate.  In the end all roads lead to the same place; some are quicker or more comfortable than others.

Tuesday, 17 July 2012

New President-Elect for the British Society of Gerontology

The British Society of Gerontology conference this year was a particularly good one for the Centre for Ageing and Biographical Studies because, in addition to the news about Bill Bytheway, we also heard that another long-standing member, Professor Sheila Peace, has been elected as the future president of the British Society of Gerontology. Sheila takes up office in 2014 but for the next two years has the role of President-Elect on the BSG committee.

Professor Sheila Peace

CABS congratulates her on this honour and wishes her every success in the role.

Wednesday, 11 July 2012

Congratulations to Bill Bytheway

Several CABS members are at the 41st annual conference of the British Society of Gerontology at the University of Keele today. We were delighted to learn that long-standing CABS member, Bill Bytheway, has been awarded the British Society of Gerontology's Outstanding Achievement Award.

Introducing the award, Professor Alan Walker said that this is the highest award the BSG can give. It is made annually to an individual or organiation that has made a significant and lasting contribution to British gerontology. This impact must be not only in the field of research but also in policy and in improving the quality of life of older people. He reported that the panel of judges had been unanimous this year and the audience certainly sounded as if they highly approved their choice.

Alan Walker mentioned Bill's many publications, especially his books Ageism and Unmasking Age, his involvement in teaching, especially at the OU, and his many research projects particularly the Research on Age Discrimination (RoAD) project. He also reminded us that Bill was a founder member of the BSG, has been Secretary and Treasurer and was for many year's Editor of the society's journal Ageing and Society.

Bill himself spoke briefly and reminded us that ageing is a property of all of us, not just of people we put in the category of 'older person'.

Congratulations to Bill on such a prestigious and well-deserved award.

Wednesday, 4 July 2012

The european union at work; getting healthcare in France

Following my previous three posts (What if I die before I get old?) my husband Dave now takes up the story of our struggle with health system bureaucracies.

At then end of 3 months of chemo the lumps (secondaries) in Jill's stomach had gone down, so we had two choices -
- whether to have another 3 months chemo
- if so, whether to have it in England or France
Difficult decision; commit to staying in the damp drizzle of a cotswold spring or the sun and vin rouge of the Languedoc.
So after her March celebration in Chippy we phoned the medecine generale (Gp) in Bizanet and asked how we'd get chemo treatment there.
'Simple; just come and see me, I refer you to a specialist, he'll see you in a couple of days, off you go'.  'Pardon; a couple of days - you mean a couple of weeks, surely?'  'Mais non'.
I'd looked at the NHS website which confirmed all EU citizens (that's us) can choose to obtain their healthcare in any EU country, talked about 'possible' reimbursement and directing us to to the CPAM (social security) office in france.  It didn't look too difficult.
The local Dr Azemar referred us speedily to the Narbonne polyclinique which delivered chemo.  They assured us that cancer treatment was paid for '100%' by the state provided you had a social security number.  So down the CPAM office we go - 'your main residence is England but you have a house here - you have proof of ownership? then we can give you a social number'.  Easy; we bring that back next day with passport and other id.  'Ah, now you need an S2'  'What?'  'le S deux!'
Nobody mentioned that.  I ring the international health team in Newcastle and after spending a couple of half hours listening to music someone finally answers. 'Yes, every EU citizen has the right to access healthcare where ever they are.  If it's an emergency use the EHIC card; if it's an existing illness (like cancer) you need an S2'  'We'll have one of those please'  'But you're already in France?  Oh no. Very strict procedure for S2.  Your UK consultant has to agree the treatment you would have had here, write to your local health commissioner who writes back to us, and if we agree we send it to your UK address.'  'Can't you send it to us in France; that's where we are.'  'Of course not; you're registered with the NHS in UK'.
We call our friendly Chippy GP, who seems uncertain who the local health commissioner is in our brave new super choice world, but she finds out who to call a lot quicker than I did and the S2 gets emailed to us in just a week.
When we return to CPAM the woman whose office we huffed out of last time calls a rugby player look alike who doesn't like our assertion that we've been asked for different things each time we visit, that the french ss 'marche bien' and you mess with bureaucracy at your peril.  He ticks off every bit of paper, we think we're there, and he says 'you have a bank account in France?'  'mais oui' says I.  'In your name? not your wife's? the treatment is for your wife, so there must be an account in her name into which we can pay reimbursements.'  'Can't you just use mine?'  'Monsieur! You think we have a revolution for liberty, equality, fraternity so you english types can come here and trouser your wife's money off our state?'  This was of course conveyed not in words but a minute, yet distinct, raising of the right eyebrow.  'Right.  We'll go and open a bank account then.'
By now we're a little anxious because we've booked chemo to start and would really like everything in place.  Into the Credit Agricole branch where I opened my account in 10 minutes a few years back 'Banks much more careful now - crisis, you know.  You must have a rendezvous to open an account and bring all these bits of paper'  'Ok, but it's urgent'  'How about a week next Friday'  'No, URGENT urgent'  'Ah.  Monday morning then'.  So after a pleasant half hour with Gael; 'I like England - work as barman in Birmingham' we finally become signed up recipients to the french health system - and I have to say, once you've got the paperwork, the medical lot do things quickly and efficiently - but that's another story  .   .