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.

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