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HEALTH

Why cancer patients in Spain are changing address to stay alive

Almost half of all oncologists in Spain are reporting huge disparities between different regions in terms of patient access to the latest life-saving cancer treatments, spurring many patients to pack up and move (at least on paper).

Why cancer patients in Spain are changing address to stay alive
Photos: AFP

Time is of the essence when it comes to cancer and stopping it in its tracks.

But in Spain, a country where bureaucratic holdups are part and parcel of daily life, the repercussions attached to slow public service delivery in the health sector can prove lethal for some.

Spain’s Society of Oncology (SEOM) has just released a study that highlights the huge disparity in waiting times for newly approved cancer medications between the country’s different autonomous communities.

The timeframe from which a groundbreaking treatment is green lighted by Spain’s Ministry of Health to the moment it reaches a cancer patient in hospital varies between 5 to 17 months on average.

The wait is influenced by factors such as where the hospital is located in Spain, whether or not the regional health department has decided to incorporate the new medication into its cancer treatment and even the individual hospital’s modus operandi.

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With a one and half-year wait obviously not an option for anyone with the disease, especially those which are particularly aggressive, patients are preferring to pack their bags and move to an address where the holdups are far less.

For this they need to be registered (empadronados) at a municipality that falls within the catchment area of the hospital that can get them the drugs faster.

Technically their names will have to be on a rental contract or title deeds in the desired location to be able to do so, although this can also be achieved in many regions if a person living at said address authorises that they be included in the ‘padrón’.

A total of 84 public hospitals from all of Spain’s 17 autonomous communities (as well as the autonomous city of Ceuta) took part in the study, with 11 new cancer medications and 5 cancer biomarkers (a substance or process that helps to diagnose cancer) used as the basis of the research.

A total of 43 percent of oncologists surveyed told SEOM they had patients who were having to wait excessively long to receive the most cutting-edge treatment and diagnosis methods theoretically available to them through the public system, with some practitioners citing three-year-long holdups for prescriptions that have already been approved by medical authorities.

In fact, the study initially encompassed 146 hospitals across Spain, but 42 percent of them failed to get back to SEOM with the relevant information.

The same confusion that envelops many bureaucratic processes in Spain has seeped into the country’s health system, the research reveals.

In this case, there’s no homogenous nationwide policy or body to call on or complain to. Sometimes it’s the hospital that decides, in other cases it’s the region’s health department, making it unclear for people who can’t afford the wait.

Perhaps for this reason SEOM hasn’t revealed where exactly cancer patients can get the latest treatment fast and easy, as it can vary enormously even within the same city or town.

Even though Spain’s public health system is highly regarded worldwide (9th best internationally in 2015, 19th in 2018 according to The Lancet), the evidence suggests these cancer treatment holdups are nothing new.

Cancer sufferers have been ‘fudging’ their address for years as the only solution available to them for the currently inefficient system, other than actually moving to another part of Spain to sidestep the bureaucratic wait.

Begoña Barragán, president of the Spanish Group of Cancer Patients (GEPAC) told online daily Público she had at one point had 17 patients registered at her home address in order for them to gain access to her local hospital, which offered far shorter waiting periods than on average in Spain.

Her organization encompasses 70 associations across the country which have helped other cancer patients do the same.

“I remember one local minister once warning me ‘I don’t want to find out that you’ve been doing this in our region’, to which I replied ‘don’t worry, you won’t find out,” Barragán told Público.

“None of this has anything to do with medical reasons, it’s all due to administrational and financial causes. Doctors themselves will always offer up the best treatment if it’s up to them.

“This is a post code lottery, a game of chance”.

With this strand of unequal health service delivery increasingly under scrutiny, Spain’s Ministry of Health has shifted responsibility to the country’s autonomous communities, saying it’s up to them to find a solution.

But cancer groups and Spain’s health patient ombudsman are calling instead for a system that is as systematic as paying taxes.

“The rights to health service access, to be cured, to save lives cannot be determined by the place where you live, says the president of Defensor del Paciente Carmen Flores.

“That’s serious discrimination.

“Therefore, Spain’s Ministry of Health must create some order among the autonomous communities, that’s why they’re given funds from the national budget after all”.
 

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HEALTH

How Spain could stamp out smoking

A fifth of Spain's population smokes on a daily basis. With such high numbers, here's how the country's pulmonologists propose to get smokers to quit.

Spain plans to get people to quit smoking
How Spain plans to get people to stop smoking. Photo: Khalil MAZRAAWI / AFP

For many outsiders, Spain is a nation of smokers. 

The stats from Spain’s Ministry of Health show that 23.3 percent of men smoke every day in Spain, compared with 16.4 percent of women.

For both males and females, the highest number of smokers are aged between 25 and 34, meaning that it’s the younger population who are smoking slightly more than the older generations. 

Spain’s pulmonologists are now pushing for the country’s tobacco laws to be tightened, claiming that reform is needed after the last legislation was approved a decade ago.

READ ALSO: Spain warns against smoking and vaping in public to avoid Covid infections

Why is smoking such a problem in Spain and what is being done about it?

The latest stats from the Spanish Ministry of Health show that lung cancer, often caused by smoking, is the third most frequently diagnosed cancer in Spain, with 29,549 cases diagnosed so far in 2021.

Given these high figures Spain’s Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has proposed five measures to help get people to stop smoking.

SEPAR points out that every time anti-smoking legislation is reformed and things for smokers made more difficult, the prevalence of smoking decreases.  

Smoking on terraces was banned in some regions during the pandemic. Photo: CRISTINA QUICLER / AFP
  • Price of tobacco to rise in 2022

The first point on their list is to raise the price of tobacco, which must cover all forms, from cigarettes to cigars, through to rolling tobacco, and electronic cigarettes.  

This first measure may soon become a reality as the Spanish government has already predicted that the price of tobacco will rise in 2022, after several years of stagnation.  

It is expected that tobacco will be responsible for almost a third of all special taxes received in 2022, equating to €21.8 billion.

According to the World Health Organization (WHO), “cheap tobacco” in Spain guarantees “a percentage of smokers above 30 percent”.

In Spain, the price of a pack of tobacco is around €5, which is much cheaper than in other countries. In Australia for example, a pack of tobacco costs around €22, and in the United Kingdom and France, each pack of tobacco costs around €12.4 and €10.5, respectively.

According to Dr. Carlos A. Jiménez Ruiz, pulmonologist and president of the society, the current anti-smoking law has “some deficiencies” that need to be addressed in order to develop legislation that is more effective and efficient, especially with regard to the prevention of tobacco consumption in young people, but also in helping smokers to stop smoking and in protecting the health of non-smokers. 

READ ALSO – Maps: Which beaches in Spain have banned smoking?

Besides increasing the cost of tobacco SEPAR proposes four other measures to get Spain to quit smoking. These include:

  • Banning the consumption of tobacco in public spaces, even outdoors
    During the pandemic, several regions approved a regulation to prohibit smoking on terraces. SEPAR proposes that smoking be prohibited not only in spaces such as terraces but also in sports stadiums, beaches, parks and bullrings, and that fines should be imposed for those who do not comply.

  • Establish generic packaging
    SEPAR also wants Spain to introduce generic packaging, which means no logos and images of the tobacco companies. This measure has also proven to lower the sales of tobacco in countries where it has been implemented, such as Australia and New Zealand. According to the latest statistics from the Australian National Drug Strategy Household Survey around 11.6 percent of adults in Australia smoke daily. 

  • The regulation of other smoking devices
    Despite the fact that all products that burn tobacco such as cigarettes are already regulated, SEPAR believes that it is also necessary to regulate the sale, consumption and advertising of electronic cigarettes. This is because e-cigarettes have become particularly popular among young people. 

  • Promote help for those seeking to quit smoking
    The last proposal is the creation and development of special units in public health departments to help people to stop smoking and to put more funds towards these programmes. 

How does Spain compare with other European countries when it comes to smoking?

According to the Organisation for Economic Cooperation and Development (OECD), while Spain does have a high number of smokers there are still several European countries that have more. The European countries with the highest number of smokers are Greece, Bulgaria and Hungary.

The latest European survey from 2020 shows that 42 percent of Greeks claim to be smokers, which is only slightly above Spain. 

On the other side, the European countries with the lowest number of smokers are mainly Nordic countries, such as Sweden, Finland, Iceland and Norway.

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