Everyone should have ready access to a competent cancer service

Aggarwal and colleagues are correct to argue against promoting “shopping around” to tackle the problem of backlogs of patients requiring specialist cancer care.1There has been emphasis on the concept of improving cancer services by centralising specialised services to guarantee quality. Given that many patients do not get timely access to services, the question is whether the increment in quality from centralisation outweighs the decrement in receipt of service caused by “distance decay.” This term describes how patients are less likely to receive a timely diagnosis and treatment when the relevant facilities are located further from their home. It applies to primary care, to all treatment modalities, and especially to socioeconomically disadvantaged patients.23Receipt of a specialised service requires presentation of the patient to a diagnostic service that needs to be local enough to be readily accessed by people who might have cancer, accurate selection of those who might benefit from specialised…
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