Mr R and Mrs D live within five hundred yards of each other. They have never met, but they have much in common.

They both have lung cancer with secondary spread.

They were both treated at the respiratory medicine department of the local District General Hospital, and they were both referred to the same radiation oncologist Dr M.

The final thing they have in common is that Dr M has recommended that they should each have a course of Tarceva.

I saw both Mr R and Mrs D this morning. They were sitting in the waiting room It is just as well they do not know each other.

I advised Mrs D about the Tarceva induced diarrhoea from which she is suffering. I counselled Mr R about his therapy.

I looked on the computer screen and saw the most recent letters from the oncologist.

Mrs D's letter is short and to the point.

click to enlarge

Mr R's letter is a little longer.

click to enlarge

What is going on here? This is not the post-code lottery. It is worse. This is about wealth. Mrs D's husband is a successful business man. The whole family has private health insurance. Mr R is retired, living on a pension, and does not have private health insurance.

Mr R will almost certainly die before Mrs D. He will have the benefit of the lung cancer nurse specialist who sees him from time to time and pats his hand. Occasionally he sees the registrar.

Mrs D does not have the benefit of the nurse patting her hand. She does have Tarceva. Consultants do not delegate the care of their private patients to nurses, so Mrs D sees the consultant personally on each trip to the hospital.

After the second consultation, I had to walk up and down the corridor for a while.Labels: lung cancer, tarceva. Posted by: Dr John Crippen    Source

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