Reply: cancer care in rural areas

Sir, The experiences of Colomer _et al_, with a flexible combination of local and central delivery of chemotherapy agreed at a local level, are an encouraging example of a way forward in

cancer treatment provision to rural areas. We reported many agreed priorities for cancer care in rural areas in our paper, of which agreed multidisciplinary protocols for chemotherapy in

local areas was one (Stevenson et al, 2003). The abilities of Colomer _et al_ to reach agreements between three centres and community hospitals are to be commended particularly in light of

the polarised views that we reported (despite taking care not to exclude combinations of local and central delivery of chemotherapy in the wordings we used and by further qualitative

analysis of opinions expressed during interviews). In Scotland, the divergent views of practitioners caring for patients with cancer are mirrored by those of patients (Bain et al, 2002), and

appear to be responsible for substantial variations in provision even within rural locations (Smith and Campbell, 2004). This variation in practice stems from a real lack of evidence about

the risks, benefits and costs of local chemotherapy provision, as well as uncertainty about how to balance uncommon but potentially serious risks against less easily measured effects on

quality of life. As ever, where there is genuine uncertainty about the correct course of action, more research is needed. In the meantime, locally agreed arrangements, like those achieved by

Colomer _et al_, could help to remove local inconsistencies, clarify protocols for rural practitioners, and reduce the uncertainties felt by many. CHANGE HISTORY * _ 16 NOVEMBER 2011 This

paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication _ REFERENCES * Bain NSC, Campbell NC, Ritchie LD, Cassidy J (2002)

Striking the right balance in colorectal cancer care – a qualitative study of rural and urban patients. _Fam Pract_ 19: 369–374 Article  Google Scholar  * Smith SM, Campbell NC (2004)

Provision of oncology services in remote and rural areas: a computer assisted telephone survey. _Eur J Cancer Care_, (in press) * Stevenson L, Campbell NC, Kiehlmann PA (2003) Providing

cancer services to remote and rural areas: consensus study. _Br J Cancer_ 89: 821–827 Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS *

Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, UK N C Campbell & L Stevenson * Northeast Scotland

Cancer Co-ordinating and Advisory Group (NESCAG), Cancer Network Office, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK P A Kiehlmann Authors * N C Campbell View author publications

You can also search for this author inPubMed Google Scholar * P A Kiehlmann View author publications You can also search for this author inPubMed Google Scholar * L Stevenson View author

publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to N C Campbell. RIGHTS AND PERMISSIONS From twelve months after its original

publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit

http://creativecommons.org/licenses/by-nc-sa/3.0/ Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Campbell, N., Kiehlmann, P. & Stevenson, L. Reply: Cancer care in rural

areas. _Br J Cancer_ 90, 1689 (2004). https://doi.org/10.1038/sj.bjc.6601770 Download citation * Published: 06 April 2004 * Issue Date: 19 April 2004 * DOI:

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