How was cancer treatment different in the US and the UK?
07.06.2025 16:11
I was diagnosed with anal cancer in 2020 and about a year after that joined a Facebook support group hosted in the USA. While there were a lot of similarities in treatment for US and U.K. residents a number of things stood out.
Treatments and tests that were expensive and unnecessary. Anal cancer has a standard treatment used the world over. It is called the Nigro protocol and was developed in the USA by Dr Norman Nigro in the 1970s. Its aim is to use radiotherapy and chemotherapy to avoid the brutal, life changing surgery (charmingly called Barbie Butt surgery) that was the only option before it was introduced and it has proven highly successful. From reading contributions made in the group by US patients, they often received surgery as first line treatment. Very, very expensive surgery. Chemotherapy is sometimes delivered by inserting a PICC line into veins. US contributors sometimes had these left in for months, even over a year, after chemotherapy ended because their insurance wouldn't pay to have it removed in case it was required again, so adding another claim to the insurance company for a second procedure.
Going back to work. Like other cancer treatments the period after treatment for anal cancer ends can be challenging for many months. Fatigue, nausea, fecal incontinence and chronic pain are frequent issues. US contributors were often going back to work, or worked throughout their treatment, because of their concern that they would lose their jobs and so their workplace health insurance or lose their salary that was paying for treatment and medication not covered by insurance..
Treatment centres that were in or out of coverage. A lot of the discussions were about which were the best treatment centres. A number of contributors in the US said how they were unable to use some with an excellent reputation (Mayo clinics came up frequently as an example of good treatment) because some hospitals were not covered by their insurance. In the U.K. I researched the hospitals with a track record of treating what is a rare cancer and asked for my treatment to be carried out there. I was then treated at St Bartholomew’s and The Homerton hospitals in London which are world leaders in anal neoplasia. The only factor in having treatment at my centre of choice was if they had the capacity, not if the NHS would support me having treatment there.
Aftercare. I received physiotherapy, dietician advice, pain management and counselling after treatment. Many of the US contributors said how these follow on treatments were not covered by their insurance as the company judged that they were not cancer treatments.
Reading your question some examples came to mind.
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