Table 4 Box 1

Box 1 Agreed priorities for cancer care to people in remote and rural areas

Diagnosis

• Patient education on suspicious symptoms

• Fast access to diagnostic services

Specialist oncology

•Best possible specialist treatment

• Fastest possible specialist treatment

• Informed discussion with patients about treatment choices

• Avoiding treatment where there is little chance of benefit

Delivery of care

• Well-coordinated delivery of chemotherapy (blood sampled primary care, drugs ready on arrival at hospital, etc.)

• Chemotherapy administered by experienced staff

• Agreed multidisciplinary protocols for chemotherapy in local areas

• At least two trained chemotherapy nurses in each place (e.g. hospital) where it is delivered (cover for holidays/sickness)

• Link person at local general hospital (e.g. specialist nurse)

• Local supportive care (blood tests, transfusions, etc.)

Communication

• Results delivered as fast as possible (e.g. via general practitioner)

• Rapid two-way communication between specialist and primary care team

• Good communication links between centre oncologists and local oncology team

• Information on specialist treatment for general practitioners

Team working

• Effective multidisciplinary team working in secondary care

• Effective multidisciplinary team working in primary care

• Care (including follow-up) devolved to appropriately trained staff

• Good training and support for local oncology team

• Good training and support for general practitioners and community nurses

Patient factors

• Comprehensive information for patients/relatives

• Good transport to specialist centres

• Good accommodation for patients/relatives at specialist cancer centres (for patients travelling long distances)

• Flexible appointment times at specialist cancer centres (for patients travelling long distances)

• Good facilities at local hospitals (for chemotherapy, outpatients, relatives' room)