Cancer treatment abroad

Cancer treatment abroad means one of a few quite different things, and the first job is to say which one you mean. It can mean a second opinion and a full staging work-up in days rather than weeks. It can mean a single planned operation, a course of radiotherapy or radiosurgery, or a treatment such as proton therapy or a bone marrow transplant that is not funded or not available where you live. It can mean a private hospital in Turkey, Germany or Spain doing the same treatment your home system would give you, sooner or for a price you can pay. And it can mean a clinic selling therapies that no cancer service at home offers because the evidence does not support them.

Cancer care is a sequence run by a team: staging, a tumour board decision, surgery, drugs, radiotherapy and years of follow-up, in an order and at a pace that affect the outcome. Taking one piece of that sequence abroad can work well when the piece is well defined and the handover in both directions is arranged; taking it abroad because someone promised more than your own oncologist would is how people lose time they do not have. This page sets out which parts of cancer treatment travel well and which do not, where people go, how it works, the risks that belong to the trip and what a quote needs to contain.

The countries divide by what they are for. Germany and, for proton therapy, the Czech Republic and Spain are chosen for specific treatments and university cancer centres, at prices close to or above home prices for Western Europeans, with reimbursement possible inside the European Union with prior approval. Turkey is chosen for large private oncology hospitals with current radiotherapy platforms, surgical oncology and short flights, at a fraction of Western prices, with no reimbursement. Poland and Romania offer European Union hospitals closer to home for Eastern and Central Europeans. Mexico and Thailand serve the Americas and Asia respectively, and Mexico is also where many of the unlicensed alternative clinics are, which makes checking the hospital's licence and its tumour board more important there, not less.

• Turkey. Oncology in Turkey: private hospital groups with comprehensive cancer centres in Istanbul and Ankara, radiotherapy and radiosurgery platforms, surgical oncology and bone marrow transplant units; short flights, low prices, follow-up at a distance.
• Spain. Oncology in Spain: private oncology groups and proton centres in Madrid and Barcelona, prices between Germany and Turkey.
• Poland. Oncology in Poland: public and private oncology centres inside the European Union, closer and cheaper than Germany for many patients.
• Mexico. Oncology in Mexico: licensed hospitals in Mexico City, Monterrey and Guadalajara for patients from the United States, alongside border clinics selling unproven therapies that no cancer service recommends.
• Thailand. Oncology in Thailand: accredited hospitals in Bangkok with oncology centres, a long flight from Europe that matters during treatment.

• Lost time. Delay between staging, surgery, drugs and radiotherapy costs outcomes; a trip that breaks the sequence can do more harm than the treatment does good.
• Unproven treatment. Alternative and complementary clinics sell therapies without trial evidence, and the cost rises as the disease progresses; no licensed cancer centre offers them.
• Emergencies far from home. Neutropenic sepsis after chemotherapy, bleeding after surgery and severe radiotherapy reactions need the treating team within reach, at night.
• Continuity of drugs. A systemic treatment started abroad has to be continued somewhere; a drug that is not licensed or funded at home stops when you leave.
• Two teams, no owner. When the surgeon is abroad and the oncologist is at home, complications and decisions can fall between them unless the handover is written.
• Rising costs. Cancer is not a package; scans, admissions, drugs and complications add up, and a quote for the first step is not a quote for the illness.
• Insurance and home services. Travel insurance excludes planned treatment; public systems treat emergencies but may refuse or charge for follow-up of care given abroad.

• A comprehensive cancer centre, not a clinic. Surgical oncology, medical oncology, radiation oncology, pathology and intensive care under one roof, with a tumour board that meets and writes its decisions down.
• Volume for your cancer. Ask how many of your operation or your treatment the centre does a year; outcomes in cancer surgery track volume.
• Evidence, not brands. A radiotherapy machine, a robot or a drug name is not a reason to travel; the written plan and the team are.
• Licence and accreditation. Hospital licence, international accreditation and the oncologists' specialist registration; alternative clinics rarely have the first.
• Emergency and supportive care. Who manages blood counts, infection, pain and nutrition during the stay, and how you reach them at night.
• Handover in writing. Treatment summary, histology, radiotherapy doses and scan schedule to your oncologist, in a format they have agreed to accept.

• Cancer Research UK, guidance on having cancer treatment abroad and on unproven and alternative therapies.
• European Society for Medical Oncology, patient guides on cancer treatment pathways and multidisciplinary care.
• National Institute for Health and Care Excellence, guidance on referral and treatment timelines in cancer care.
• European Society for Radiotherapy and Oncology, patient information on radiotherapy techniques including proton therapy indications.
• NHS England, guidance on going abroad for planned medical treatment and the treatment of complications.