ABSTRACT
What are the main economic issues that will shape cancer care over the next few years, exercising an influence on actual patient care that is often occult but powerful?
The requirement for services grows partly out of demand as requested by patients themselves and partly from need – the definition by professionals of the quality of service and level of access to services which is professionally acceptable. Cancer services will be affected by compelling new pressures both from rising demand and from changed definitions of need. Additional demand will rise mainly from a factor which is usually termed expectations, but expectations are shaped in different ways. They could rise because of improved or faster access to information through the media or internet. They could reflect changed perceptions of the right or fair level of service so that there was less willingness to take no for an answer and less deference, or expectations might change because of altered perceptions of risk, return and side effects.
