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Letters
January 30, 2008

Gasoline Costs and Treatment Choices

JAMA. 2008;299(4):407-408. doi:10.1001/jama.299.4.407-b

To the Editor: In their Commentary on peak petroleum, Dr Frumkin and colleagues1 examined the implications of diminishing oil supplies on the health care system. They provided broad coverage of the issue without considering specific fields of medicine that could be particularly affected.

The field of radiation oncology is highly dependent on patient transportation; for many patients, this commute may be daily for more than 8 weeks. Increasing distance to the nearest radiation facility may bias a woman's choice between mastectomy and breast conservation toward the former.2 A possible consequence of impending $5-per-gallon gasoline costs could be reluctance of patients to consider important adjuvant therapy such as radiation after lumpectomy. Shorter treatment options, such as partial-breast irradiation and stereotactic radiotherapy that can be given over the course of a week, are likely to find greater appeal for a population struggling to afford the extra co-pay of filling the tank.

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