Breast cancer treatment in 389 Oncology clinics in Europe

I am a professional who moved here to contribute to uplift industrial activity in my own area. Heard great input from friends on Helios, about English speaking staff, better handling than long and declining German medical system. When registered my wife for birth and checkup at the last stage of pregnancy - and recently visited, the rooms are hot (making the patient more inconvenient), then we requested female doctor/nurse due to our own comfort and values, but instead when the female doctor arrived she ended up giving me lecture to understand their culture, you are in germany, even in your home country there are only Male doctors & Staff (which she doesn't know 60-70% of medical employees are female in my home country). She was straight forward denying the service if we do not agree on the male attendant. We had no other option but to say yes, however, this has been traumatic experience turned from a happy moment. As a Service provider the doctor should be able to provide a relaxing and comfortable environment. And the treatment was not something that couldn't be done alone when requested. It was a one person job, she could have do it herself, but forced to have male attendant to just hand over tissues or so. And even after that told me to expect male attendant regardless you want or not during delivery.. Service providing is the key. highly disappointed.

I could put 0 or -5 if that was possible. I guess 1 star goes to nursing personnel some of whom were nice. My mother was admitted there with stomach cancer and fluids in abdomen supposedly for immune therapy (we know it is a last resort). Doctor (Ali Nuri Hunerliturkoglu) even wasn't fully aware of the diagnosis at the admission. At putting the port for immune therapy/chemotherapy, lung was punctured leading to an infection. Biopsy results were late, hence no promised immune therapy was provided just a general, non-specific chemotherapy, which weakened the patient together with hospital-induced punctured lung and infection to the point of not being able to walk and normally function. No help at all, just prolonging of suffering. To top it off, transportation to pick her up and deliver home was not allowed to approach hospital premises and a lying patient on a rolling bed had to be transported for 10 minutes outside in the cold. Avoid if possible

I had this year three operations in Krefeld hospital.Two of them was not planned one of them was planned.Everything goes smootly.Personal are very friendly doctors also will try to explain everything till the end.Food quality also not that bad like hospital food.My plate was empty always.I had only one small minus the pillow for your head its like a carpet to clean your shoes so tin and not comfy at all 😀 Even this hospital is one hour where i live but anyway i would always choose this hospital and recommendate to others

one day I was very sick and had to go to the Emergency. They said they would not treat me. Because I had to be referred to the home doctor first. I wonder which house doctor can be reached at 4 in the morning? They didn't treat me and I wasn't even able to walk. I cried and had to go to another hospital. Besides, the staff working there were very rude. They were talking to me as if they were shouting at me. And even when I asked some questions, they wouldn't even answer me. They didn't even look at me because I was a foreigner. I do not recommend it to anyone. If I had fainted there, I think they would have referred me to a home doctor.

I visited for the second time the emergency today. The first time nobody could point out a doctor as nobody could speak even a little bit English. Today I found a kind lady in the morning reception who gave me instructions to come again at 18:00, visit the 1st floor, to see a doctor for my emergency. I did. As I arrived I said that I don't speak German. None of the assistamts there could speak. They kept my Insurance Card and I was waiting for my turn. I heard my name and a nurse gave me a cup to pee. I used google translate to ask what the cup has to do with my pain and if they have at least someone speaking a little bit English to say what my problem was. They were explaining to me in German and as I could not understand they were just rolling eyes. If you are German prepare to get some rude responses as the specific assistant was yelling to people. If you do not speak German prepare to die as the punishment for not knowing German is death. I feel very disappointed

Really shocking service - be ready to waste your time. I wonder - what would the world be like if we all had the same attitude to each other as the staff do to their patients? HORRIBLE

It's unfortunate, this already seems like social security and even worse!!! I've been here in the emergency room for THREE hours and I'm still waiting....with my back hooked and with horrible pain as they tell me that this is in order of severity...what a mess...well for me it is mine is urgent of course and painful!!! The lack of health personnel and the delays that make patients suffer is a shame!!!! Why do we pay private insurance???? To receive this terrible medical care!!!! It really is sad!!!

Private hospital where you arrive at the emergency room and wait 3 hours to be treated because they only have 3 doctors! And to have an ultrasound it took them more than a month to make an appointment and since they had to change it until January they don't have time... It's a shame to pay private insurance for this. Disaster of organization and way of managing this hospital. The people who work there are charming and professional, it's a shame that they have to work for such a poorly run center.

Unpunctuality and poor patient care. I give one star, not because of the doctor's treatment, but because of the lack of professionalism of those who manage the appointments. It seems to me that, in addition to underestimating the time of those of us who have to suffer the delay of consultations, they try to make us look like fools, making whoever they want go first. The least they could do is give a ticket upon entering to assign a shift, as in other services at the same center. I don't understand how they don't know how to report how long they estimate the wait will be, or at least how many patients are ahead.

Cardiology sent me to ER for a heart issue (atrial flutter). Dr. Garabetyan totally ignored that, and ended up fabricating a non-existent pneumonia. She then IV’ed a fluoroquinolone (floxed me) w/o my knowledge or consent. I now have permanent disability (FQAD), which includes peripheral and small fiber neuropathy, tendinopathy, vitreous detachment (floater) and myriad other disorders and symptoms. Nobody cares, they gaslight you. Be careful.

I visited emergency room in this hospital. Had an acute abdominal pain. I do not speak Spanish well and was afraid of misunderstanding but all hospital staff, physicians and nurses, were very polite and tried to speak with me in English. Also all analysis, CT and medicines were done in a timely manner. Finally, I went home with required treatment. Thank you All!

Thank you very much for safe my life, ZABALETA CARVAJAL, IVAN ANDRES🙏🧚🏻‍♂️and hospital very nice clean comfortable convenient

The new rooms in the new area of the hospital are nice, clean and modern, but the old rooms in the old part of the hospital need to be refurbished, they do not live up to the hospital standards. The food was very basic, not much flavor and for the price of a day stay in the hospital the food should be better quality, taste better and have options on what you would like to have. They also need to improve the wifi/phone signal because nor the wifi nor the internet from my mobile phone provider worked in my room. The television only had Spanish channels and for a high quality hospital one should have international channels in English and other languages. The personal attention was great, the nurses and doctor where amazing. They took excellent care of me.

Had a surgery here and it went very well, staff were working with upmost care and respect. Compared to most hospitals in the US where I'm from, this one deserves 5 stars for the quality and value.

Terrible hospital. The staff are very unfriendly, and if you struggle to speak Spanish they will not put any effort in to try help you in English. I have been there twice in the past 4 weeks for the same issue and the doctor always just prescribes ibeprufon when it’s clear my situation has gotten worse. They also don’t have any equipment, he used his iPhone as a torch and put a pencil in a latex glove and used that to push my tongue down to examine my throat. Completely pathetic the service one gets from this “private” hospital.

I booked an appointment via their online platform with the Diagnostica d’imatge department, because I needed to take a MRI exam for my leg. In the online platform I uploaded my traumatology doctor’s referral where it says I should have two MRI exams taken, one in a rested state and another one after running for 20 minutes to see the difference in my muscle. I even sent the referral via email to the Diagnostica d’imatge department in order to make sure they knew about the fact that I need to make two exams and not only one. They didn’t answer to that email even though I asked for confirmation of receipt. I had no luck reaching the right department via telephone because I don’t speak Spanish or Catalan so well so I gave up on trying to get a confirmation that way. Anway, when I arrived on the day of my appointment, the secretary in the Diagnostica d'imatge department told me that I should have booked two appointments instead of one and it was a problem, but she will try her best to find a solution. I was afraid because I came to Barcelona only for this appointment (I live 3 hours away from the city). After waiting for around 20 minutes the secretary (her name was Andrea, I think) called me and confirmed that I can take the two exams one after the other right away! Eventually everything turned out well and the staff was super friendly, even when I only spoke English. Big thank you again Andrea you saved my day!! :)

Excellent service . Professional doctores and they take care of their patients in a very human way

Im calling all day to cancel an appointment with traumatology, no answer all day, it's been always like that i have to keep calling for hours maybe they pick up the phone, but today no one pick up the phone.

I had to attend the oftalmología urgencias department and the four staff present treated me fantastically. This was on Saturday October 7, and they were busy all day. I had lots of tests and was given an appointment to return on Monday to the main department for a revision. Spain really has the best public care in the world, I'm sure of it. Muchas gracias.

The urgent care facility is dirty, poorly organized. The staff engages in unsanitary practices: trash receptacles-including those that take hazardous waste are left uncovered, and you often see trash littering the floor around the trash cans. Also, multiple patients are asked to sit and lie on the same paper covering on the examining tables. I saw this in multiple examining rooms. The doctor who cared for me, Manuel Luis Gomez Blanco, was rude, impatient and haughty. He tried to dismiss me after treating me for only one of the ailments I came for. It was a very unpleasant experience, but I was able to get the treatment I sought. I just should not have had to deal with such an unprofessional environment and uncaring treatment by staff. I am fortunate my ailments were not life threatening.

I didn’t even want to give you a star. First this La Paz hospital is not friendly to English speaking patients. For international tourists or expats! You will die here . I brought my daughter to their ER. She was having shortness of breath..due to her asthma exacerbation. they made us wait for 3 hours but no treatment given nor tests done. Horrible private hospital. I went to see the doctor to tell her that my daughter needs to be nebulized. Instead of talking to me properly. They sent me out because none of them speaks English and they said wait to be called ! For 3 hours of waiting nobody gave my child management nor diagnostic procedure ! They didn’t care as to what I was pleading for . i will complain to Adeslas my health insurance and will make a report on this . I’m a dermatologist and a medical journalist from the philippines. I know the management to asthma very well. Their doctors/ nurses are all rude and with no empathy to patients. They should have. English speaking representative for the tourists coming to Spain. It’s pathetic that they have no treatment .-

Awful. Patient Management is closed when it have to work. No response via phone to ask why you must pay specific amount of money and for which services. Huge respect for doctors, but management of clinic is awful and they deserve even less than 1 point out of 5.

After almost 30 hours, they still don’t know when they can perform surgery on my kidney stone. They only gave me 5 glasses of water! When I asked them about my situation and the plan, nobody answered! I’m thirsty, hungry, and in pain from the stone for more than 1 day. This is simply the worst hospital I have ever seen in my life!

Unfortunately but I have a pleasure to have surgery on pancreas cancer here. UK NHS said its noopetatable😬. The rooms 10 stars out of 5🙂, super clean, staff constantly checking on you, everything went smooth and pain free(thanks to epidural and painkillers). I have been sent home when I was ready, no complications and, 7 month out and good so far. Highly recommend, plus beautiful town which I was able to see before surgery.

Good doctor, good behavior. Satisfied patient.

I got to see two fabulous doctors, the first in emerg and the second in cardiology (who confirmed the original diagnosis). Both were extremely caring and knowledgeable. I felt in good hands. Minus a half star for the long wait to see the first doctor (but triage ekg was quick so I guess it wasn’t urgent). Minus another half star for the filthy, seatless public toilet for the waiting room but bonus point for the outstanding quality of the doctors.

You doctors who work in the Pitie Salpetriere hospital, bow your heads to the ground and beyond, for all those children's souls, whom you do not stop from their straight and fast path to earth. May all the joys with which you spoil yourselves, turn you into ashes, and let your empty souls shatter like the lives of the innocent, whom you leave daily prey to their suffering, evil and disease, without trying to save them, although their last hope it was with you. And we are not talking about terminal cases, but about people who can be saved easily, if you ONLY tried! World top 10 hospital: an advertisement for nothing!!! You shouldn't even be in the top 3 of a pitiful city, forgotten by the world! Great doctors who don't even see the patient, just sign to be discharged, and hide behind the reception, because you are busy. With what? Did you destroy the next man's life? How many people do you dust a day? Do you have a commission from cemeteries? Change all the staff! You made terrible recruiting mistakes! Give them difficult cases, without them knowing that they are being tested, and see what "doctors" you have! The rest, take their diplomas and useless documents and start sweeping the street, don't let them have the power to turn good people into dust!

I recently was looked after by Department of Thoracic Surgery and they coordinated and led my multidisciplinary operation. I would like to thank all the teams involved in looking after me and providing me with the highest quality of healthcare. I am extremely thankful and humbled by the professionalism and excellent quality of service that you provide to the public day in, day out.

Alert: avoid this hospital for giving birth. During my labor in August, the anaesthetist came very late and failed her job. She did not manage to give me the pain killer Epidural as agreed prenatal, which resulted in an extremely painful delivery. The doctor did not even accomplish the basic task. very disappointed. will not recommend USZ at all.

I am a tourist that presented to the emergency room with stroke symptoms (headache and memory issues). The care was excellent! Every staff member was very caring and knowledgeable! Everyone was very personable. I have worked in Healthcare in the United States for 40 years and feel the care I received far exceeded what I have seen or experienced in the US. Zurich can be proud of their outstanding medical center! A stroke was ruled out and I was diagnosed with amnesia related to a migraine! I highly recommend this medical center for your healthcare needs and appreciate the care they gave me.

Poor management, miscommunication between staffs leading to patient’s EXTREME DISCOMFORT, no empathy whatsoever, PLUS the lack of information given to the patient; having to wait for 2 days still going on with little to no food (to prepare for the surgery which only takes 20 minutes as the doctor had said). The surgery that was planned, gets delayed due to the miscommunication between the staff members. But this was not relayed to the patient and the patient’s family until after waiting for 8 HOURS, keeping the affected ones in the dark. Then promising to do the surgery the next morning but then it gets pushed back to afternoon and then again at around 9 pm. But AGAIN it gets postponed until next day saying the doctor went home, which meant the patient was starving the whole day preparing for the promised surgery which was not done. Even after all this has happened because of their MISCOMMUNICATION and CARELESSNESS, NOT A WORD OF APOLOGY or any better explanation. Sure, it’s a hospital, there could sometimes be many emergency patients at once but they should also have MANAGED properly, they should not have promised something they could not do or they should have made proper plans OR they should have communicated well, at most the staffs should be trained properly on what they should be doing. Save lives but also not try to make any more patients. Hopefully an improvement in the management, the behavior of the staffs towards the patients, and their skills can be seen in the FUTURE if not now because it’s a PURE DISAPPOINTMENT right now.

My dad was supposed to have a surgery on 8 am after the hospital gave an appointment. He wasn’t allowed to eat or drink from midnight til the surgery. But they somehow had a “communication error” saying that the operation room got occupied by another patient after 8 HOURS!! My dad had to wait 8 HOURS in pain without any food or water waiting for the doctor to do the operation in the room. But NOTHING!! It was so irresponsible of them! It felt insulting as if they were looking down on us because we are of different race. I felt so bad for my dad!! Now the operation is gonna take place tomorrow! I had expected better from the hospital!! I wouldn’t even give 1 star if I could but unfortunately I have to, to write this review!!

A mother spent three days begging Help Island psychologists to help her child not commit her seventh suicide. A psychologist and a social worker. The meeting was prepared for three days. Twenty-first century, in the ambulance of the city of Bern, out of 140 thousand Russians and the same number of Russian speakers, but there was no interpreter for the appointment. The elite of the hospital, in the person of a highly paid psychologist and social worker, passed judgement; Listen, ...parents ; the mother should call the police! In truth, they pay 8,000 francs a month out of your taxes to the great healers of the land of Switzerland. There's a Russian saying "don't throw beads in front of pigs". Mother left in silence. The arrogant took it as a victory! A victory over a helpless, disabled woman. Arrogance is formed from the absence of everything else. Education, upbringing, having compassion, morals, responsibility, being helpful...) How does fascism spread? The chief said, you have to smash your forehead, but follow orders! Back in the emergency room, after five hours of being ignored, the mother was brought out a poster, A4 sheet format. It said in large letters, "We won't help you and the three-digit police phone number is 911. The leading psychologists of the hospital and here, showed their professionalism, big letters for a stupid Russian mother. These letters shout: "the doctor said to the morgue, so to the morgue". The mother, of course, was sick, but unlike the friendly staff of the Ostrovny Hospital, she could remember a seven-digit phone number. Where do these mothers get their strength? She brought the baby in. И? Refused!!! This is another story, how she managed to survive, get to the nearest town and finally get help. And what about the friendly staff of the Ostrovny Hospital? They found a clinic where they put a sick, tormented child, called and told them to get rid of him. What does the ambulance care about the clinic? How close, how united is the corporeal spirit, in the pleasure of mocking the Russian, sick mother. Friends, "The future is not for everyone. " Klaus Schwab Unite!

Swedish healthcare in a nutshell. Low quality and racist doctors since free doesnt always mean better. If you dont want to die, travel to a nearby country for 21st century medicine. Also if you read the comments below foreigners all agree. Its only swedes who think their healthcare is amazing. They think that because they compare it to US and feel grateful its ”free”. If you have to wait weeks and months to see a doctor and get a proper diagnosis for even the simplest things; its not worth it and you can die, loose productivity. Its much better if its more expensive and quicker.

European exchange students. Broken finger. We were sent to a private clinic despite having the European Health Card. It seems easier that the pacient goes to a private clinic and pays and eventually and luckily gets their money back from their Social Security than giving them a proper treatment and getting the money from the origin country. Shame

Backward medical system even 100 times lower quality as much as Nepal Especially the old(head?witch?) nurse in emergency reception is killing patients slowly.

I am shocked at how mediocre and overrated this nationally famous clinic is. Even as an international, self-paying client my appointments in late 2022 were continually mixed up and, worse still, the 3 weeks of extensive diagnoses were inconclusive and they recommended cortisone for the pains throughout my body, claiming there was no alternative to this treatment. My pains steadily increased and at one stage I could no longer get out of bed without help. I finally visited a microbiologist in Hamburg who correctly diagnosed the cause, and with a simple change of diet I was pain-free within a week!. I am now completely off cortisone.

The worst childbirth that you could imagine! Unfortunately, we chose this clinic for childbirth. At the 39th week Dra. Laura Muñoz Saá said me, that labor induction was needed. Although we did not agree with this, but we trusted her words that everything will be fine and that it is better for me and child. The doctor assured only about the advantages of induction of labor. However, there was not a word about complications and possible consequences. Although everything was written in the informed consent. After the start of induction, irregular labor began (opening from 2 cm to 10 cm per hour). I screamed from pain and begged for pain relief due to excruciating pain. Everyone just said that I should breathe, and I will never forget the words of the anesthesiologist who came to install epidural anesthesia. He said "all women give birth, what do you mean you can't sit down for 2 minutes?" In those moments, I prayed that it would end soon and barely sat through those 2 minutes of hellish pain. After the examination, the doctor on shift told that the cervix was already fully dilated and the child was in distress. I was told that a caesarean section should be performed immediately. To go through hellish pain so that it ends with an operation is not the worst. The worst thing is when they start making an incision, and you say that you feel pain, just pain, and not the feeling that something is being done. In response from the anesthesiologist, I heard "don't make it up, you can't feel pain." No one but me will understand the torments that I went through and that left a mark on my heart forever. The most beautiful day of my life became one of the worst for me due to excruciating pain and a feeling of helplessness. When you beg for pain relief, which they still think about giving you or not, because they don't believe that you can feel such unbearable pain. The only thing that was at the highest level was the help of the nurses and the matrons with the child. Thank you very much for your work and help!

My parents have been getting treatment at this place since 2018 and since it's doors first openend then, the customer service and quality has gone down by a lot. They are taking on too many people and they are loosing sight of what matters most: the patient and their family. I lost my father recently and I am sure that his doctors at the CUN could have looked after their patient more in detail rather than making us wait for hours sometimes and the most difficult part was for my dad or me to get a hold of his doctors. The ER room service is also basically non existent. I will never use that Clinic again. Great doctors, latest Tecno but not attention to detail and bad administration.

I was lucky enough to be hospitalised here (you know what I mean) : without exception the doctors, nurses and auxiliaries were nothing less than superb. I thank them all!

Private hospital based in Pamplona and Madrid. It is worth making the trip to attend any of its specialties, which are not few. In my case, they have given us endless possibilities. All staff are attentive, they explain each intervention/treatment in detail and work with insurance. Everything is organized and they have professionals for everything. Appointments are usually on time, the waiting time in the room is short. There is a parking lot right in front. We will repeat and I recommend this clinic.

An incredible service, the best hospital I have ever been too. Bedside manner from doctors, nurses, and all staff is fantastic

Not possible to schedule appointment via phone, only email. Very long waiting time, appointments are always late for 30-60mins or longer, and management does not notify about delays, patients time is not respected at all.

**^Racism warning. I met with Dr Raquel Vieira to have my implant taken out as me and my husband wanted to start trying for children. Firstly she wouldn’t let him be in the room even after I insisted. Then during the procedure she proceeded to tell me “COLOURED men like to have many wives” and told me I needed to “really check” to see if he had other wives, and children I didn’t know about. This was extremely shocking to hear, coming from Sweden and the U.K. I felt very uncomfortable as she was stitching me up I was in shock and felt very unsafe around this doctor. I can only imagine how she would treat me if I was darker skinned or god forbid decided to make her my doctor for my pregnancy. Very unprofessional and unpleasant let alone racist and illegal.

The service too bad I’m trying more than 2 months to take appointment to show exams to the dr their phones never answer! They never respect people

Came here for an emergency with my travel insurance during my vacation on a Portuguese public holiday. We were received well and in timely manner.

My husband, Kevin, had spinal surgery on Friday 19th May. The care and skill of the surgeon, Dr. Ricardo Frada and of the team of nurses, auxiliaries and the physio on the ward- fantastic. The hospital is very clean and pleasant and the patients’ rooms have natural light and plenty of space. Even the food was high quality. We would both recommend this hospital very highly for spinal or orthopaedic surgery.

High quality hospital with quick response time and professional staffs

My wife and I have been going to this hospital for a couple of years. We have a family doctor (always late but doctors do have other patients with problems that need intervention, I like to think) speciality doctors for hematology, dermatology, gynecology and urology. They all have a specified amount of time to allot to each patient for consultations so sometimes it seems rushed but they have all been very professional and in almost all cases attentive and caring. The hospital is very busy and i think the receptionists do an excellent job of helping patients.

Mammogram and ultrasound checks everyone's helpful. Friendly and professional felt relaxed with all the helpful doctors .nurses and receptionistist would give them more stars 🌟 then five

Recepcionists who answer the phone are hysterical and rude. The worse!! The lady who answered to me and didn’t want to transfer to her boss or the person I called for, started yelling as crazy to me. Asking me personal information but she denied to give me even her name or transfer the call. I even advise her to take a valium and she hung up on me. Crazy lady

I had the worst experience in care, I had an obstetrics consultation, and Dr.Ana Branco, who attended to me, was extremely rude, I felt offended, talked about my country of origin and even revealed the sex of my baby, without even asking. If you would like to know, you leave the room completely destabilized, I'm thinking like a doctor who treats pregnant women, doesn't have the slightest bit of empathy! It's a shame to pay so much for a consultation and go through a situation like this! I chose Hospital da Luz, because I believed that there would be excellent professionals there to assist me, especially at such a sensitive stage, which is often pregnancy! But I would give 5 stars to the nurse and attendants who were super friendly and attentive, the opposite of the doctor.

Good experience in the A&E but regular appointments get very delayed. The doctor was 29 minutes late for my appointment. Not a good use of my time.

Hospital

I had a horrifying experience with Manuela Soares. I do not wish to post my personal details here, but this woman should NOT be allowed to see patients. I filed a complaint and the hospital said they “investigated” but didn’t contact me or make any attempts to solve this issue. Better to be safe and go to Luz Hospital.

I've been to this hospital 4 times in 6 years and always had a very good experience (as good as it can be while sick or injured). Staff and doctors are friendly, speak English. It's well organized, services are pretty close to each other and we're given good guidance. The service coverage by insurance is excellent, I've gotten out of here with consultation + 4 exams done including multiple X-rays and blood analysis paying only 20€, while clinics charge 70 for a basic consultation. If anything, material seems insufficient: I've seen cleaning staff having to ask doctors for gloves and my doc's computer froze regularly, stalling the consultation ~15 mins.

Simply disgusting quality of service from the administration. I give them one star! Alternatively, the hospital management enter the kpi for their work. The more people you serve, the more your salary will be, because it’s unbearable, they do everything they want, just not their work.

I waited for 1h40min for an appointment and it got to the point where they wait was ridiculous, I had already had to cancel my next thing, and felt absolutely frustrated for coming all the way for a consultation, waiting so long to then desist as I don’t have more life to lose on this. The only reason I don’t give it 1 star is that the receptionist was nice and helpful and that the check in was easy. I don’t plan on going to CUF for help ever again.

They performed the surgery well. But was too expensive, they took far too long for a private hospital and they didn't explain costs. I cannot dispute the charges without making an account but I can only make an account by going in person. Not sure if it would be better than a public hospital in most countries

Just want money, no more than that. They told us to pay an amount of money regarding an appointment in the hospital and we already paid it then found a higher invoice to be paid later while we confirmed in the hospital several times that there would be no extra cost.