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Chris Jackson. Photo/Ken Downie/Listener

How the Cancer Control Plan aims to stop NZ's survival rates falling further behind

Cancer is the leading cause of death in New Zealand; it kills nearly a third of us, and our growing elderly population means this is likely to continue. By 2040, the number of people diagnosed is predicted to be about 144 a day.

Now, however, there is a sense of excitement among clinicians and researchers who believe we have our best chance in generations of making changes that will have a meaningful result, thanks to the soon to be released Cancer Control Plan and the newly formed Cancer Control Agency.

The plan, already released in its draft form, takes a wide-ranging view of things we could be doing better – such as extending the current Breastscreen Aotearoa programme, fully rolling out bowel cancer screening, increasing funding for medicines, speeding up access to new drugs and increasing genetic-testing services.

New Zealand has been falling behind other comparable countries in survival rates for some of the biggest cancer killers. In a study published last year in Lancet Oncology, which looked at seven key cancers in seven high-income countries, we were in the bottom two for pancreatic, lung and ovarian cancer. University of Auckland research comparing New Zealand with Australia told a similar story.

Read more: US specialist whose husband died of cancer says we need to stop toxic treatments and get smart

“As an oncologist who sees patients every day, it hurts on a personal level,” says Chris Jackson, medical director of the Cancer Society. “Many have been on waiting lists and the first thing you have to do is apologise for the wait time. It sucks, it’s terrible. You sit with a family and say, here is the situation, and know in your heart you could do more if there were more resources.”

Although research for future treatments is important, Jackson believes there is a lot to be gained by better resourcing the service we already have, and using existing tools more effectively.

“We need to invest in systems, not just drugs,” he says. “Waiting times, workforce capacity, up-to-date electronic systems so people’s doses aren’t scribbled on a handwritten note … All these small things along the way are what contribute to high-quality care.”

There is a lot of money in it for companies that market new diagnostics and therapies. Jackson stresses that it is important not to get overwhelmed by the hype around them, particularly when there are still wins to be had with basic prevention tactics – according to the World Health Organisation, eliminating smoking has the potential to get rid of 22% of cancers, for instance.

Jason Gurney. Photo/Supplied
At the heart of the new cancer plan is fixing inequities in the system, whether that means addressing the postcode lottery around who has access to the best treatments or fixing the disparities between different sectors of the population, particularly the fact that Māori are 20% more likely to get cancer and nearly twice as likely to die from it as non-Māori.

For some cancers, Māori are getting diagnosed at a later stage. That is a contributing factor but far from the only one, according to recent research by Jason Gurney of the University of Otago, Wellington.

Take our biggest killer, lung cancer. “With lung cancer, Māori are less likely to be offered curative treatments and more likely to be offered palliative treatments,” says Gurney. “There are various reasons, but stage of disease at diagnosis is not one of them.”

What is at play is the fact that Māori are more likely to have other health problems, such as diabetes and cardiovascular disease. Clinical trials exclude people with these conditions, meaning there is less proof treatments will work and subsequent reluctance among doctors to prescribe them.

“There is compelling evidence that we’re undertreating patients with co-morbidities, and we’re suspicious it’s happening across all cancers,” says Gurney.

Redesigning the system so that it works better might mean having more Māori medical personnel. Or new approaches such as the self testing that has been suggested as part of the proposed HPV screening programme to make it easier to target communities that have been reluctant to go for the existing cervical cancer pap test.

It is a complex problem and there will be multiple ways of approaching it.

Gurney admits he gets depressed when he looks at how little progress has been made so far. But he believes the new cancer initiatives have a shot at improving the situation for Māori, as long as there is enough buy-in.

“We shouldn’t hold out hope that inequities are going to be fixed by technology,” he says. “They will be solved by political and social will, and making difficult choices about what we are going to prioritise and resource.”

This article was first published in the February 15, 2020 issue of the New Zealand Listener.

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