Fighting to Improve Care

The decision to fully-fund Herceptin for those with HER2-positive breast cancer has provided a lifeline to hundreds of New Zealand women. But there’s still a long way to go before breast cancer survival rates in this country match those in many other western nations.

The most recent New Zealand statistics available on breast cancer survival rates from the Northern Regional Cancer Network make for sobering reading. They reveal that New Zealand’s five-year survival rate for breast cancer is around 84.4 per cent. This compares with 87.8 per cent for Australia, 88.7 per cent for the United States and 87 per cent for Canada.

There’s so much more that can and should be done to ensure New Zealand women have access to the best possible treatment in a timely fashion so that we see better breast cancer survival rates.

There are eight key areas that need to be looked at. These are:

Long waiting times for breast cancer treatment

There are women who have had to wait more than three months between surgery and chemotherapy. Such delays not only cause distress to patients and their families, but are likely to result in poorer outcomes for patients.

Among other things, a severe shortage of qualified oncologists and medical staff further exacerbates this problem. It is important that the Government ensures that District Health Boards (DHBs) are accountable for ensuring adequate staffing in critical areas such as medical oncology, surgery and radiation oncology.

Low and slow access to breast cancer medicines

New Zealanders, including women with breast cancer, have low and slow access to the latest innovative medicines. The 2007 Karolinska Report showed that of 25 countries surveyed only Poland spends less on cancer medicines than New Zealand.

Women with breast cancer have suffered directly from delays in funding important medicines. For example, taxanes have long been recognised as effective chemotherapy agents. Australian women were given funded access to taxanes in 2001 but New Zealand’s drug-buying agency, Pharmac, failed to provide access in this country until 2006. It’s tragic that New Zealand women had to wait five years before they could access the same life-saving treatment as their Australian counterparts.
In addition, two other breast cancer medicines are currently funded in Australia, but not in New Zealand. These are the innovative and effective anti-emetic aprepitant (Emend) and the targeted anti-HER2 medicine lapatinib (Tykerb), used in advanced breast cancer.

The Government has allocated an extra $139 million over four years for medicines as part of the Budget 09, but believes more needs to be done to bring New Zealanders’ access to medicines in line with other similar countries in the OECD.

Inconsistencies in provision of cancer services across the DHBs

The kind of treatment you receive for breast cancer will vary depending on where you live. This kind of inconsistency is unacceptable and there needs to be a uniform approach to the provision of breast cancer treatments and services throughout the country.

Lack of a comprehensive Cancer Register

It is very difficult to make decisions about future breast cancer care and treatment without detailed data on the disease. Unfortunately, New Zealand does not collect comprehensive data on cancer. We gather basic information about the occurrence of the different types of cancer across ages and ethnic groupings, and mortality rates. But we do not formally collect data on stage, precise diagnosis, the nature and timing of interventions and outcomes that would allow us to understand the full demographics of the disease, or the impacts of treatments and the performance of service providers.

An excellent start has been made with the establishment of Auckland and Waikato Breast Cancer Registers, and others are scheduled to roll out to other centres. However, a comprehensive national cancer register also needs to be established and implemented urgently.

Poor outcomes for Māori and Pacific women

Māori and Pasifika women tend to have breast cancer at a younger age, have a higher proportion of the aggressive HER2 positive form of breast cancer and a higher death rate than European women.

In addition, Māori and Pasifika women are less likely to attend breast screening and tend to present with the disease at later stages, so targeted recruitment for screening is especially important for this group.
The provision of community and iwi-based programmes is needed to help detect breast cancer in these vulnerable populations and to support those women who are diagnosed with the disease.

Low uptake of breast screening

Statistics show that breast screening rates are lower than 70 per cent for eligible women, and even lower for Maori and Pasifika women. Early detection of breast cancer is key to tackling the disease and ensuring a positive outcome.

Breast Screen Aotearoa (BSA) has also identified various ways to increase the number of women screened, and the Government needs to support BSA in its endeavours to ensure more eligible women take advantage of this potentially life-saving test.

Limited consumer representation on various government cancer-related organisations

Cancer consumer (or patient) representatives are not included on many of the official Government bodies set up to oversee cancer care in this country.

There needs to be a greater representation of cancer patients/consumers on these bodies so that they can provide valuable insights and wisdom across the cancer continuum and ensure the delivery of effective patient-centred services.

Lack of psychosocial support for women with breast cancer

At present there is little support provided within the New Zealand public health system to help cancer patients with the psychological and emotional upheaval of a cancer diagnosis. Instead, most psychosocial care and support is provided by non-Government organisations, such as the Cancer Society, BCAC and Breast Cancer Support.

Counselling and support services should be established within the public health system to help cancer patients through what is an emotionally difficult time.

If you’d like to see improvements in cancer care, write to your MP outlining the need to address the issues above. Alternatively, you can support BCAC in its work to improve breast cancer care by visiting www.breastcancer.org.nz and clicking on the donations and sponsorship link.