Cancer Control Agency – Expert Reaction

The Government has announced it will establish a new Cancer Control Agency by the end of the year.

The announcement was part of the release of the Cancer Action Plan, which includes a funding boost for PHARMAC and an interim National Director of Cancer Control – University of Otago’s Professor Diana Sarfati – who starts the role immediately.

The SMC gathered expert comment on the announcement.

Dr George Laking, Te Whakatōhea, Medical Oncologist, comments:

“I welcome the document. I feel our politicians are aware that cancer is an electorally relevant issue. If they are seen to get cancer wrong, they jeopardise their electability.

“The plan for cancer is a benchmark example of high-quality, accessible, taxpayer-funded public services, I especially like the emphasis on equity.

“The tricky bit is that this plan represents a step ahead for cancer services, but it is still necessary to protect equity across society, not only when people are afflicted by cancer. There is a real risk that investment in one worthy area, i.e. cancer, will cause harm by increasing inequity in other areas. So I would expect a similar level of attention and investment in other public services, including for example, other areas of health and disability, education, housing, transport, and employment.

“I refer to the RACP’s ‘Make It The Norm’ campaign, that calls for Equity through the social determinants of health. Make It The Norm calls for Healthy Housing (e.g., residential Warrants of Fitness), Good Work (e.g., a Living Wage), and Whānau Wellbeing (e.g., a child-centred approach to all legislation).

“As noted above, this cancer plan is a benchmark for high-quality, accessible, taxpayer-funded public services. It is my view that for our public sector to perform equitably at this level, requires an increase in revenue. New Zealanders who like this cancer plan have a duty to make a vocal call for increased public revenue, which to my mind means increased taxation, both personal and corporate.

“Apart from that, in terms of the plan’s technical content, as an oncologist who treates people with lung cancer, I strongly support the intention to ‘Promote vaping to support smokers to switch and introduce legislation to ensure vaping is regulated appropriately’.

“I have a project that broadly seeks to implement the principles of Sir Mason Durie’s Te Whare Tapa Whā into cancer care. In relation to this, I strongly welcome the plan’s appeal to Māori models of service delivery.

“One concept that should be further developed in the plan is that of Te Taha Wairua – the spiritual aspect of health. I understand it broadly as the search for meaning and purpose in life. So far the document mentions wairua only once, in the context of wairuatanga, and a promise to ‘undertake specific actions to ensure equitable outcomes for tangata whenua, and … ensure that tangata whenua world views, values and wairuatanga (spirituality) are present in our work’. The Plan still needs work on this aspect. I could find only two further references to the word ‘spiritual’, one in a section on Patient Experiece, and the other in a section on Rongoā Māori.

“The role of Cultural Safety should be further developed. It is currently positioned in relation to workforce performance. I would position Cultural Safety as the basic template for quality assurance of services.”

Conflict of interest statement: These comments are made in my personal capacity. I Chair End Smoking New Zealand, which advocates for tobacco harm reduction including vaping. I am the NZ President-Elect of the RACP. I am a member of the Australasian Professional Society on Alcohol & other Drugs (APSAD), and of the Society for Research on Nicotine & Tobacco (SRNT).  

Emeritus Professor Peter Davis, Population Health and Social Science; Honorary Professor, Department of Statistics, University of Auckland, comments:

“Are there major problems with New Zealand’s cancer services? No, although there is always room for improvement. A review of 71 countries published in The Lancet last year put New Zealand in the top eight for cancer survival.

“Are New Zealanders being denied life-saving cancer drugs by PHARMAC? No, although there are many cancer drugs that are either unproven or of marginal clinical significance. A 2016 published paper comparing Australia and New Zealand on cancer drugs found that those not funded by PHARMAC did not deliver clinically meaningful health gains.

“Is there a problem in the approval system for cancer drugs? Yes. A review of oncology approvals by the European Medicines Agency 2009-2013 found that most drugs entered the market without evidence of benefit on survival or quality of life, and this still was not evident three years afterwards.

“Is there a danger that generous funding of cancer drugs can provide no benefit? Yes. Most drugs paid for by the UK’s Cancer Drugs Fund had ‘no meaningful benefit‘.

“Will a Cancer Control Agency make a difference? Maybe! But we need to inject more solid evidence into the debate!”

Conflict of interest statement: As a health policy and health services specialist, I have followed the fortunes of PHARMAC since the days when it was a purchasing unit in the Ministry of Health in the late 1980s, and regard it as an exemplary, evidence-based decision-making health agency.

Professor Gregor Coster, Dean, Faculty of Health, Victoria University of Wellington, comments:

“The Government’s announcement that a Cancer Control Agency is to be established, along with an extra $60 million over two years for Pharmac to purchase cancer drugs, is exciting and timely.

“Recently New Zealand has been falling behind in its performance for cancer treatment compared to a number of other countries. And the disparities in cancer outcomes for Māori and Pacific peoples leaves us ashamed of our failure to make any headway there.

“So what will be different with the new plan? Firstly the Cancer Control Agency will wrap up four existing Cancer Control Networks into one and begin progress towards obtaining better cancer outcomes independent of where we live, that is to say removing postcode variations.

“The proposed development of Quality Performance Indicators for most of the major cancer groups is welcome. But it will be important that DHBs have the health workforce, including cancer specialists, radiologists, radiotherapists, oncologists, cancer nurses, and many others, to enable these services to be delivered.

“We know that New Zealand has a shortfall of these cancer treatment professionals, and that filling the gaps has a long lead time. In addition, there is much to do in ensuring DHB hospitals are properly equipped to deliver cancer treatment services. This is linked to funding, and we know that DHB deficits for the year ending June 2019 are likely to exceed $500 million. How are DHBs going to deliver better services with these workforce and funding pressures?

“The increased funding for cancer drugs has been a long time coming, as is the welcome speeding up of the process for drug registration and progress through the drug tendering process. Pharmac has been slow to respond to the availability of new cancer drugs but now it has an opportunity to demonstrate to the public how it can respond to the new Cancer Action Plan.

“It is a shame that it has taken so long for a Government response to the calls from cancer patients for action, but on the positive side we can now see light at the end of the tunnel and look forward to some real action.”

Conflict of interest statement: Former Deputy Chair of Pharmac, nine years on board, 2000-2009; Former West Coast and Counties Manukau DHB board chair.