Vol 134 No 1545: 12 November 2021

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Issue Summary

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Exploring the response to the COVID-19 pandemic at the rural hospital–base hospital interface: experiences of New Zealand rural hospital doctors | OPEN ACCESS

Garry Nixon, Katharina Blattner, Stephen Withington, Rory Miller, Tim Stokes

In many overseas countries, those living in rural areas have experienced poorer health outcomes as a consequence of the COVID-19 pandemic than their compatriots living in cities. This study interviewed 17 senior doctors in different New Zealand rural hospitals about their experience planning for the pandemic in its early stages. In particular this study considered their interactions with the local DHB and base hospital. There was considerable variability in how well the rural doctors felt supported by their DHB. It was common to feel both forgotten by the DHB and at the same time overwhelmed by masses of often contradictory information that was not always relevant to their situation. Established clinical leadership and a stable workforce aided pandemic preparations, as did pre-existing high quality relationships with the local DHB. The rural doctors were concerned about the ability of their local facilities to handle large numbers of seriously unwell and highly infectious patients, but were even more concerned about the ability of the system to transport those needing advanced care to the base hospital. Having the needs of rural health considered at a national level, rather than DHB by DHB, could have improved the response. Many were very relieved that the system had not been tested the way it has been in other countries.

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Food, nutrition and cancer: perspectives and experiences of New Zealand cancer survivors

Rana Peniamina, Cheryl Davies, Losa Moata’ane, Louise Signal, Huia Tavite, Lisa Te Morenga, Rachael McLean

We interviewed cancer survivors from three New Zealand ethnic groups (Māori, Pacific Peoples, NZ European) about their experiences of food and nutrition during and after cancer treatment. Most reported they had received little or no nutrition advice or support as part of their cancer care. For some, that meant they did not realise nutrition could be important for cancer outcomes. Many said they wanted their cancer care team to provide them with advice and information about what to eat to help them with their recovery during treatment and prevent cancer coming back in the future. In addition, support (eg, access to a dietitian, financial/practical support) is needed to help cancer patients eat well to support their recovery and ongoing health beyond treatment, and to reduce inequities in cancer outcomes.

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Barriers to physical activity in prostate cancer survivors

Asmita Patel, Grant M Schofield, Justin WL Keogh

Physical activity is beneficial for patients throughout the prostate cancer continuum, from diagnosis through to survivorship. The majority of prostate cancer survivors are not engaging in sufficient physical activity to achieve health-related gain. This qualitative study designed to identify barriers to physical activity in 16 prostate cancer survivors found only two of the six barriers for physical activity directly related to having had prostate cancer. With an increase in prostate cancer survivorship, practitioners who treat prostate cancer patients or see prostate cancer survivors on a regular basis for the monitoring of prostate specific antigen (PSA) levels and for other conditions are ideally positioned to provide advice or referral for physical activity or physical activity programmes.

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Breast cancer costs in New Zealand’s public health system

Chunhuan Lao, Mohana Mondal, Marion Kuper-Hommel, Ian Campbell, Michael P Cameron, Ross Lawrenson

The costs of treating breast cancer in New Zealand’s public health system are substantial and have been increasing. Most of the cost was in the first year post diagnosis, and surgery and immunotherapy cost accounted for the biggest proportion. The greatest costs were for the treatment of younger women and those with more advanced disease

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Use and results of systemic treatments for de novo and recurrent metastatic breast cancer: a population-based cohort study

Chunhuan Lao, Marion Kuper-Hommel, Ian Campbell, Mark Elwood, Ross Lawrenson

Although Māori patients had good access to systemic treatment for metastatic breast cancer, Pacific women with metastatic breast cancer were less likely to receive chemotherapy and trastuzumab (herceptin) than non-Pacific women. Endocrine therapy, chemotherapy and trastuzumab all improved survival in patients with the specific biomarkers that are used to target therapy.

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Addressing equity: a 10-year review of strabismus surgery in 0–19-year-olds in the New Zealand public health system

Cheefong Chong, Alexandra Lawrence, Dan Allbon

Disproportionately fewer strabismus surgeries were performed in Māori. Disproportionately fewer strabismus surgeries were performed in Pacific Peoples. Minority ethnic groups are less likely to receive secondary operations following a primary procedure when compared to European ethnic group. There appears to be inter-regional variation in the incidence of surgeries performed, which could reflect inter-regional disparities in access surgical services. The findings could also suggest earlier access to surgical services for Europeans when compared to all minority ethnic groups.

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A distance-based approach to rurality and remoteness in health: concept, methodology and correlates of a patient-centred health services spatial accessibility index

Emmanuel Jo, Chris Lane, Keri McArthur, Fei Xu

How many health practitioners will be required to meet the needs of patients in rural and remote areas in New Zealand in future years? That was a question that the analytics team in the Health Workforce Directorate of the Ministry of Health was trying to answer, but there wasn’t a reliable way to identify which rural and remote patients should be targeted. To identify such rural and remote patients, the team calculated a “distance score” based on how far they live from primary care facilities and from hospitals with extensive specialist and emergency services. The 20% of patients with the highest distance scores live mainly in smaller towns and rural and remote areas and have a relatively high proportion of older people, Māori and people living in high socioeconomic deprivation. Being able to identify these patients means the Ministry of Health has a better understanding of which health services are currently serving these patients and where resources need to be put to improve services to them.

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He Pikinga Waiora Kimi Ora lifestyle programme: case study of a successful community-based Indigenous diabetes intervention

Bridgette Masters-Awatere, Shemana Cassim, Jade Tamatea, Nina Scott, Chae Simpson, Cherie Paekau

This paper describes a co-designed programme that involved collaboration between Māori healthcare providers, community members, research advisors and wider community agencies. Together they developed and implemented the Kimi Ora lifestyle programme that was tailored to work with Māori communities in a responsive and flexible manner. Kimi Ora resulted in successful biomedical outcomes, high level of engagement and 100% participant retention.

Editorial