“We are at a crossroads where our choices, or refusal to make choices, have clear implications for our ability to provide care in the future. How can we provide care, improve options and outcomes for patients with cancer, and do so within a socially responsible, cost-effective and sustainable framework?”
Sullivan et al, Lancet Oncology (2011)1
Cancer is the leading cause of death in Aotearoa/New Zealand. The number of those affected by cancer is forecast to increase by 50% in the next 15 years, primarily driven by a growing and ageing population.2 Our survival rates from cancer lag behind those of Australia, Canada and Scandinavian countries, and are not improving at the same rate as elsewhere.3 Even more telling is that our outcomes for cancer vary within New Zealand. Our Indigenous and most marginalised fare worse, with Māori and Pacific people having higher rates of preventable cancers, worse survival and higher death rates than other New Zealanders.4–6 Increasingly, regional variations in care and outcome are being reported.7
At the same time, the costs of cancer care are escalating beyond our capacity to afford them. Drivers include the rising number of people with cancer, increasing age and comorbidity of patients, technology and new drugs, increasing specialisation, and increasing awareness of and demand for supportive care. The pace of change in cancer management, particularly new drugs and technology, presents major challenges for our systems and services.1
The management of cancer is uniquely complex, impacting on every aspect of our healthcare services, and so any solution must have a whole-of-system focus. Of course, many of the challenges we must face in relation to cancer care and control are not unique to us in New Zealand,1 and there is much to be learned by looking abroad.
These issues are not new. During the late 1990s, the sector worked together, led by the NZ Cancer Control Trust (funded by the Cancer Society of New Zealand and the Child Cancer Foundation), to develop a comprehensive Cancer Control Strategy.8 The Strategy was launched in 2003, more than a decade and a half ago. That strategy had a strong equity focus, its scope was broad, encompassing cancer prevention through to palliative care and research. It was followed by a series of cancer action plans that were more operational in their intent. By 2015, the focus of cancer control had largely narrowed to emphasise cancer treatment occurring in hospitals, with the advent of “better, sooner, more convenient cancer care”.9 This initiative was supported with treatment-related targets, which while popular, were not clearly related to improved outcomes. Achieving equity was largely absent from ongoing policy, and resource allocation was hamstrung by the reduced investment in Māori providers and the 2006 Ministry directive that the Treaty of Waitangi clause be removed from official documents.10 In the last three years the Cancer Control Council, and Te Kete Hauora, the Māori Health Business Unit at the Ministry of Health have been disestablished, key prevention opportunities such as Sunsmart initiatives, alcohol and tobacco supply reduction, and action against obesity have all seemed to falter. Many in the cancer sector came to view progress on cancer control as stalled, and lacking in key government leadership.
In response, the Cancer Care at a Crossroads conference was held in Wellington in early 2019.11 This was a landmark event jointly hosted by the University of Otago, Wellington and the Cancer Society of New Zealand, in partnership with the Ministry of Health and the New Zealand Society for Oncology. It was attended by around 400 people from across the cancer control spectrum; people affected by cancer, NGOs, primary and secondary care service providers, academics and policy makers. The conference was opened by a powerful call to action from Blair Vining, who has terminal bowel cancer and his wife, Melissa, with the words [from Melissa] to the Minister of Health “You have failed Blair, you have failed me and my children, and you have failed many other New Zealanders by not having a cancer plan”.
Invited speakers covered wide-ranging topics, identifying strengths, weaknesses and high priority cancer control activities for governance, surveillance, prevention, early detection, treatment, palliative care and research. There was a strong focus on Māori leadership and rights, addressing health needs of Māori and other underserved populations, with a view to eliminating inequities in outcomes from cancer. Speakers from the UK, Canada, Australia and Europe described effective global responses, which included the development and redevelopment of dedicated cancer agencies, comprehensive cancer control plans, central planning and monitoring of both processes and outcomes within cancer systems. Local speakers and attendees highlighted a growing frustration at the sense of lack of progress in cancer control, and the mood was that we are indeed at a crossroads.
Several key themes emerged.
The meeting garnered three days of continuous media attention, and saw the Minister of Health answering questions across a variety of media outlets about his Government’s response to cancer control. The Minister noted he had heard the call and was deeply moved by Blair and Melissa Vining, and promised to commence work on a national cancer plan, with a draft to be delivered by June. The voice of the sector and the demand for change was clearly conveyed.
The remaining question is what the quality and scale of the response will be. Will a new cancer control plan address the entrenched structural issues in New Zealand, that have seen the delivery of inequitable and uneven care? Will we have a programme that delivers bold and evidence-based prevention goals that challenge our political comfort? Will there be a leadership framework and technology evaluation process that sets us on a path that can engage with the realities of managing growth in demand and cost, as well as ensuring high-quality and equitable care? A repacking of current efforts and labelling this as a cancer control plan would risk selling New Zealand short for a generation. We are at a crossroads and face a choice; that choice (or failure to make a choice) will have profound implications for many years to come.
Table 1: Examples of centrally funded comprehensive cancer institutes.
“We are at a crossroads where our choices, or refusal to make choices, have clear implications for our ability to provide care in the future. How can we provide care, improve options and outcomes for patients with cancer, and do so within a socially responsible, cost-effective and sustainable framework?”
Sullivan et al, Lancet Oncology (2011)1
Cancer is the leading cause of death in Aotearoa/New Zealand. The number of those affected by cancer is forecast to increase by 50% in the next 15 years, primarily driven by a growing and ageing population.2 Our survival rates from cancer lag behind those of Australia, Canada and Scandinavian countries, and are not improving at the same rate as elsewhere.3 Even more telling is that our outcomes for cancer vary within New Zealand. Our Indigenous and most marginalised fare worse, with Māori and Pacific people having higher rates of preventable cancers, worse survival and higher death rates than other New Zealanders.4–6 Increasingly, regional variations in care and outcome are being reported.7
At the same time, the costs of cancer care are escalating beyond our capacity to afford them. Drivers include the rising number of people with cancer, increasing age and comorbidity of patients, technology and new drugs, increasing specialisation, and increasing awareness of and demand for supportive care. The pace of change in cancer management, particularly new drugs and technology, presents major challenges for our systems and services.1
The management of cancer is uniquely complex, impacting on every aspect of our healthcare services, and so any solution must have a whole-of-system focus. Of course, many of the challenges we must face in relation to cancer care and control are not unique to us in New Zealand,1 and there is much to be learned by looking abroad.
These issues are not new. During the late 1990s, the sector worked together, led by the NZ Cancer Control Trust (funded by the Cancer Society of New Zealand and the Child Cancer Foundation), to develop a comprehensive Cancer Control Strategy.8 The Strategy was launched in 2003, more than a decade and a half ago. That strategy had a strong equity focus, its scope was broad, encompassing cancer prevention through to palliative care and research. It was followed by a series of cancer action plans that were more operational in their intent. By 2015, the focus of cancer control had largely narrowed to emphasise cancer treatment occurring in hospitals, with the advent of “better, sooner, more convenient cancer care”.9 This initiative was supported with treatment-related targets, which while popular, were not clearly related to improved outcomes. Achieving equity was largely absent from ongoing policy, and resource allocation was hamstrung by the reduced investment in Māori providers and the 2006 Ministry directive that the Treaty of Waitangi clause be removed from official documents.10 In the last three years the Cancer Control Council, and Te Kete Hauora, the Māori Health Business Unit at the Ministry of Health have been disestablished, key prevention opportunities such as Sunsmart initiatives, alcohol and tobacco supply reduction, and action against obesity have all seemed to falter. Many in the cancer sector came to view progress on cancer control as stalled, and lacking in key government leadership.
In response, the Cancer Care at a Crossroads conference was held in Wellington in early 2019.11 This was a landmark event jointly hosted by the University of Otago, Wellington and the Cancer Society of New Zealand, in partnership with the Ministry of Health and the New Zealand Society for Oncology. It was attended by around 400 people from across the cancer control spectrum; people affected by cancer, NGOs, primary and secondary care service providers, academics and policy makers. The conference was opened by a powerful call to action from Blair Vining, who has terminal bowel cancer and his wife, Melissa, with the words [from Melissa] to the Minister of Health “You have failed Blair, you have failed me and my children, and you have failed many other New Zealanders by not having a cancer plan”.
Invited speakers covered wide-ranging topics, identifying strengths, weaknesses and high priority cancer control activities for governance, surveillance, prevention, early detection, treatment, palliative care and research. There was a strong focus on Māori leadership and rights, addressing health needs of Māori and other underserved populations, with a view to eliminating inequities in outcomes from cancer. Speakers from the UK, Canada, Australia and Europe described effective global responses, which included the development and redevelopment of dedicated cancer agencies, comprehensive cancer control plans, central planning and monitoring of both processes and outcomes within cancer systems. Local speakers and attendees highlighted a growing frustration at the sense of lack of progress in cancer control, and the mood was that we are indeed at a crossroads.
Several key themes emerged.
The meeting garnered three days of continuous media attention, and saw the Minister of Health answering questions across a variety of media outlets about his Government’s response to cancer control. The Minister noted he had heard the call and was deeply moved by Blair and Melissa Vining, and promised to commence work on a national cancer plan, with a draft to be delivered by June. The voice of the sector and the demand for change was clearly conveyed.
The remaining question is what the quality and scale of the response will be. Will a new cancer control plan address the entrenched structural issues in New Zealand, that have seen the delivery of inequitable and uneven care? Will we have a programme that delivers bold and evidence-based prevention goals that challenge our political comfort? Will there be a leadership framework and technology evaluation process that sets us on a path that can engage with the realities of managing growth in demand and cost, as well as ensuring high-quality and equitable care? A repacking of current efforts and labelling this as a cancer control plan would risk selling New Zealand short for a generation. We are at a crossroads and face a choice; that choice (or failure to make a choice) will have profound implications for many years to come.
Table 1: Examples of centrally funded comprehensive cancer institutes.
“We are at a crossroads where our choices, or refusal to make choices, have clear implications for our ability to provide care in the future. How can we provide care, improve options and outcomes for patients with cancer, and do so within a socially responsible, cost-effective and sustainable framework?”
Sullivan et al, Lancet Oncology (2011)1
Cancer is the leading cause of death in Aotearoa/New Zealand. The number of those affected by cancer is forecast to increase by 50% in the next 15 years, primarily driven by a growing and ageing population.2 Our survival rates from cancer lag behind those of Australia, Canada and Scandinavian countries, and are not improving at the same rate as elsewhere.3 Even more telling is that our outcomes for cancer vary within New Zealand. Our Indigenous and most marginalised fare worse, with Māori and Pacific people having higher rates of preventable cancers, worse survival and higher death rates than other New Zealanders.4–6 Increasingly, regional variations in care and outcome are being reported.7
At the same time, the costs of cancer care are escalating beyond our capacity to afford them. Drivers include the rising number of people with cancer, increasing age and comorbidity of patients, technology and new drugs, increasing specialisation, and increasing awareness of and demand for supportive care. The pace of change in cancer management, particularly new drugs and technology, presents major challenges for our systems and services.1
The management of cancer is uniquely complex, impacting on every aspect of our healthcare services, and so any solution must have a whole-of-system focus. Of course, many of the challenges we must face in relation to cancer care and control are not unique to us in New Zealand,1 and there is much to be learned by looking abroad.
These issues are not new. During the late 1990s, the sector worked together, led by the NZ Cancer Control Trust (funded by the Cancer Society of New Zealand and the Child Cancer Foundation), to develop a comprehensive Cancer Control Strategy.8 The Strategy was launched in 2003, more than a decade and a half ago. That strategy had a strong equity focus, its scope was broad, encompassing cancer prevention through to palliative care and research. It was followed by a series of cancer action plans that were more operational in their intent. By 2015, the focus of cancer control had largely narrowed to emphasise cancer treatment occurring in hospitals, with the advent of “better, sooner, more convenient cancer care”.9 This initiative was supported with treatment-related targets, which while popular, were not clearly related to improved outcomes. Achieving equity was largely absent from ongoing policy, and resource allocation was hamstrung by the reduced investment in Māori providers and the 2006 Ministry directive that the Treaty of Waitangi clause be removed from official documents.10 In the last three years the Cancer Control Council, and Te Kete Hauora, the Māori Health Business Unit at the Ministry of Health have been disestablished, key prevention opportunities such as Sunsmart initiatives, alcohol and tobacco supply reduction, and action against obesity have all seemed to falter. Many in the cancer sector came to view progress on cancer control as stalled, and lacking in key government leadership.
In response, the Cancer Care at a Crossroads conference was held in Wellington in early 2019.11 This was a landmark event jointly hosted by the University of Otago, Wellington and the Cancer Society of New Zealand, in partnership with the Ministry of Health and the New Zealand Society for Oncology. It was attended by around 400 people from across the cancer control spectrum; people affected by cancer, NGOs, primary and secondary care service providers, academics and policy makers. The conference was opened by a powerful call to action from Blair Vining, who has terminal bowel cancer and his wife, Melissa, with the words [from Melissa] to the Minister of Health “You have failed Blair, you have failed me and my children, and you have failed many other New Zealanders by not having a cancer plan”.
Invited speakers covered wide-ranging topics, identifying strengths, weaknesses and high priority cancer control activities for governance, surveillance, prevention, early detection, treatment, palliative care and research. There was a strong focus on Māori leadership and rights, addressing health needs of Māori and other underserved populations, with a view to eliminating inequities in outcomes from cancer. Speakers from the UK, Canada, Australia and Europe described effective global responses, which included the development and redevelopment of dedicated cancer agencies, comprehensive cancer control plans, central planning and monitoring of both processes and outcomes within cancer systems. Local speakers and attendees highlighted a growing frustration at the sense of lack of progress in cancer control, and the mood was that we are indeed at a crossroads.
Several key themes emerged.
The meeting garnered three days of continuous media attention, and saw the Minister of Health answering questions across a variety of media outlets about his Government’s response to cancer control. The Minister noted he had heard the call and was deeply moved by Blair and Melissa Vining, and promised to commence work on a national cancer plan, with a draft to be delivered by June. The voice of the sector and the demand for change was clearly conveyed.
The remaining question is what the quality and scale of the response will be. Will a new cancer control plan address the entrenched structural issues in New Zealand, that have seen the delivery of inequitable and uneven care? Will we have a programme that delivers bold and evidence-based prevention goals that challenge our political comfort? Will there be a leadership framework and technology evaluation process that sets us on a path that can engage with the realities of managing growth in demand and cost, as well as ensuring high-quality and equitable care? A repacking of current efforts and labelling this as a cancer control plan would risk selling New Zealand short for a generation. We are at a crossroads and face a choice; that choice (or failure to make a choice) will have profound implications for many years to come.
Table 1: Examples of centrally funded comprehensive cancer institutes.
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