Dr Neil Graham's talk - presented to the Health Select Committee

The following talk was presented by Dr Neil Graham to the Health Select Committee on 7 August 2019 to support the submission calling for the Select Committee to strongly recommend funding of two life-saving treatments.

“My written submission was to request funding for ibrutinib and venetoclax for CLL, two examples of the new era of cancer treatment medications.

In early 2019 the Cancer at the Crossroads conference was held in Wellington, a major national conference to assess and review the status of cancer treatment in NZ.
An editorial was published in April this year in the NZMJ, reviewing the conference.

To quote from the first paragraph of that editorial:

“Cancer is the leading cause of death in Aotearoa/NZ. The number of those affected by cancer is forecast to increase by 50% in the next fifteen years…..

Our survival rates from cancer lag behind those of Australia, Canada, and Scandinavian countries, and are not improving at the same rate as elsewhere “.

This is a red flag for how we manage the commonest cause of death in our country. We are not doing well by international standards.

In the last decade or so there has been a revolution in cancer medication development internationally, of a magnitude greater, perhaps, than any one area of disease ever. It has been likened in effect to the development of antibiotics for infectious diseases almost a century ago. And it is growing exponentially. It has been predicted that cancer will become controllable, even curable, in the next decade or so.

Some NZers have had their lives saved by these new medications – two of those (Ben and I) sit in front of you today. For me, five years ago, I had transfusion-dependent bone marrow failure. I was likely to die. I was given access to ibrutinib, went into remission, and have been well ever since, working, contributing to society, paying taxes, and living a full life. Ibrutinib saved my life.

Other NZers have not been so lucky.

Most new era life-saving cancer drugs are not funded. If you are wealthy, sell your house to pay, beg in its various guises, move to Australia, or get into a drug trial, you live. If not, you die. And die of a treatable disease. And NZers ARE dying, unnecessarily, because they can’t access these life-saving medications.

Pharmac can’t, or won’t fund them. This is in contrast to Australia, UK, Canada etc, where these medications, including ibrutinib and venetoclax, are funded.

This is still not widely known nationally, but there is an increasing awareness because of this May’s march on Parliament, Blair Vining’s case publicity, and others. When this becomes widely known, it is likely that the NZ population will be critical of NZ health services for allowing this to happen. It is unlikely to be tolerated. You may remember the outcry over hepatitis C in the early 1990’s.

Two other points:
Pharmac has said recently that medications have a relatively small role in cancer treatment. Whilst overall this has some truth, it is not the case for leukaemias, where prevention and screening for early detection have no role, and surgery and radiotherapy have a minimal role. Treatment is all chemotherapy/medications.
And it is the mainstay of treatment in the context of attempted cure in the case of serious cancer in the form of metastatic disease.

Secondly, international guidelines, written by world authorities and specialist societies are not adhered to in NZ, as medications when not funded are generally not able to be used. In CLL, venetoclax, and, even more so, ibrutinib are the first choice medications in international guidelines for severe forms of CLL. But they are not used when not funded.

So people in NZ die unnecessarily.

NZ will increasingly stand out as doing badly in cancer medicine because of this lack of funding – what has been described as third world medicine in a first world country.
So, to finish, the current Pharmac model is not working for modern oncology practice.
My submission makes suggestions regarding this (5 – 9).

The Pharmac model needs to change for modern oncology.

Current Pharmac processing of applications for oncology medications takes almost two years. When you’re dying of cancer, this is woefully inadequate. A rapid access programme for cancer treatments must be developed for these patients.

I would ask/beg this committee to recommend review of Pharmac’s model in modern oncology practice, particularly funding. We spend 5% of our health budget on medications. Other similar countries spend 10 – 15%+.

Involved groups (clinicians, policy makers, Pharmac, patients, and the industry) need to get together and develop a new model to stop the disgrace of NZers dying unnecessarily.”