Government unveils national cancer agency and $60 million injection into Pharmac

This article was originally published on the New Zealand Herald

The Government has today unveiled plans to establish a national cancer agency, which will be led directly by experts of the deadly disease, and a $60 million injection into Pharmac.

Key announcements:

Until today, decisions about how to tackle New Zealand’s cancer “crisis” came from bureaucrats within the Ministry of Health.

By December 1, the Government has promised decisions will come from a team of top cancer specialists who will report directly to Health Minister David Clark. That is the date the agency will officially be up and running.

World-leading public health physician and cancer epidemiologist Professor Diana Sarfati has been appointed as the Ministry of Health’s interim national director of the agency.

“This is huge for New Zealand. It’s the biggest change in cancer care in at least 15 years, if not ever. When the UK appointed a national cancer director there was an unprecedented improvement and survival rates increased dramatically,” Cancer Society of New Zealand medical director Chris Jackson said.

It comes after a powerful public movement started by dying dad Blair Vining who launched a petition calling for a national cancer agency to hold District Health Boards to account and put an end to postcode lottery.

His petition gained more than 140,000 signatures from New Zealanders across the country.

One of the main aims of the plan is to have equitable cancer survival rates across New Zealand by 2030 – including across geographic areas and across ethnicities. Māori cancer outcomes will be one of the first priorities as Māori have higher rates of cancer and poorer survival rates overall.

Funding decisions will be made with an “equity first” methodology, the plan says.

For example, the national bowel screening programme, which is still being rolled out, makes screening free for people aged 60-74.

But because Māori people tend to develop bowel cancer at an earlier age, the plan suggests the screening programme could be made free for Māori ten years earlier, between the ages of 50-74.

Another aim is for New Zealanders to suffer from fewer preventable cancers.

Lung cancer is the top of the list, with prevention strategies including promotion of vaping and the finalisation of a Smokefree 2025 Action Plan.

The plan also highlights improved detection and management of Hepatitis A, B and C, reducing HIV transmission, increasing the uptake of the HPV vaccine and addressing Helicobacter pylori infection in priority populations.

Skin cancer will also be a target, with promotion of sun safety – particularly among children – and sunscreen could also be regulated as a therapeutic product, the plan says.

A programme will also be developed to prevent work-related cancers.

Another aim of the plan is to improve survival rates once people have cancer, with an emphasis on better, earlier screening, and improved treatment once diagnosed.

Strategies including increasing the age of free breast screening from 70 to 74 years old, progressing the national bowel screening programme and exploring bringing in HPV screening as part of the cervical screening programme.

The radiation and oncology workforce could also see a boost to its workforce and resources.

Fast-track diagnostic pathways will be developed for “priority cancers”, and there would be a national agreement on the scope and distribution of specialist cancer services.

“Quality performance indicators” will be introduced under the plan to ensure specific cancers are being diagnosed and treated consistently across New Zealand.

Bowel cancer has been used as a test case for QPIs with the first results published for diagnosis and treatment in March this year. The Bowel Cancer Quality Improvement Report compared DHBs on measures such as death rate after surgery, length of stay in hospital and where at least 12 lymph nodes were examined.

By early 2020 prostate, lung and neuro-endocrine tumours will also have similar reports published.

Health Minister Dr David Clark said the Government has listened to calls for strong central leadership and will deliver the promised Cancer Control Agency by December 1, 2019.

“Cancer care is woven into so much of the work that our public health service does, so while the agency will have its own chief executive, it makes sense for it to be housed within the Ministry of Health.

“I’m also pleased to announce that leading public health physician and cancer epidemiologist Professor Diana Sarfati has been appointed interim National Director of Cancer Control, starting immediately. She will lead work to improve the quality of treatment.

“An immediate priority will be establishing quality performance indicators for specific cancer types. This will mean we can measure progress towards consistent care across DHBs.

“We are also combining the four current regional cancer control networks into a National Network to help remove regional variations in care,” Clark said.

More Pharmac funding welcomed

Pharmac has welcomed the $60m funding injection, which includes $20m for this year and $40m for 2020/21. That’s on top of $10m announced in this year’s Budget.

That brings Pharmac’s annual medicines budget to over $1 billion, Pharmac board chair Steve Maharey said.

In last year’s Budget, the Government increased Pharmac’s funding by more than 13 per cent, from about $870m to $985m. That compares to increases of 2.4 per cent and 6.3 per cent in National’s last two years in government.

Pharmac announced this afternoon it was proposing to funding three new medicines to treat ovarian cancer (olaparib, known as Lymparza), breast cancer (fulvestrant, known as Faslodex) and leukaemia (Venclexta – used to treat chronic pymphocytic leukaemia).

It is also proposing making contraceptives Mirena and Jaydess available to more people, and making the meningococcal ACWY vaccine free for people in close living situations like hostels and army barracks.

The medicines could be available from November if consultation feedback is positive.

Pharmac said it was also looking to get the best deal for New Zealanders for a particular type of advanced breast cancer.

Two registered medicines palbociclib (Ibrance) and ribociclib (Kisqali) could be suitable, experts believe.

Pharmac said it had issued a request for proposals and one of these medicines could be available from April next year.

Prime Minister Jacinda Ardern said from next year Pharmac will also speed up its decision-making by considering applications for funding while Medsafe assesses the safety of new medicines.

“Rather than waiting until that work is complete as it does currently. Work on options for early access to new cancer medicines is also progressing well,” Ardern said.

New Zealand’s history of tackling cancer:

1999

– Labour Government announces plans are under way for first ever cancer plan.

2003 – Cancer control strategy released included cancer prevention, screening, early detection, treatment, rehabilitation, support and palliative care.

2005 – Labour Government establishes national agency known as Cancer Control Council, formally Cancer Control of New Zealand, to provide independent advice free from political interference.

2014 – National Party-led Government introduces three-year cancer plan, including a faster cancer treatment target requiring most patients to start treatment within 62 days of diagnosis.

2015 – National disestablishes Cancer Control Council, saying it is no longer necessary as it has been superseded by new plan.

July 2017 – Pre-election, Labour promises to set up a National Cancer Agency, with $10 million to establish the agency and a further $10m to get work under way.

2018 Labour-led Government ends public reporting of DHBs’ faster cancer treatment target results, although the data is still collated.

Jan 31, 2019 – Melissa Vining blasts Health Minister David Clark for not following through on promise to establish cancer agency.

Clark announces the Government’s plan to tackle cancer is under way and he expects to see a draft by the end of June.

May 6, 2019 – Herald starts investigation revealing hundreds of Kiwi cancer sufferers have received large taxpayer-funded payouts after being let down by the public health system.

June 28, 2019 – Blair Vining launches petition calling for a national cancer agency to hold District Health Boards to account and improve the health care system.

June 29, 2019 – Herald reveals Prime Minister’s letter to Blair’s daughter Lilly Viningsuggesting agency is not part of the Government’s plan.

More than 650 New Zealanders gathered in Invercargill to join Vining as he handed over a petition to National’s Michael Woodhouse.

July 7, 2019 – Vining’s petition closes to the public.

Today – Government’s unveils plans to establish a national cancer agency lead by experts of the deadly disease.