BCAC met with the Ministry of Health’s Cancer Team earlier this month for an update on issues raised in our Ministerial Briefing in March. We were pleased to hear that good progress has been made in breast reconstruction and the provision of fertility services. However, we remain concerned about inadequate funding for new medicines and inconsistencies among DHBs in offering lymphoedema services.
Below is a summary of the main issues and their current status:
- Breast reconstruction
It is now national policy that every breast cancer patient needing breast reconstruction surgery is entitled to have the operation. Once on a waiting list a patient cannot be removed and should receive surgery within 4 months of being fit and ready to proceed. This policy has not yet been universally adopted across all DHBs but the Ministry’s Elective Surgery Team will visit heads of surgical teams in August to explain the policy and ensure plans are in place to implement it throughout the country. BCAC advises everyone having breast cancer surgery to discuss reconstruction with their breast surgeon at the time of initial surgery. If you think you may want the operation some time in the future, make sure your surgeon notes that this will be part of your treatment. It will be much easier to decline reconstructive surgery if you eventually decide you don’t want it than to get onto the list with high priority at a later date.
- Fertility services
We were delighted to hear that comprehensive fertility services are now available for people whose fertility has been affected by cancer treatment. This is another issue you should discuss with your oncology team as soon as possible after your initial diagnosis, to be sure there is enough time to get treatment before chemotherapy. Services include funding for a first specialist appointment to assess the situation and develop a treatment plan; various investigations and treatments; genetic analysis where needed; fertility preservation; peri-treatment care; clinical follow-up; social work and counselling; referral to other services; and gamete and embryo storage. Details of the Assisted Reproductive Technologies available can be viewed at this link: https://nsfl.health.govt.nz/service-specifications/current-service-specifications/specialist-surgical-service-specifications
- Feedback on Tumour Stream Standards of Service Provision
Two regional cancer networks (Midland and Central) will review DHB performance against the Ministry’s recently developed Standards of Service Provision for Breast Cancer Patients http://www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/faster-cancer-treatment-programme/national-tumour-standards. Surprisingly, no timeframe has been given for their feedback so it remains unclear when full implementation is expected.
- Clinical trial access
In our March briefing BCAC encouraged the Minister to take action to improve the clinical trial environment in New Zealand to allow cancer patients faster access to the latest breakthrough treatments. We learned that an audit of clinical research is now planned and this could potentially lead to increased funding to boost research.
- Lymphoedema services
Given the inconsistencies in lymphoedema treatment offered around the country, BCAC asked the Ministry to ensure DHBs are meeting the standards of service provision required for breast cancer. We noted that this is an issue that continues to be raised with BCAC and that providing lymphoedema services would not carry a high cost. The Ministry was unresponsive on this, stating that this is not a current priority.
- Need for increased funding for medicines
BCAC restated our case for greater investment in innovative, effective medicines that are funded elsewhere; we noted that New Zealand has worse cancer outcomes than in Australia and other countries that provide better access to medicines. We are behind in funding important breast cancer medicines, including Perjeta, Kadcyla, Abraxane, Afinitor and Halaven. The Ministry stated that medicines funding is not their responsibility but is a matter dealt with entirely by PHARMAC. BCAC challenged this by noting that the Ministry is charged with reducing the gap between New Zealand and other countries and that it has the responsibility of providing advice to the Minister.
BCAC will meet again with the Ministry of Health in October. If you have any issues you would like raised at this meeting, please email us at bcac@breastcancer.org.nz before 1st October, 2015.
27 July 2015
