Chair Libby Burgess and Secretary Fay Sowerby recently delivered BCAC’s 2024 Ministerial Briefing to Hon. Dr Shane Reti, Minister of Health. The briefing identifies priority areas for action to improve breast cancer outcomes. (You can read the full briefing by clicking here). Libby and Fay also met with Hon. Dr Ayesha Verrall (Labour) and MP Todd Stephenson (ACT) to discuss the briefing in detail, and it was copied to politicians with an interest in health and technology from all parties.
BCAC thanked Minister Reti for adding $604M to the medicines budget, allowing Pharmac to fund two medicines for advanced breast cancer: Keytruda for triple negative and Enhertu for HER2 positive. These breakthrough medicines will give women more precious time with their families, in their workplaces and contributing to their communities.
We stressed the importance of additional budgetary increases, given the remaining gap of 23 breast cancer medicines and 27 uses that are funded in other countries and/or recommended in international guidelines. Sixteen of these are funded in Australia. We asked the Minister to aim to bring our investment level up to the OECD average. Dr Reti acknowledged the gap but didn’t commit to a further uplift in the next Budget. He did say he would support Hon. David Seymour, Associate Minister of Health (Pharmac) if he makes the case to Cabinet for further funding in the next Budget cycle. Todd Stephenson stated that his party is looking to expand Pharmac’s evaluation of medicines to include a broader analysis of societal benefit. This would include assessing health gains and increased productivity resulting from treating people and beneficial impacts across the whole of Government rather than the current siloed budget approach. Dr Verrall commented that it would be helpful to have an updated report from Te Aho o te Kahu, the Cancer Control Agency, on essential cancer medicines that remain unfunded.
We stated our support for the new cancer treatment target of 90% of patients receiving cancer management within 31 days of a decision to treat but expressed concern at the four months timeframe for a first specialist assessment after suspicion of cancer. Dr Reti assured us that this would be managed within clinical teams and that cancer patients would be prioritised for earlier appointments without the need for a shorter formal target. It was reassuring that Dr Verrall had a similar perspective.
A solution we offered for cancer workforce shortages within our public hospitals was to expand the model of care to allow more input by private providers. Precedents for this have already been set to expand capacity with cancer surgery and radiotherapy, enabling delivery of timely treatment to patients who would otherwise wait in the public system. We proposed that this should be normalised and expanded to include delivery of medicines, where private clinics already have efficient systems to infuse medicines that our public hospitals struggle with. The Minister didn’t have a problem with shared care and said he’d look at this once the current tranche of newly funded medicines is in place. Any such model would need to ensure that insurance companies still pay their share. He told us a Cancer National Clinical Network (NCN) is now being formed withing Te Whatu Ora Health NZ to drive unified healthcare standards, reduce variations, and enhance equitable access nationwide. They would be charged with developing innovative, efficient and evidence-based solutions to inform investments and workforce planning and could consider how best to leverage private providers. The NCN would work with Te Aho o te Kahu to establish guidelines and standards of care. We stated that BCAC would be delighted to see the reintroduction of clinical guidelines for breast cancer, to ensure high care standards of equitable care around the country. Dr Reti said Te Whatu Ora’s Health Workforce Plan would provide guiding strategy to solve workforce capacity issues. Todd Stephenson stated that ACT would be very comfortable with greater use of private capacity, while Dr Verrall acknowledged creative solutions are needed and that shared care models have already been used successfully. She noted that this would require Labour to review a long-standing policy.
Our briefing encouraged politicians to enable delivery of oncology services closer to home wherever possible, to relieve pressure on our hospital oncology services. We provided the example of medicines formulated for delivery by rapid injection under the skin (sub-cutaneous/sub-cut) rather than slow infusion. Options for this include medicines for HER2 positive breast cancer that can be delivered in doctors’ rooms and medical clinics, i.e. sub-cut trastuzumab (Herceptin) and Phesgo, a sub-cut combination of Perjeta (pertuzumab) and trastuzumab. These would have immediate productivity benefits by freeing up hospital oncology staff and infusion chairs, allowing people to spend less time away from their families and workplaces.
We thanked the Minister for asking BreastScreen Aotearoa (BSA) to begin the roll-out of the extension of the upper age limit of breast screening from 69 to 74. This long overdue expansion of eligibility will allow earlier detection and will save lives. We also encouraged a lowering of the youngest eligible age from 45 to 40, along with risk stratified screening that considers factors contributing to personal risk.
High breast density both increases the risk of getting breast cancer and obscures tumours in mammograms. We made the case for BSA to measure and report breast density with every mammogram, as is done in many private clinics. Last year, the Royal ANZ College of Radiologists recommended that breast density reporting should be mandatory. This would inform women if they were at a heightened risk of breast cancer and allow them to avoid late detection by choosing additional surveillance with ultrasound, MRI etc. We also encouraged the integration of Artificial Intelligence (AI) into mammographic readings, to better identify those at high risk and alleviate system pressures caused by the current shortage of radiologists. All politicians were supportive of the efficiencies offered by AI, with Dr Verrall noting the need for social licence.
We asked that a precision health approach be adopted across the breast cancer landscape. This would include germline testing, gene expression profiling and genomic testing to provide prognostic and predictive information, allowing precise selection and tailoring of treatments to achieve maximum benefit and minimal side effects for each individual. We recommended the approach taken by OMICO in Australia (https://www.omico.com.au/), where researchers, clinicians, industry partners, Government, advocacy groups and patients collaborate to improve outcomes for cancer patients. OMICO uses fast-tracked molecular and genomic screening, biomarker-led clinical trial set-up and patient enrolment from the entire nation to accelerate access to next generation cancer treatments and preventive strategies.
We discussed the need for changes to NZ law to prevent insurers from using the results of genetic tests to refuse cover or increase premiums for individuals and their immediate family. This is needed to remove a barrier to early detection and better enable preventative interventions to reduce risk, encourage more precise disease management as well as access to appropriate clinical trials. Fay spoke of her ongoing involvement with Against Genomic Discrimination Aotearoa to introduce protective provisions into the Contracts of Insurance Bill. Such legislation would align NZ with a range of countries including Canada, where insurers are prohibited from using genomic test results to refuse services or charge more for them. The Minister commented that genomic discrimination is completely unacceptable so we anticipate he will want to enact strong protective legislation.
We enjoyed positive, productive discussions with Dr Reti, Dr Verrall and Mr Stephenson and are hopeful that beneficial actions will follow.
19th October 2024
