Prostate Cancer Foundation of New Zealand (PCFNZ) is a non profit community based organization which assists with supporting Prostate sufferers and their families. Read the blog to find latest prostate related news from around the world.
CANGO (the alliance of Cancer Non-Governmental Organisations) has adopted a position on improving the access to new cancer medicines and treatments in New Zealand. We call on this Government to urgently consider and implement changes for reasons of equity, evidence and deep concerns about the systemic underfunding of more effective cancer treatments. In our view, the existing decision processes disadvantage, delay or deny access to innovative treatments, such as targeted therapies and immunotherapy, that are now accepted abroad as the standard of care.
The Cancer Landscape
In 2018 more than 23,000 New Zealanders were diagnosed with cancer, of whom more than 9,000 are expected to die. Cancer is our biggest killer and causes 30% of all mortality in New Zealand.
Most cancer patients have no time to wait and many are dying prematurely because they do not have access to the right medicines at the right time in their treatment cycle. Many of these medicines are freely available in other OECD countries.
New Zealand ranks 19th out of 20 OECD countries for access to new medicines; just 23.5% of medicines registered between 2012 and 2017 in New Zealand have subsequently been reimbursed.
When comparing access to new medicines with Australia in the period 2011-2017[i], New Zealanders are severely disadvantaged:
24 new cancer medicines have been reimbursed in Australia but not in New Zealand
The approval process takes considerably longer in New Zealand (190 days longer on average)
One of Labour’s pre-election pledges was to provide world class cancer care and a swifter process for funding new innovative treatments like targeted therapies and immunotherapy that are the standard in comparable OECD countries.
Since being elected, the Government has confirmed cancer is one of its major health priorities, although New Zealand has not yet seen a commitment to world class cancer care demonstrated in policy, nor an increase in funding nor an alternative access programme to clear the backlog of cancer treatments still sitting on the Pharmac waiting list.
We need to do better for our most vulnerable.
Rapid Access Scheme for Cancer Medicine
Under the current PHARMAC model, new cancer medicines typically take 3 years to be assessed for funding and there is also a significant backlog of unfunded medicines. Clearly the current system is detrimental to the wellbeing of cancer patients and many are dying needlessly or dying sooner than they should.1,2[ii]
Public dissatisfaction with the lack of access many patients have to new medicines and treatment is growing – this has been demonstrated in public campaigns in the past for Herceptin (for breast cancer) and Keytruda (for melanoma cancer) and more recently in the petition presented to Parliament for Ibrance (again for breast cancer).
Additionally, media frequently report cases of patients needing to resort to funding schemes such as Givealittle to self-fund medicines and treatments that are available and funded in comparable OECD countries. Patients fortunate enough to have medical insurance rely on this to cover costs of their cancer treatment. We are fast becoming a two-tier society of “haves” and “have-nots” when it comes to cancer treatment increasing inequities in cancer care. 3
CANGO believes this is unjust and the situation needs to be addressed.
CANGO supports the development of a Rapid Access Scheme for new and novel cancer medicines and treatments. Such a scheme in UK (their version 2) is very successful and provides a model of what could be developed in New Zealand.
Again, we remind this Government of its pre-election pledge to introduce a Rapid Access Scheme for new cancer medicines and treatments and offer our knowledge and experience across the cancer spectrum in working with Government to resolve this issue.
CANGO (Cancer Non-Governmental Organisations) is an alliance of prominent New Zealand cancer charities including;
Breast Cancer Foundation New Zealand; Bowel Cancer New Zealand; Leukaemia & Blood Cancer New Zealand; New Zealand Gynaecological Cancer Foundation; Prostate Cancer Foundation of New Zealand; Unicorn Foundation New Zealand; Melanoma New Zealand; Lung Foundation New Zealand; Gut Cancer Foundation; Cancer Society of New Zealand.
The group was formed in 2007 in an effort to increase collaboration among cancer charities and to advocate on behalf of cancer patients and carers.
Member organisations meet regularly to discuss key issues facing the sector; to meet and share information with representatives from the Ministry of Health and others working in cancer-related areas; and to work together on specific initiatives that reflect the shared goal of all members to reduce the incidence and impact of cancer on New Zealand and New Zealanders.
[i] IQVIA Access to Medicines Report 2018 available from Medicines NZ
1 “I’m still here” Insights into living -and dying – with Advanced Breast Cancer in New Zealand
Having a supportive partner can benefit cancer survivorship, but single men with prostate cancer may face challenges in initiating a new relationship.
Dr Erik Wibowo, Lecturer, Dept. of Anatomy, School of Biomedical Sciences, University of Otago, is conducting a study which aims to identify factors that may enable or prevent men from initiating new relationships following diagnosis.
If you are not currently in a relationship or have started a new one following prostate cancer diagnosis, you might consider completing a brief survey for the study. It only takes about 20 minutes to complete, participants need only complete it once, and as a thank you can enter a draw to win a NZ$100 gift card.
While a number of prostate cancer patients in New Zealand are given MRI scans as part of their diagnostic process, this is limited by both the availability of the high quality technology required, particularly in regional centres, and the limited access to MRI scanners in the public health system. Clearly this new Guidance issued by the UK’s NHS is an approach New Zealand should adopt.
The Prostate Cancer Foundation of NZ congratulates Patron Professor Brett Delahunt ONZM FRSNZ on being awarded the prestigious Hercus Medal by The Royal Society Te Apārangi.
Professor Delahunt is a recognised international leader in the field of prostate cancer and is a strong advocate for awareness and better testing of men for prostate cancer. In 2015 he was invited to accept the role of Patron of the Foundation in recognition of his major contributions in this area.
Foundation President Mr Mark von Dadelszen QSM says “I am delighted Professor Delahunt has been recognised by the Royal Society Te Apārangi by being awarded the Hercus Medal. This demonstrates the significance of his work in the area of prostate cancer, especially his key role in developing the novel system recently adopted for grading prostate cancer. He is also passionate about promoting awareness and a more consistent approach to testing in New Zealand and a strong advocate for the role our Foundation has working in these areas.”
Not all prostate problems are caused by cancer. BPH (Benign Prostate Hyperplasia) is a far more common issue and typically causes problems with urination in men as they age. Professor Peter Gilling in Tauranga is an expert in this condition and has provided some helpful explanations and insights in this article at Health Central.
In a change of position, the U.S. Preventative Services Taskforce has reversed its earlier recommendation against PSA screening, to now recommend that men aged 55-69 make an individual decision about prostate cancer screening with their clinicians but recommends against routine screening for men age 70 and older. The new recommendation is based on new evidence that shows there are now more options, and therefore more information available to clinicians and patients when deciding whether or not to undergo treatment. The adoption of more Active Surveillance, better MRI imaging capability in the diagnostic process and a growing understanding of the disease have all contributed to this new decision, which is largely in line with the New Zealand Guidelines published in 2015. Read the LA Times story about this decision, see the U.S. Recommendation here. Watch this CBS news piece.
In a New Zealand first, bladder neck stents have been implanted in two men with bladder neck contracture, following radical prostatectomies. Dr Jim Duthie, prostate cancer surgeon and medical advisor to the Prostate Cancer Foundation is very excited about this new tool in the arsenal to treat bladder neck contracture following prostate cancer surgery and has high hopes for it. The great news is that ACC will cover the costs of this procedure through the private system, whether or not the original surgery was public or private.
Bladder neck contracture occurs when scar tissue develops at the surgical join between the bladder and urethra (anastamosis), and it happens to between 8 and 12% of men. Current treatment is to stretch or cut through the scar tissue, but it often recurs and can be a real burden in some men. The two men treated today were in this situation, and so had nothing to lose from trying the new procedure. The stent is especially designed to be anchored in the urethra with a narrow wire that goes across the sphincter so that continence is preserved. If the stent is ineffective it can be removed easily under local anaesthetic. The guys with bladder neck contracture can have a really miserable time of it, so this is a great tool for when all else has failed.
A University of Auckland research study shows that New Zealand men are being diagnosed with prostate cancer later in life at a higher prostate-specific antigen (PSA) level and higher disease grade compared to men in the United States.
The study was conducted by Dr Nishi Karunasinghe and colleagues at the Auckland Cancer Society Research Centre at the University’s Faculty of Medical and Health Sciences compared prostate cancer data from New Zealand and US.
Dr Karunasinghe says that several factors could be behind the discrepancy, including lower levels of PSA screening, delayed referral to specialist care and lower subsequent biopsies on those with elevated PSA levels, all of which warrant attention from the New Zealand health authorities.
Reference: Karunasinghe N, Ambs S, Wang A, Tang W, Zhu S, Dorsey TH, et al. (2018) Influence of lifestyle and genetic variants in the aldo-keto reductase 1C3 rs12529 polymorphism in high-risk prostate cancer detection variability assessed between US and New Zealand cohorts. PLoS ONE 13(6): e0199122. https://doi.org/10.1371/journal.pone.0199122