In a five-part series, Herald health reporter Martin Johnston investigates controversies in cancer testing and treatment and reports on the moving stories of people afflicted with cancer.

The number of New Zealanders with cancer is rising steadily - as is the number of desperate patients who have resorted to asking strangers to help pay for expensive treatments that could save their lives.

This year, more than 20,000 people will have a cancer diagnosis registered, and about 9000 will die. For some, the cost of treatment that could increase their chance of survival can run into hundreds of thousands of dollars and is simply unaffordable.

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The number of people turning to crowd-funding sites like Givealittle is increasing. This year alone, more than 650 appeals have been started by patients, or their friends and family, who have nowhere else to turn to when seeking non-taxpayer-funded medicines or other support.

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Our cancer death rate is higher than the average for developed countries. If our rate matched Australia -- where some drugs such as Keytruda are state-funded -- about 700 fewer New Zealanders would die of cancer each year.

Today, the Herald begins a five-day cancer series. We look at controversies in cancer screening and treatment, we investigate high-cost cancer medicines not funded by the Government, and we interview a number of people with cancer, some whose outlook is grim, others who have experienced remarkable remissions.

One is Leisa Renwick, a 47-year-old teacher with advanced melanoma. The mother of three adult children has cashed in her superannuation because the Government won't yet pay for Keytruda, a drug which fellow sufferer Bob Hill says has left him free of melanoma symptoms more than a year after he stopped taking it.

Leisa Renwick has advanced melanoma which at present is responding to a medicine, but the disease is expected to become resistant to the drug. Photo / Alan Gibson.
Leisa Renwick has advanced melanoma which at present is responding to a medicine, but the disease is expected to become resistant to the drug. Photo / Alan Gibson.

Mrs Renwick said: "It does come down to how much money you are able [to pay]. Getting sick makes you really value life somehow. I think everyone would be willing to pay to live, but are they unable to. It seems to me that in this country, rich people are able to get treatment and poor people aren't. They are sent home with lots of pain-killing drugs. They are sent home to die. I think that's really wrong."


The rate shown in the graph below is per 100,000 population (age standardised)

Mrs Renwick decided against starting a Givealittle page to help with Keytruda, expected to cost up to $300,000 -- including a supplier discount -- for two years' treatment.

"I don't believe people should have to beg for their lives."

Givealittle data shows at least 650 individual causes with the tag "cancer" were set up from January to mid-October, by which time they had attracted donations totalling nearly $3.6 million. In 2013, 141 cancer causes raised $919,316.

Cancer specialist Dr Richard Isaacs is upset by the "ridiculously" high prices charged for drugs such as Keytruda and some new breast cancer medicines, which he said few of his patients could afford and were not covered by most insurance policies.

But he said people facing imminent death from cancer were a captive market willing to pay high prices for fantastic new drugs.

"You are frightened, you are at the end of your life and this is a way of getting maybe several more months of quality time.

"The drug companies will always argue research and development costs but, good heavens, the development of technology has improved immensely over the last decade. You would have to suspect that these drugs are being generated at lower costs than they are worth."


The rate shown in the graph below is per 100,000 population (age standardised)

Paul Smith, director of Keytruda supplier Merck, Sharp and Dohme NZ, said the drug's price was "consistent with other cancer therapies across the globe". It reflected the high cost of making a biological product, its benefits in lives saved or improved, and the enormous amount of research and development involved.

Keytruda is being evaluated by Pharmac, the agency that decides which drugs receive state funding.

Like some new drugs for advanced breast cancer that are not taxpayer-funded in New Zealand, Keytruda is state-funded in Australia.

A study by Australia's medicines industry association found that of 20 developed countries, Australia ranks 18th for state-funded access to new medicines. New Zealand is 20th. OECD data puts New Zealand's spending on drugs well below the average of developed countries.

When asked if he was concerned about NZ's low ranking, Health Minister Jonathan Coleman cited Pharmac research findings that, of 22 cancer medicines funded in Australia but not NZ, only one clearly exceeded international thresholds for clinically meaningful gains and that drug was being considered by Pharmac.

"This analysis shows you simply can't look at the actual number of funded cancer medicines. Pharmac's role is to seek the best health outcomes within its budget provision.

"It indicates that generally we are not missing opportunities to consider potentially useful treatments and has enabled us to avoid significant expenditure on cancer medicines that are either unable to provide a supporting evidence base, are potentially harmful versus standard care, or offer relatively low health gain."

The Government had spent nearly $63 million since 2008 on its faster cancer treatment programme.

To find out more about Keytruda visit: www.fightmelanoma.co.nz

The Series


Today: Breast cancer
Tomorrow: Bowel cancer
Wednesday: Lung cancer
Thursday: Melanoma
Friday: Prostate cancer