Public Interest Journalism funded through NZ On Air
Lung Foundation New Zealand CEO Philip Hope says funding by Pharmac of a new cancer drug is an important step forward. He acknowledges this progress, but says New Zealand is still a long way behind the developed world with funding the standardof care for lung cancer.
Lung cancer is the largest cause of cancer death in New Zealand, with 1,800 deaths per year.
Pharmac is now funding a new immunotherapy medicine called durvalumab (Imfinzi) which could be life-changing for the 300 patients diagnosed with Stage 3 non-small cell lung cancer every year in New Zealand.
Durvalumab is the first immunotherapy drug to be funded for lung cancer in New Zealand and it has the potential to control cancer beyond the point of detection.
Hope said LFNZ acknowledge Pharmac and AstraZeneca for negotiating reimbursement of durvalumab, which is the standard of care for this type of lung cancer - mindful of the 1500 patients diagnosed with Stage 4 lung cancer who do not yet have access to the standard of care in New Zealand.
He said Māori and Pasifika patients are more likely to be diagnosed with advanced or metastatic lung cancer, which means they are less likely to benefit from the access to durvalumab.
Lung Cancer Foundation New Zealand CEO Phillip Hope. Photo / Supplied
Hope said 45 per cent of patients across Aotearoa are diagnosed with lung cancer following presentation to a hospital emergency department. These patients are more likely to have advanced, incurable disease (Stage 4) compared to those diagnosed through a clinic or GP visit.
He said statistics tells us that primary healthcare in New Zealand must improve early cancer detection.
"Doctors must investigate symptoms, rather than take a wait-and-see approach," Hope said.
Symptoms of lung cancer include - but are not limited to - shortness of breath, chest pains, an unexplained or persistent cough, and noisy breathing.
He said Māori need to be alert to cancer symptoms, as they are more likely to be diagnosed with lung cancer at a later stage and at a hospital's accident and emergency department.
Hope said the rate of lung cancer incidence for Māori is three times that of non-Māori.
He said Stage 3 cancer can be treated if detected in time with drugs like Imfinzi, but Stage 4 cancer, where the majority of Māori are first diagnosed, shows New Zealand is out of step with the developed world with regard to its funding of targeted therapies and immunotherapies in the public health system.
"This inequity is unacceptable and is causing unprecedented financial hardship for lung cancer patients and their families, who are being forced to either self-fund their treatment, raise funds, or face premature death," Hope said.
He said there were a number of reasons why lung cancer screening for Māori should be a priority.
"Smoking history alone does not explain the high incidence of lung cancer in Māori, because there is a higher incidence of lung cancer in Māori [who] don't smoke and do not have a history of active tobacco exposure."
Hope said research suggests the incidence of lung cancer and chronic lung conditions in Māori could be genetic.
"Several lines of evidence suggest lung cancer, and other chronic lung conditions are genetically determined, thereby ethnically related, and this goes some way to explaining why Māori have a susceptibility [to] lung cancer that is not caused by environmental and behavioural exposures," Hope told the Herald.
"We must also acknowledge that many Māori (not all) have also been impacted by disadvantages; for example, overcrowded living conditions, limited access to primary healthcare, and lower rates of school completion.
"Lung cancer registrations and mortality rates are four times higher in Māori women and nearly three times higher in Māori men," Hope said.
"Lung Foundation New Zealand has advocated as a fundamental priority; lung health promotion and early detection campaigns targeting Māori must be co-designed and co-delivered.
"We have also advocated for all Māori to have access to molecular testing for all known bio-markers," Hope said.
"We need to take a screening programme that is focused on high-needs Māori communities to address the equity gap.
"We must be careful to not to stigmatise, because this will compromise the success of a screening programme - hence, the programme would not be called 'lung cancer screening', but rather promoted as a 'lung health check'."
Hope said it really would help if whānau were actively encouraging our tane and wāhine to be aware of and investigate symptoms for lung cancer.
"We also need to improve health literacy for the whole family: 'Dad, please go and investigate your unexplained cough.'"
Hope said health professionals must also be watchful for symptoms.
"GPs, and pharmacists, too, must have a much higher index of suspicion of lung cancer and investigate symptoms without delay," he said.
"Knowing that 45 per cent of lung cancer patients are diagnosed at A&E tells us there are big gaps between primary health and secondary health, and our health system is failing in this important area of timely healthcare.
While Imfinzi is now being funded by Pharmac, New Zealand is still well behind Australia in cancer care drug availability, Hope laments.
"In fact, New Zealand is twice as slow to publicly fund medicines as comparable OECD countries, irrespective of what data set one looks at," he said.
"We fund less than a third of the lung cancer treatments (immunotherapies and targeted therapies) that are readily available in Australia.
"What a paradox we live in; Māori have the Treaty here in NZ, yet Māori are far better off living in Australia if diagnosed with lung cancer.
The difference between Australian government-funded drugs and New Zealand government-funded cancer drugs. Image / Supplied
"We have also seen many instances whereby foreigners who have shifted to live and work in New Zealand, bringing important skills to our country, have returned home soon after being diagnosed with lung cancer when they realise just how far behind the developed world we are regarding access to standard of care treatments."
Hope said access to treatment is access to life, and all patients diagnosed with lung cancer deserve to thrive.
