Colin Feek: Delays in cancer therapy coming under control

A diagnosis of cancer is undeniably distressing for everyone involved, more so if there any delays in treatment.

The most important message is that those patients needing chemotherapy who are prioritised because they will benefit most from treatment are getting it. Those most likely to face delays are patients clinicians have assessed as likely to receive relatively less benefit.

Despite the greater prevalence of cancer and the medical advances that now make many cancers treatable, the disease still triggers a level of dread in patients rarely seen with any other disease. This places greater responsibility on the media to take more care in handling the issue. There are more patients being treated with more therapies than ever.

In terms of chemotherapy - one of the two major options for some cancer victims - there are, unfortunately, some delays in treatment in some parts of the country. But New Zealanders still receive roughly the same level of care, and speed of access to that care, as they would in countries such as Canada and Australia.

We are one of the few countries with reliable information about national waiting times for cancer. This information is vital to tell us how well we're doing and provide a benchmark for measuring the impact of initiatives aimed at improving cancer control.

Holding out an option of private care for chemotherapy is not as simple as a Herald editorial suggested.

Private hospitals require trained staff, usually trained in the public system, and a new private hospital doesn't necessarily mean more people can be treated, just that some staff have changed employer, leaving the capacity of the system as a whole largely unchanged.

Private hospitals do provide a glimpse into how much the Government invests in cancer care. Chemotherapy drugs are expensive, the cost of paying for them privately is beyond the reach of many and the drugs themselves are, in many cases, not covered by health insurance.

That is why the Government fully funds hospital-based care.

Since 2001 many new drugs have been added to the list of treatments provided in public hospitals. This has increased the numbers of patients able to be treated, as well as the number of cycles of treatments for the range of drugs.

In terms of radiotherapy, there has been considerable investment in the past four years in improving the country's cancer treatment ability by training more staff and investing in infrastructure.

New Zealand's 18 linear accelerators, which deliver radiotherapy treatment to cancer patients, are often the largest single treatment items for district health boards. In the past five years there has been a steady upgrade programme.

Two linear accelerators were replaced last year and two new ones were built in the two years before that.

Radiotherapy waiting times have dropped throughout the country in the past year. In December, five of the six cancer centres were meeting recommended guidelines on treatment times. Information was not available from the sixth centre because of technical problems.

We are no longer having to send patients to Australia for radiotherapy; that was always only a short-term solution until we had adequate staff trained and infrastructure in place.

The Government is committed to reducing harm caused by cancer. There is good agreement on a strategy to do this (released last year), and a council is being appointed to ensure leadership of the strategy. An action plan is due out next month.

As well, the key appointment of a principal cancer adviser in the Ministry of Health is expected soon.

We are by no means out of the woods. There remain international shortages of trained staff in all cancer specialties. We know that treatment delays will come and go but we also know that the overall trend is good and no different from what other countries are facing.

When the Herald editorial was published late last week, it quoted the number waiting for chemotherapy treatment in Auckland at about 80 or 90 - down from 160 patients waiting for treatment before Christmas. That figure is now down to 62. Work continues to reduce it even further.

That is largely thanks to the dedication and care of staff working in district health board cancer centres.

This is a complex problem that requires continual improvements, rather than a quick fix. Unfortunately, there is no magic bullet.

* Dr Colin Feek is the deputy director-general of the Ministry of Health's clinical services directorate. He is responding to a Herald editorial which said it was unacceptable that cancer patients were being denied adequate and timely treatment.