Malcolm and Wiki Mulholland protesting over Pharmac funding of cancer drugs. Photo / Supplied
Malcolm and Wiki Mulholland protesting over Pharmac funding of cancer drugs. Photo / Supplied
Malcolm Mulholland lived through the three years his wife Wiki was dying of breast cancer and was still trying to wrangle grief when he was diagnosed with aggressive prostate cancer.
"I was in shock. As soon as I heard (the diagnosis) I thought, 'I'm f***ed'."
For the years between Wiki's diagnosis and death last November, Mulholland had stood at her side to fight for every day that medicine could give.
It was a fight that led to challenging government and the drug-buying agency Pharmac after it became clear medicines which would prolong Wiki's life with Mulholland and their three children weren't publicly funded.
That included setting up the lobby group Patient Voice Aotearoa, marching on Parliament and eventually winning a review of Pharmac. That review was released in November on the day Wiki died.
Then, eight months later, Mulholland - aged 46 - found he was staring down his own death when diagnosed with prostate cancer and filled with anguish at the prospect of leaving their three children without either parent.
He was asymptomatic and visiting a gastroenterologist for a life-long condition when it was suggested he get a screening test for prostate cancer. The Prostate-Specific Antigen (PSA) test measures the presence of a protein in the body caused by the prostate but also prostate cancer cells.
"It was just pure chance," said Mulholland, who hadn't yet hit the age most prostate screening checks take place. "Chances are if I hadn't had that test it would have been too late when they checked out what was going on (when symptoms occurred)."
Mulholland's PSA levels were high for his age, leading to an MRI scan and then a biopsy. "That's when they found it was aggressive," he said. A positron emission tomography (PET) scan, in which a radioactive compound enters the body, lit up the cancer showing its spread.
Malcolm and Wiki Mulholland with their children (from left) Patrick (14), Ihaia (17) and Molly Rose (21). Photo / Supplied
In some ways, it was Groundhog Day for Mulholland. He missed only one of Wiki's medical appointments after her diagnosis and was fully immersed in her management of cancer and the barriers that existed.
Those barriers to managing breast cancer existed also with prostate cancer. The academic, historian and author, whose expertise includes the relationship between Maori and the State, found himself again immersed in the language of expensive cancer medicines.
For prostate cancer, there's Apalutamide (Erleada) and Enzalutamide (Xtandi) on Pharmac's waiting list while funded in dozens of countries.
"I thought, 'here we go again'. How can you not fund a drug that's so effective?"
For Mulholland, he bypassed the public system and went for private surgery as fast and effectively as possible - even though it racked up $60,000 in bills. The surgery removed the prostate gland and surrounding lymph nodes. The outlook is positive with hope PSA tests in December will show he is clear.
Before then, though, came the conversation with the children - Molly Rose and her teenage brothers Ihaia and Patrick. As with their mother, Mulholland told them everything.
"It was really important we didn't jump to conclusions. I did myself, to be honest."
He sought her out before the surgery, standing at her grave at the cemetery and having a conversation.
"I said, 'help me, be my guardian angel at this time'. That was one of the really hard things going through it - I didn't have my Wiki.
Wiki Mulholland was diagnosed with breast cancer in 2018 and died in 2021. Photo / Mike Scott
"There's no one to roll over in the middle of the night and say, 'my mind is racing - I just need someone to talk to'."
And yet, said Mulholland, "in a funny way, I feel she's looking after me".
Beyond drug funding, Mulholland said New Zealand needed to widen the scope of screening. The guidelines currently stated those over 50 should be screened and only if symptomatic. If Mulholland's pathway was guided by the rules, he would be dead.
"It's just a blood test. Go get tested. Come up with a plan with your GP - there's nothing stopping that."
Cancer Control Agency acting chief executive Nicola Hill said it had carried out work to show how services could be improved in New Zealand and was now working on how those proposals could be picked up by Te Whatu Ora Health New Zealand, and Te Aka Whai Ora Māori Health Authority.
On medicines, the agency's Cancer Medicines Availability Analyses report idenfitied ":gaps where drugs which were publicly funded in Australia but not in New Zealand". It had been passed to Pharmac.
A Givealittle page to help cover the cost of Mulholland's medical treatment has been set up by one of the many people he and Wiki met through campaigning.
