Speech:Tony Ryall - Inaugural International Cancer Symposium   14 Feb 2011

I’d like to acknowledge the participation of the Mayo Clinic. To have people from such an internationally renowned centre of excellence in cancer care is a great honour for New Zealand.

Similarly, it is a privilege to also have clinicians here from the Dana Farber Cancer Institute in the United States, and the Royal Prince Albert and Peter MacCullum Cancer Centres in Australia.

I’d also like to recognise the many New Zealand cancer clinicians here who make such a great contribution.

The increasing burden of cancer is a significant challenge for all health services. Cancer is one of our biggest killers, and the fear of cancer weighs heavily on the minds of all New Zealanders.

The National Government’s approach to cancer puts the patient’s perspective first. Our approach has a number of goals which are consistent with many other countries:

• To help New Zealanders prevent cancer through reducing risk factors;
• Reduce the impact of cancer through screening and early detection
• Ensure timely access to diagnosis and treatment
• Improve the patient and family experience of cancer care
• Improve cancer control through quality research.
All these add up to better cancer services within the New Zealand public health service; and are paying dividends as cancer survival rates here improve and compare well internationally.

New Zealand’s cancer services are broadly organised around six regional cancer centres. There is now an increasing emphasis on clinical networks across these centres led by cancer clinicians.

The Government wants to ensure all New Zealanders living with cancer have access to the best possible care.

We have invested an extra $1.2 billion in public health services in the last two years.

Prevention
Prevention strategies help New Zealanders reduce their risk of developing cancer.

Our government has put particular focus on tobacco control. The price of tobacco is expected to increase by a third over a 20 month period, as a result of an unprecedented three-step increase in tobacco tax.

This is the largest increase in tobacco taxes ever and is one of a number of significant public health initiatives we have taken.

In addition, both hospital and primary care clinicians are now being encouraged to offer smoking cessation support to all smokers they see as part of the Government’s Six National Health Targets.

Right now, 70% of all smokers admitted to hospital have been offered smoking cessation support under the ABC approach (Ask, Brief, offer Cessation).

Another cancer prevention programme is the national vaccination programme for HPV which has been rolled out across the country.

Physical activity reduces the risk of some cancers. Significant public money is being invested in improving physical activity in schools through the Prime Minister’s “KiwiSport” initiative.

Being overweight increases the risk of some cancers. So the Government is working well with industry to enhance activities improving nutrition education particularly with school children, including "Fruit in Schools"

Screening
More and more New Zealand women are participating in national breast screening and cervical screening programmes. There’s continuing substantial improvement in uptake.
In the next few months the Government will pilot a multi-million dollar bowel cancer screening programme, based in north and west Auckland.
Bowel cancer is the most frequently diagnosed cancer and the second highest cause of cancer death in New Zealand. In 2007 almost 3,000 people were diagnosed with bowel cancer and 1,252 people died from the disease.
A nationwide bowel cancer screening programme could ensure earlier diagnosis and treatment of bowel cancer and I'm advised, an increase of up to 270 lives saved per year.
People have been calling for bowel cancer screening for many, many years, and this Government is proud to begin the programme, particularly in such tight financial times.
Treatment
The Government is investing substantial resources into reducing waiting times for cancer treatment. We know that timely and accurate intervention saves lives.
One of our six national Health Targets is reducing cancer radiotherapy waiting times to a maximum of four weeks… the world gold standard. This target applies across the whole country so all New Zealanders can benefit.
Over the past 2 years, significant progress has been made in reducing radiotherapy waiting times down to a maximum of six weeks.
This is one of the singularly most important achievements the public health service has made for patients in the past 2 years.
Previously some patients waited up to 15 weeks, with many being sent to Australia for radiation treatment, with all the additional pressure that entailed.
Publicly funded chemotherapy clinics have increased 25% in two years, to just over 57,000 outpatient sessions in public hospitals.
The increase in chemotherapy volumes is mainly due to a larger number of people getting extra courses of chemotherapy treatment, and the introduction of new drugs, rather than an increase in the total number of new cancer cases.
We are investing heavily in new cancer medicines, including access to 12 months Herceptin, and wider access to drugs for patients with lung cancer, lymphoma, and colon and rectal cancer.
Patient Experience
Fundamental to all we do in cancer care is ensuring that patients feel they have sufficient control over their care to improve satisfaction and outcomes.
In 2009, Cancer Control New Zealand surveyed cancer patients to see if the services they received matched their needs and expectations.
Patients in the survey placed the greatest importance on their relationships with health care professionals, on the information they received, and on facilities and amenities.

On the flip side, patients thought more could be done in assisting with emotional support, and with information on how their lives would change.

An additional $30m of funding to the Hospice movement over the past 2 years recognises the vital role it plays in the issues raised by patients.

Hospice recognises the dignity that we owe everyone with a fatal illness to have the fullest possible life right now.

Our clinical leaders are using this better understanding of patient experiences to improve the way they care for patients and their families.

Quality Research

To determine the effectiveness of any of our strategies – prevention, screening, treatment, research – we require good national cancer data.

Without quality information, there’s no good way to know whether these initiatives are doing any good. And that’s where the Cancer Registry comes in.

Revamp of NZ Cancer Registry

The New Zealand Cancer Registry was established in 1948. In 1993, Parliament passed the Cancer Registry Act mandating the reporting of all malignant tumours from pathology lab reports.

However, in Opposition and in Government, clinicians made it clear to me that the registry is in need of change to improve its utility.

This was highlighted to me when I asked a senior cancer clinician how many linear accelerators did he think New Zealand needed in 5 years time, and he replied “How would we know?”.

As you’ve heard, the Government asked Cancer Control NZ, in collaboration with the Ministry of Health, to consider a revamp of the Cancer Registry. Led by Professor John Nacey, a panel made a number of recommendations which we are acting on.

As indicated to you earlier by Professor Atkinson, the Government is announcing today a significant upgrading of the New Zealand Cancer Registry.

The Registry will be expanded to encompass data from both the public and private health services, along with the types of data, and how it is collected.

The upgraded registry will be online, and easier for clinicians to use with a standardised format. Information will be collected along the whole of the patient journey in a much more timely way.

You’ve just heard Professor Greipp talk about how standardised data collection – rather than the variation inherent in hand written notes - can improve patient care (“synoptic reporting”).

The Cancer Registry will be overseen by clinicians themselves.

The benefits are significant for care and for planning. Cancer data which is more available and more directly accessible will help improve cancer outcomes.

We’ll learn more about what increases cancer risk, preventative measures and environmental factors.

We’ll learn how changes in treatment practice will impact on our investment in technology like linear accelerators!

It is expected that authorised clinicians, like GPs, will access the registry data on their own patients so they can better interpret their own practice and DHB performance and outcomes.
Patients too should expect to be able to see their own information.

Upgrading and revamping the Cancer Registry is important work. I’ve directed the Ministry of Health to provide all the support Cancer Control New Zealand needs to accelerate this initiative.

Conclusion
As has been said, cancer is largely a disease of ageing. As New Zealand’s population grows and ages, the number of people diagnosed with cancer will increase.
Given this increasing number of New Zealanders living with cancer, and the continuing development of expensive new drugs and treatments, the cost of cancer to the public health service – and taxpayers - will only rise.
Continuing to improve cancer survival rates, and providing care and treatment for more people who are living with cancer, will require ongoing investment in capacity and infrastructure.

That’s a commitment New Zealanders want us to make. And we will.
The New Zealand public health service consumes an ever increasing share of total tax dollars – now around 20% of all government spending.
The cost in human terms, both to patients with cancer and to their family, is huge.

Health is a very challenging portfolio in Government. It is a real privilege for me to work with such committed and dedicated people as those in our hospitals, our community providers, the Ministry of Health and at Cancer Control NZ.

Thank you for the opportunity to talk to you today.

(New Zeaaland Government)

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