Bryce Edwards: Will the Government improve access to cancer drugs?

Bryce Edwards: Will the Government improve access to cancer drugs?

Are New Zealanders dying unnecessarily because the government won’t fund cancer drugs that are considered standard in other countries? That’s the message from CANGO, a coalition of not-for-profit cancer organisations who launched a campaign yesterday, on World Cancer Day, for better access to cancer drugs for New Zealanders.

There is now a full-scale debate going on about whether the Government is doing enough in terms of cancer care. The allegation from cancer patient advocates is that successive governments have become complacent about cancer treatment, to the point where cancer treatment in this country is in crisis, and patients are paying the price.

Some are suggesting that Labour is already breaking promises over cancer treatment and little has changed with the change of government.

Drug funding is always one of the most contentious and prominent issues in cancer debates. A number of cancer patient advocate groups are campaigning for improved access to life-saving drugs, as well as calling for a review of the Pharmac drug-buying agency. This is best seen in Duncan Garner’s call yesterday, saying “We as New Zealanders should be demanding better drugs and more funding” – see: Time for inquiry into Pharmac’s funding of cancer drugs.

Garner argues New Zealanders are “getting third class medicines”. For example, because of more limited access to drugs in this country, “A woman with stage four breast cancer will live five years in Holland, but just 13 months here.” He says that “in the time Australia has approved 24 new cancer drugs, we have approved – wait for this – none.”

The broadcaster points the finger at the new Government: “Labour promised voters world class cancer care but, of all the rocks I’ve looked under, I can’t find any evidence anyone has done anything – and the clock is not only ticking but people are dying waiting.” Furthermore, Garner alleges that Parliament’s health select committee “wants a proper inquiry into Pharmac” but “the Beehive isn’t keen”.

Prime Minister Jacinda Ardern appeared on Garner’s AM Show this morning and answered his questions about drug funding and Pharmac, putting the case in favour of the status quo – see Zane Small’s Jacinda Ardern: Not fair to compare Pharmac with Australia’s system.

Ardern reiterated that Pharmac has “been pointed to as being the envy of others”, and she defended the system that keeps drug buying decisions “separate from politics”, saying “I will always maintain the principle that I should not be the one making decisions about drug treatment in New Zealand.” She also explained that Pharmac refuses to buy new medicines if they don’t “add anything that a past product” already has.

The Minister of Health, David Clark, has also reportedly “been quick to dismiss any plans to review the agency” – see Ruby Macandrew’s Health organisations join calls for a review into government drug-buying agency. This article details growing support, especially amongst health organisations, for a review of how Pharmac operates and why it is so slow in adopting new cancer treatments.

Apparently, in “its 25-year history Pharmac has never been reviewed”. This doesn’t mean that there have never been questions raised about its operations, and Breast Cancer Aotearoa Coalition chairperson Libby Burgess says: “History shows us that navel gazing by Pharmac and the Ministry unsurprisingly leads them to the conclusion that everything is just fine. Meanwhile New Zealand patients are suffering and dying needlessly through lack of access to effective modern medicines”. She argues that the “grindingly slow pace of Pharmac’s opaque decision processes is a national disgrace”.

The New Zealand Cancer Society appears to have sympathy with this point of view. It’s medical director, Dr Chris Jackson, is reported as believing “Pharmac need to consider an early access scheme to new cancer treatments which had not been considered for funding” – see Melanie Earley’s Northland father-of-three forced to sell ‘dream home’ to fund cancer treatment.

According to this news report, “There are no timelines around when Pharmac needed to make decisions on whether to fund a drug or not”, and Jackson says: “In the UK there are outlined timelines, I’d like to see something like that here so patients aren’t left in limbo – the window of opportunity for those affected by cancer is now.” Jackson also calls on Pharmac “to rethink the funding of Keytruda”.

In fact, according to a statement from David Clark, the Government is considering adopting the UK model. Isobel Ewing reported yesterday, “He has officials assessing the performance of the English NHS Cancer Drugs Fund and expects to have a better idea of whether it can be adopted here by the end of this year” – see: ‘Difficult situation’: Cancer patient leads pleas for better Govt funding of treatments.

This news item also reports on the alliance of eight major cancer non-profit organisations, CANGO, which “wants the Government to introduce a rapid access scheme for new cancer treatments in New Zealand”. According to CANGO, “thousands of New Zealanders are dying unnecessarily because treatments that are considered standard care overseas aren’t available here.”

Furthermore, the CEO of the Lung Foundation, Philip Hope, is also reported as explaining “Pharmac’s current funding model favours low value, high volume treatments and more expensive and effective treatments get delayed or denied.”

In the weekend, 1News reported on the latest plea for advanced breast cancer sufferers to get access to the two new and expensive medicines, Ibrance and Kadcyla – see: World-leading breast cancer expert calls on Pharmac to make two new breast cancer drugs more affordable. The report tells the story of how “Auckland woman Wiki Mullholland has been pushing for better treatment of advanced breast cancer since she was diagnosed in May.”

There is expert weight behind this campaign: “A world authority on terminal breast cancer, oncologist Dr Fatima Cardoso is supporting the cause.” Dr Cardoso also reflects on wider access to cancer drugs in New Zealand, saying “The medium survival of patients with this disease in New Zealand is about half of what it is in other developed countries. From those results, it is not good, and it needs clearly to be improved”.

Cardoso’s analysis of the availability of breast cancer drugs is also provided in Ruby Macandrew’s news report, ‘We’re giving up too soon’: Advanced breast cancer expert calls for attitude change in NZ.

According to this, Pharmac has already made a decision to make the two type of medicines available, albeit with some key exceptions in regard to patients already receiving other treatments. Cardoso is reportedly disappointed with this, stating: “In countries where drugs like these are available, metastatic patients [those with ABC] can sometimes live eight, nine, ten years. So this is unacceptable that a country like New Zealand has a one-year median survival for these patients.”

Finally, Duncan Garner is currently leading the charge for better access to cancer medicines, and so it’s also worth looking back at his open letter to the Minister of Health in August in which he challenges him to return to his promises: “why do warrior opposition MPs promise record spending on world-class cancer treatments when they want your vote, then upon getting the chance start talking like a stiff cold robot who is too scared of repeating the promise in case he or she has to make it come true” – see: Dr Clark, this is life or death, please help.