I am hopeful about our cancer care system, here’s why

Sunday, 1 September 2024

Rami Rahal took to the job 14 months ago, having come from Canada.

Rami Rahal is chief executive of Te Aho o Te Kahu, the Cancer Control Agency.

OPINION: Fourteen months ago, when I left my home in Canada with a goal to help improve Aotearoa New Zealand’s cancer system, I was aware of many of the challenges I was likely to face. I came to the role of chief executive with international experience and some understanding, through prior advisory roles, of the immense pressures New Zealand’s system has been under.

Anyone who has had cancer, or is supporting loved ones going through it, knows the personal impact of the challenges in the health system. Most of these problems are not unique to New Zealand. Across the world we are seeing countries struggling with long wait times; a stretched and often exhausted health workforce; governments trying to manage the increasing costs of new medicines and technologies; and most worryingly, persistent inequities in experience and outcomes faced by many members of society, particularly indigenous peoples.

Health New Zealand has reversed its decision and will now grant early access to the cancer drug Keytruda for patients, after initially rejecting the offer of free medication before government funding.

There are also challenges that are more pronounced in New Zealand. When compared to other countries, we have the highest proportion of cancer patients diagnosed in the emergency department, when their cancer has advanced to a late stage. Difficulty accessing primary care, coupled with insufficient community diagnostic services, sometimes means symptoms are not caught early enough. Māori and Pacific people are often most affected.

To get a deeper understanding, I travelled the country to learn first-hand how the system was performing from the perspectives of those at the heart of it. I listened to patients receiving their chemotherapy treatment in Whangārei, I heard from hard-working clinicians in Dunedin and talked with dedicated Māori community health providers in Rotorua.

So, why am I hopeful? Despite the clear challenges I saw, I was encouraged by the many examples of commitment, dedication, innovation, and resilience in every hospital, primary care clinic, Hauora Māori provider, hospice, and cancer lodge I visited.

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If you were with me as I spoke to Kiwis receiving chemotherapy treatment, you would hear the same message: praise and gratitude. Patients consistently commended the care and compassion they were receiving from doctors, nurses and other health professionals. Patients pulled me aside to share the name of their clinician in the hope they would get acknowledged for their hard work. That is a testament to the uncompromising commitment to high-quality patient care provided by our health workforce, despite the difficult circumstances. That commitment and dedication should never be taken for granted – it’s not a given in other parts of the world.

There are other hidden treasures in our cancer system that are making a big difference to local patients. There’s the fast-track diagnostic service in Palmerston North where general practice and specialist oncologists work together to ensure people with possible cancer symptoms don’t experience preventable delays in being seen and tested. There’s the primary care clinic in Wakefield, outside of Nelson, where GPs with specialist training remove skin cancers that generally require a hospital surgery. There’s the breast cancer “one-stop shop” at Manukau SuperClinic that provides wraparound screening, diagnostic and treatment services making navigating the system easier for patients and whānau.

At the Cancer Control Agency, we are working with other health agencies to ensure all New Zealanders have improved access to timely, high-quality cancer care. One notable example is helping the system implement the recent funding announcement for new cancer medicines. We are focused on not just enabling the health system to deliver on the newly funded medicines but building its resilience and lifting its capacity to be able to better respond to current and future demands.

A part of this is about hiring more cancer doctors which has already begun this past week. But it also includes shifting appropriate treatments to smaller local hospitals and community settings like primary care so it is available closer to home. And expanding roles of specially trained nurses and pharmacists to support more aspects of chemotherapy delivery allowing cancer doctors to focus on the more complex care only they can provide.

As I look at the work ahead of us, I recognise the challenges we face as we support the system to deliver the care all New Zealanders deserve, in a way that meets all needs and leaves no one behind. But I’m also confident that across the health system, we have the people with the talent, creativity, and commitment to help us get there. We can put a big dent in the burden of cancer, and we will do it by all working together.

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