‘Something’s really broken’: What is going on with gynae cancer surgery?

Saturday, 18 October 2025

Lower North Island patients have to fly to Christchurch for operations, the country has fewer than half the specialists it needs, and the trainee pipeline is leaking all its skills over the ditch. Nikki Macdonald investigates what is going on with gynaecological cancer surgery.

When Daryl Evans emerged from the shop changing room to show an outfit to her girlfriends, she noticed her stomach seemed enormous.

“I honestly looked eight months pregnant.”

Her doctor suspected gut inflammation, but when nothing had changed a week later, they sent her for blood tests. After 15 hours on a corridor bed at Wellington Hospital’s overloaded emergency department, she got the news everyone dreads.

“Rosie - I’ll never forget her name - came down at three o’clock in the morning and said ‘Sorry to tell you, but you’ve got ovarian cancer’. I was shocked and just in denial.”

But the shock didn’t end there. Doctors told her the cancer was the most advanced - stage four - and she needed a hysterectomy. Despite living less than an hour from the capital, on the Kāpiti Coast, the 58-year-old found out she’d have to travel 300km to Christchurch for surgery.

“I was like ‘What?’… It just seems pretty Third World.”

Even nine months on from learning she had cancer, Evans is still so traumatised she struggles to say the C-word, and can’t bear to name chemo, calling it “nemo”. So to face travelling for treatment while still reeling from the diagnosis of a cancer that only about one in six women survive was “pretty horrific”, she says.

“Going through this is hard enough without having to navigate flying to Christchurch.”

Evans is one of 59 Lower North Island women Health NZ has sent south for gynaecological cancer surgery this year, after the Wellington service collapsed in November 2024 when its sole remaining gynae oncologist resigned.

That left the country with fewer than half the specialists it needs to provide surgery for the cervical, uterine, ovarian, vulva and vagina cancers that make up one in 10 female cancer cases - and one in 10 deaths.

Women now depend on a service that even official documents admit is strung together by goodwill, and risks the burnout of the two Christchurch surgeons who say they’ve been doing the work of six people.

And there’s little hope of a quick fix, with only one of the past eight gynae oncology trainees still working in New Zealand. The specialist training pipeline has sprung a mighty leak - mostly spilling its precious skills into Australia.

‘It’s just crazy’

Evans has only praise for her treatment in Christchurch. Health NZ paid flights and accommodation for her and her support person, sister Tracy Vine, and the team were “phenomenal”.

But being so far from home takes a toll. While out-of-region patients have always travelled for treatment, they were at least in driving distance. Vine had to negotiate 11 days away from work, and was so overwhelmed with being the only support person, her daughters flew down to support her.

“I did have a little bit of a breakdown,” Vine says. “It was tough not having anyone to help me and - when I was exhausted - someone to take over. It was all me.”

Both Evans and Vine struggle to comprehend how the capital can be left without a specialist gynae cancer surgery service.

“It’s just crazy,” Vine says. “I think it’s terrible. Something’s really broken in the system to have to fly people to Christchurch.”

The experts, generally, agree.

“Wellington's our capital city. It's quite shocking that there isn't a service there any more,” says Royal Australian and NZ College of Obstetricians and Gynaecologists (RANZCOG) president Gillian Gibson.

“It’s just not sustainable. These are highly complex cancer operations. They’re hard work. And women deserve safe and timely care closer to home.”

A 2023 submission to the Health Ministry called the country’s gynae cancer specialist service “critically understaffed and highly vulnerable”.

There are just seven gynae oncologists in the whole country - four in Auckland and three in Christchurch. That’s the same number as in 2011, when there were a million fewer Kiwis.

“We should have 15 to 16, and at least three should be in Wellington,” Gibson says.

Nelson-based Cancer Society medical director Kate Gregory dispenses medical, rather than surgical, treatments to women with gynaecological cancers.

“As a community of specialists who treat gynaecological cancers, we don’t think it’s acceptable. Wellington is a tertiary centre, and it should remain so.”

Even Health NZ said in a December 2024 aide-memoire that it was already worried about the vulnerability of the national service before Wellington stopped operating. None of the gynae cancer surgery centres - Wellington, Christchurch or Auckland - were fully staffed, it said.

“None of the three sites has the required number of gynaecology oncologists to deliver resilient, sustainable services.”

How did we get here?

Peter Sykes was New Zealand’s first specialist-trained gynae oncologist, returning to work here in 1997, after qualifying in Melbourne.

Since the Wellington surgery service folded, the Otago University associate professor has also been one of two Christchurch specialists trying to look after gynae cancer patients from the entire South Island, and half the North Island.

“Two of us have been doing the work of six people, since Christmas … We’ve survived,” he says quietly.

As of last week they now have a third gynae oncologist to replace their colleague, who is off sick. It’s a long way from the three-centre national service Sykes helped conceive almost three decades ago.

He thought then, and still does, that Auckland, Wellington and Christchurch all needed their own service, each with at least two gynae oncologists. But even two is “fragile“.

And Wellington has always been more fragile than most, with Christchurch periodically covering gaps previously. But the issue came to a head when Wellington’s last gynae oncologist left in November 2024.

“The whole of the New Zealand health system is under strain, and so you feel that wherever you’re working,” Sykes says.

“Those issues of pressure come out in different ways. So sustainability of the workforce has been a real problem. If we had retained all those eight people we had put on the training scheme, we’d be fine. But it hasn’t worked.”

What happens now for lower North Island patients depends on the kind of cancer they’re suffering from.

Some patients can be managed by Wellington gynaecologists and cancer specialists, who still deliver chemotherapy, radiation treatment and nursing support.

And as well as sending patients south, Health NZ is sending surgeons north. Once a month, a Christchurch gynae oncologist heads to Wellington to operate on lower complexity cancers that need less after-care, such as cervical, uterine and vulval cancers.

That’s great for patients, but not so great for the surgeons.

“We are still travelling to Wellington, which is a strain on us,” Sykes says. “We’re going up once a month for three days. That’s just shared by two of us.”

The most complex cases, such as Evans’ advanced ovarian cancer, all go to Christchurch. But those patients often also need chemo, which is still given in Wellington, fragmenting their care.

Gregory, of the Cancer Society, says while the service is working well, it’s held together by “goodwill and determination that patients don’t suffer”.

“As time goes on, that gets more stressful, trying to sustain that level of additional work. It’s not like they were sitting around doing nothing prior to this.”

The Health NZ aide-memoire said if the extra workload proved too much for Christchurch, women could be sent to Australia.

There is some hope. The Christchurch service has recruited two extra specialists from America and Australia, one of whom started last week, and one starting in January.

Health NZ says it’s also working to identify what’s needed to support Christchurch’s extra workload, including anaesthetists and pathologists.

Sykes is optimistic things will improve in the south.

“It’s much easier to recruit to a stable, functional unit that’s already adequately resourced. Recruiting to an under-resourced centre is difficult … And then there’s trainees who want to come here. So I think the future is good, solid.”

The future for lower North Island gynae cancer patients, however, is anything but solid.

Health NZ national clinical network director Mary Cleary-Lyons says they were unable to recruit a second specialist to Wellington, despite trying hard. And running the unit with just one surgeon was unsustainable.

Work is under way to consider the best long-term approach, but there are no plans to recruit to Wellington for the next four to five years, she says. In the mean time, they’ll keep sending complex cases to Christchurch, or Auckland.

Gregory worries that will be the death knell for specialist surgery in Wellington.

“It’s hard to reinstate a service that’s gone away.”

Why can’t we keep the specialists we train?

Michael Burling always intended to come back.

Having moved to New Zealand from Tonga in 2001 for medical school, he was drawn to the breadth of gynaecology and obstetrics, from the adrenaline rush of delivering babies to following gynae cancer patients for five years.

In 2015, he moved from Waikato to Auckland to start sub-specialist training in gynae oncology.

Even then, New Zealand had only about half the specialists it needed, but trainee positions were hard to come by and Christchurch was the only Kiwi centre offering the fellowship job you needed to complete the training.

So Burling looked overseas.

“That was really tough. You would go to these conferences and be nearly begging the limited units in Australia to take you on as a fellow.”

He landed a training job in a Sydney hospital, but always intended to return. Then he met his wife, with whom he now has two young children.

“I got where I am because of New Zealand - there’s no doubt about that. But it’s just really hard to think - would I go back?”

Now 42, Burling works in both public and private and makes about triple what he would in New Zealand. His patients have better access to novel medications, and working in a bigger centre eases the pressure of a job that’s mentally and physically exhausting, he says.

“Some of the surgeries we do can take up to 10 hours. If you're doing the job with a bigger number of doctors, it's less stressful, and your work life balance will be so much better. You'll stop things like burnout of doctors.

“You can't say no to the operating list that one of your colleagues has called in sick for. Whoever's free needs to suck it up and go and do it.

“But no-one rings us and checks on how we are doing. We have operated four days in a week - doing one day of operating is an equivalent, nearly, to a marathon.

“It's absolutely exhausting on our backs, our joints, most of us, by the age of 50 to 55 have worn ourselves out completely.

“Every time I talk to my colleagues there, it’s obvious that they’re overworked and under-staffed. And it’s still not changed. The amount they’re getting paid, to do the job they’re doing, I wouldn’t leave my job here to do.”

And that makes solving the specialist shortage difficult.

RANZCOG has doubled Auckland’s training places to two, and hopes to do the same in Christchurch, meaning New Zealand could produce four new gynae oncologists every three years.

But that only helps if we can keep them. And while plugging gaps with overseas recruits might help, that can actually make it harder to train more homegrown specialists, as they might not be accredited to oversee trainees.

Gibson says the specialty needs more training capacity, and national workforce and pay plans.

While spending time overseas on a training fellowship can be useful, they’re now trying to entice trainees to return by offering job contracts before they leave, she says.

“It’s trying to maintain a workforce, and it’s also trying to train a workforce. We just need to build a more sustainable health system for the future.”

Gregory says training more homegrown specialists make sense. But they’ll only stay if conditions improve.

“I think it’s understandable that people don’t come back, when you’ve got these departments that are under huge stress, and you see that as a trainee, and you think ‘Do I really want to spend my working life in this environment?’”

Cleary-Lyons says Health NZ is recruiting for extra gynae oncology specialists in Auckland and Christchurch, but they’re in high demand internationally. There are also two fellows in training.

It is also reviewing the specialty’s pay and retention package. In Auckland, surgical capacity is meeting demand, Cleary-Lyons says. She does not believe New Zealand needs 15-16 specialists.

“Having 10-11 gynae-oncology surgeons across the motu will mean we are well placed to deliver excellent care to the women who need it.”

Back on the Kāpiti Coast, Evans can understand why young surgeons might be drawn to Australia’s better salaries and conditions. But leaving Wellington without a specialist gynae cancer surgery service should not be an option, she says.

“It must be costing hundreds of thousands of dollars flying us down, and putting us up. And that money could be better spent somewhere else … It was bloody hard, leaving Wellington. And obviously I didn't have the support from other friends and family to come visit.'

Nine months on from her diagnosis, Evans has finished chemo. She’s still on hardcore painkillers and has good days and bad days. She can’t work, and surviving on a benefit is brutal. And she’s still processing the heartbreak of having to put her 85-year-old mum in a rest home, because she can no longer look after her.

But she’s not done fighting.

“The prognosis for ovarian cancer isn’t great. But I’m going to survive.”