Kiwi women die twice as fast; health system turns its back
7 September, 2018
Kiwis are dying of advanced breast cancer (ABC) twice as fast as people in comparable countries – and it’s not just about the lack of new drugs.
Shocking facts have emerged in a new report by Breast Cancer Foundation NZ released today, titled “I’m still here”.
• Average survival for a Kiwi patient with advanced breast cancer (ABC) is just 16 months, compared with two to three years, or more, in countries like Australia, Germany and France.
• Maori five-year survival is abysmal, just 5%, compared with 15% for non-Maori.
• Once diagnosed with ABC, Kiwis seem to receive less treatment than in comparable countries, and up to one-quarter receive no treatment at all.
• Half of ABC patients receive no chemotherapy – and those that do are often pushed to the back of the queue
Advanced breast cancer (ABC) is also called metastatic, secondary or stage four breast cancer. It is breast cancer that has spread beyond the breast and lymph nodes to another part of the body.
BCFNZ’s research manager Adele Gautier says, “Until now, we had no idea how bad things were for New Zealanders whose breast cancer has spread. It’s thanks to the data revealed for the first time by the Breast Cancer Foundation National Register that we’ve now learned the truth.
“We are very good at treating early breast cancer – world-class, in fact. Sadly, the numbers prove the same can’t be said once breast cancer spreads.”
The Chair of Breast Cancer Foundation NZ’s medical advisory committee, Dr Reena Ramsaroop, says this is vital new information for the medical community.
“We did this study because patients were telling us they feel forgotten, and cast aside,” she says. “No-one wants to think we are falling behind the rest of the world, yet the evidence is clear that this is happening.”
Why is our survival so poor? The data reveals that:
• Kiwi ABC patients are getting less treatment, not just with new drugs, but with existing ones. For example, half of patients do not receive chemo that could extend their lives. Of those who do have chemo, many have only one line of treatment, which may be of shorter duration than overseas. Whether our low chemo rates are the result of doctors’ recommendations or patients declining treatment, it could be a major contributor to our poor survival.
• ABC patients are often pushed to the back of the queue. For example, in some regions they are bottom priority for the chemo suite; access to diagnostic tests is delayed; new lesions often are not biopsied.
• The team approach that is the gold standard in cancer treatment (and is followed in early breast cancer) disappears in ABC. For example, ABC patients are not discussed in multidisciplinary team (MDT) meetings.
What do we want?
1. An urgent change in attitude that sets expectations higher for people with ABC in New Zealand. Kiwi lives are worth the same as Australian, Canadian, French and German lives.
2. New drugs, but just as importantly, we need to use the options we already have more assertively (as they do overseas). We need more lines of treatment; no-one should get nothing.
3. Local guidelines for ABC treatment that will remove inequities and ensure everyone gets the best possible care.
4. A kinder approach to ABC patients. For example, at the very least:
a) Every ABC patient should have free GP visits and free prescriptions
b) If people are funding their own staggeringly expensive drugs, they should receive the infusions free in public hospitals, which would save them thousands of dollars each month in private clinic costs.
The “I’m still here” report combines the output of three studies commissioned by Breast Cancer Foundation NZ: a survey of medical professionals; a patient survey; and the first statistical analysis of data about advanced breast cancer treatment and survival from the Breast Cancer Foundation National Register.
See the Q&A below for more information.
To read “I’m Still Here” report, visit www.breastcancerfoundation.org.nz/ABC