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An
in-depth study into breast cancer care in New Zealand
has suggested four key ways to improve outcomes for
patients.
The research was conducted earlier this year
by Economist Impact, and sponsored by Merck Sharp &
Dohme (New Zealand) Limited (MSD). Released during Breast
Cancer Awareness Month, it analyses how New Zealand can
improve patient-centred care and build awareness, promote
screening, early detection, diagnosis and prognosis, and
ensure access to high-quality treatment, including
supportive and palliative care.
Emily Tiemann, Health
Practice Manager at Economist Impact, says: “Low
awareness, late diagnosis, and restricted access to
treatment especially for disadvantaged communities has meant
that breast cancer outcomes can be poor. However, there are
significant opportunities to improve breast cancer care in
New Zealand by understanding the patient-centred care
pathway for early breast cancer diagnosis and treatment and
investigating the unmet needs in the management of breast
cancer.”
The four opportunities identified to
optimise early breast cancer care and improve outcomes for
people living with breast cancer in New Zealand
are:
1. Move beyond mortality and focus on
quality of life: The outcome measures for breast
cancer management should go beyond simply mortality
reduction. The target should be to improve quality of life
by providing patient-centred care and support.
2.
Establish a coalition or alliance of
stakeholders: To align the priorities of
individuals impacted by breast cancer (patients and carers)
and the preferences of the decision-makers, a breast cancer
expert coalition or strategic alliance should be established
with patient advocates, industry representatives, academia,
and relevant healthcare professionals. To ensure
patient-centred care, it is crucial to involve the
patient.
3. Aspire for world-class care with
improved access to innovative treatments: To meet
the international standards of breast cancer care, the
health system should identify the right outcomes and define
tangible key performance indicators (KPIs) and quality
performance indicators (QPIs). The aim should be to achieve
improved patient-centred care and treatment options and
ensure that health budgets are better targeted towards the
interventions that would have the biggest effects on patient
care and outcomes.
4. Ensure screening
programmes are available and are equitable: Since
screening programmes play a vital role in early detection,
impacting patient outcomes, monitoring and evaluating
screening programmes at regular intervals is essential. The
screening programme data, alongside important KPIs such as
coverage and uptake, can be used to inform policy makers
whether the screening programme is delivering the expected
benefits or not. Ensuring timely uptake and availability of
screening programmes is accessible for Māori and Pacific
peoples is key to improving outcomes.
Key
findings:
Awareness: Awareness is
the first step towards any change. It is critical to promote
health literacy to increase participation in preventive care
measures such as lifestyle changes and exercise,
self-examination of breasts, regular check-ups with GPs, and
screening for eligible candidates. Many stakeholders
including NGOs, patient advisory groups, and the government
are involved in promoting awareness of early breast cancer
and associated risk factors such as alcohol consumption and
obesity. However, lack of access to information particularly
for Māori and Pacific peoples is a big barrier to the
optimisation of patient-centred care in New
Zealand.
Screening and Diagnosis: New
Zealand has a robust national breast cancer screening
programme which is responsible for early detection and
reduction in mortality. However, the majority of diagnosis
is via non-screen routes – GP referral or ED visit.
Additionally, inequity in access to screening and diagnosis
for Māori and Pacific women and those at high risk or
outside the screening age is a big challenge in New
Zealand.
Treatment: New Zealand last
published guidelines for early breast cancer management in
2009, covering informed decision-making and a
multidisciplinary approach to treat cancer. However, the
guidelines should be updated to deliver high quality,
evidence-based care, improve outcomes, reduce variation, and
make good decisions with resources. New Zealand should
consider how it equitably prioritises access to modern,
innovative medicines for its
population.
Survivorship: Continuity
of care and psychological support for cancer survivors are
important elements of patient centred care. In New Zealand,
there is an opportunity for specialist nurses and primary
care providers/ GPs to offer continuous support to cancer
survivors at the community level. Psychological support,
though acknowledged, is identified as an unmet need, which
must be addressed.
Workforce:
Workforce availability was identified as a challenge across
all steps of the patient journey. To optimise
patient-centred care, there is a need to develop, retain,
and up-skill the health workforce in New
Zealand.
Those who took part in the study included
Breast Cancer Aotearoa Coalition, the Breast Cancer
Foundation New Zealand, plus a number of healthcare experts
including surgeons and oncologists. The research is part of
an APAC project, which also covers Japan, Thailand,
Singapore and South Korea. The New Zealand findings are the
first of the five countries to be released.
The facts
about breast cancer in New Zealand:
New Zealand is
among the countries with the highest prevalence of breast
cancer, affecting one in nine women, and more than 600
deaths every year. The incidence rate exceeds the OECD
average and is second only to Australia. According to the
WHO New Zealand Cancer profile, the total breast cancer
cases per year are expected to increase by 31% and reach
4,584 by 2040 from 3,504 in 2018.
Breast cancer is
among the leading causes of death in New Zealand with an
overall mortality rate of 6.3% and, after lung cancer, it is
the most common cause of cancer death for women. Māori
women have a 60% higher breast cancer mortality rate than
women of European descent in New Zealand.
Breast
cancer diagnosed at an early stage, when it is not too large
and has not spread, is more likely to be treated
successfully than breast cancer diagnosed at an advanced
stage. Advanced breast cancer not only creates an urgent
health challenge but also impedes the quality of life, and
brings significant economic costs for patients, their
families and public health systems.
Breast cancer is
the second-most expensive cancer (following colorectal
cancer), costing $126.7 million (NZD) per year and
accounting for 14% of total cancer costs. However, treating
patients with early-stage breast cancer is less costly than
treating those with advanced (metastatic) disease. Overall,
surgery, diagnostic tests, and targeted therapy are the most
significant costs. Median costs for Stage 1 are $26,930,
rising to $50,388 for Stage IV.
Key
quotes:
“The need for improvements in other
cancer streams has reduced the level of focus on breast
cancer. It shouldn’t be one cancer against the
other.”
says Ah-Leen Rayner, CEO of the Breast
Cancer Foundation New Zealand
“Breast cancer is
overall a very survivable illness across all stages,
especially if caught early with screening and self
examination. In NZ, we have good access to surgical options
including reconstruction and radiotherapy. There is further
work needed to improve access to funded medications in some
scenarios,” says Dr Katherine Gale, Oncoplastic Breast
Surgeon at the North Shore Hospital.
“And it’s
much more than just mortality figures. It’s about reducing
morbidity from breast cancer, it’s about improving quality
of life, facilitating breast conservation wherever possible,
and preserving femininity. The outcome measures have gone
beyond mortality reduction,” says Adam Stewart, Breast
& General Surgeon, National Clinical Lead, BreastScreen
Aotearoa.
“If you have early diagnosis, everybody in
this country is going to benefit, for example, evidence
shows that the 10-year survival drops from 97% for stage 1
to 71% for stage 3 disease,” says Fay Sowerby, Secretary
of the Breast Cancer Aotearoa Coalition.
Equity issues
must be addressed, particularly the abilities of Māori and
Pacific women to access screening services, as well as
follow-up care. These under-represented groups should have a
voice as decision-makers. “Shifting of the cultural norms
that inform design and practice can only improve the quality
of the cancer system for all,” says Stephanie Turner, AYA
Cancer Network Aotearoa board member and Director, Māori
Health at the Health Quality & Safety
Commission.
To
read the full report, go to Economist Impact Perspectives
site.
Press enquiries:
For more
information or to arrange an interview, please contact:
Annie Hogan, Ogilvy NZ PR & Activations Lead, email: annie.hogan@ogilvy.co.nz
mobile: 021 725 259
About Economist
Impact:
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think-tank with the creativity of a media brand to engage a
globally influential audience. We believe that
evidence-based insights can open debate, broaden
perspectives and catalyse progress. The services offered by
Economist Impact previously existed within The Economist
Group as separate entities, including EIU Thought
Leadership, EIU Public Policy, Economist Events and
SignalNoise.
Our track record spans 75 years across
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unique in the marketplace. Visit www.economistimpact.com
for more
information.
…
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