Report warns of increasing deaths caused by lung cancer

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“New Zealand should increase funding, improve screening and reduce ethnic disparity”
Economist Intelligence Unit Report cites areas of improvement

Venkat Raman
Auckland, November 19, 2021

Lung Cancer is the biggest killer in New Zealand and although the country is punching above its weight, there is vast scope for improvement, a significant study has concluded.

The Study, conducted by the Economist Intelligence Unit (EIU) of London for the Auckland based Merck Sharp & Dohme (MSD) New Zealand Limited said that New Zealand should improve screen programmes and increase public funding for lung cancer treatments such as immunotherapies and targeted medicines.

The Report also said that Maori are three times more likely to die from the disease and revealed the existing ethnic disparities and limited access to personalised medicines.

The Report is based on a study of the policies, programmes, funding, efforts to prevent and control and other elements relating to lung cancer in ten countries of the Asia-Pacific region, namely Australia, China, Hong Kong, Indonesia, Japan, New Zealand, Philippines, South Korea, Taiwan and Thailand. Domain Scores on various aspects have been rated as Low, Moderately Low, Moderate, Moderately High and High.

Funds not matching needs

Dr Rohini Omkar, Senior Associate (Health Policy and Clinical Evidence) of EIU in Singapore, who prepared the Report, cited Te Ahu O Te Kahu (Cancer Care Agency) of New Zealand as an example of what can be done when national efforts are focused on a big problem.

The Report reviewed seven drugs used across 13 non-small cell lung cancer indications and found that none was funded in New Zealand.

According to Dr Omkar, this was in stark contrast to Australia and Japan which funded 11 and 13 of these indications, respectively.

“New Zealand is on par with the Philippines and Thailand with respect to drug reimbursement. However targeted drugs gefitinib and alectinib are reimbursed by the New Zealand public health system. Patients in New Zealand can access unfunded medicines through the private health sector if they can afford to pay. The stark divisions between the quality and availability of care in the public and private health services has created a two-tier system,” she said.

Maori suffer disparity

The Report found significant disparities in health outcomes experienced by Maori.

“Maori are often diagnosed at a late stage in hospital emergency departments, which leads to poorer lung cancer outcomes. But there is room for improvement,” Dr Omkar said.

The Report has also revealed variations in lung cancer care across New Zealand.

Taking tumour testing as an example, the Report said that it is important to determine the type of lung cancer in a patient so that the right treatment procedure can be followed.

“While tumour testing is available in New Zealand, not all District Health Boards offer this service. Lung cancer treatment guidelines and standards were found to be applied differently depending on where you live. Referral to respiratory specialists also varied depending on your location,” it said.

(Picture from LinkedIn)

Lotteries in Cancer care

MSD New Zealand Managing Director Paul Smith acknowledged the progress being made.

“We have a strong legal framework for tobacco control and Te Ahu O Te Kahu is doing a very good job of pulling in resources and focusing the national attention on cancer control efforts.

“But we must do better. The EIU found that guidelines and timeframes were not being applied consistently throughout the country, patients were not receiving public access to personalised medicines and Maori were disproportionately affected by lung cancer. We are hopeful that current efforts at the national level will help to ensure better screening, diagnosis and access to lung cancer treatments. This will ultimately put an end to postcode lotteries in cancer care,” he said.

Lung cancer leading cancer mortality

Stating that lung cancer is the leading cause of cancer mortality in the Asia-Pacific region, the Report said that deaths resulting from this ailment will increase dramatically unless governments take decisive steps to control the disease.

“A million people in Asia-Pacific countries died of lung cancer in 2018, and annual deaths are expected to increase to over 1.8 million by 2040. The main causes of this crisis are tobacco use, both through smoking and exposure to second-hand smoke, air pollution, and weaknesses in health systems and policy,” the Report said.

According to Dr Omkar, most countries surveyed for the Research have updated their Cancer Control Plans or published them during the past five years.

This is a positive sign, she said but found that a majority of these countries did not have specific Cancer Control Plans.

“This is discouraging,” she said, adding, “such plans are needed to help countries to fully prioritise lung cancer at the top of their agenda.”

Harmful effects of tobacco

In terms of dealing with the challenge posed by lung cancer, disparities remain across countries in the implementation of bans on public smoking and restrictions on e-cigarettes. In addition, smoking rates in men in the region are among the highest in the world, while air pollution places a disproportionate burden on non-smokers and women.

“Many other weaknesses are evident in the provision of rapid diagnosis and referral to quality care. Access to targeted therapy and immunotherapy also varies significantly across the countries of study. Psychological support for patients is lacking, and shared decision-making is a relatively unfamiliar concept in many countries’ lung cancer care pathways. Finally, comprehensive, high-quality data remains in short supply. This makes it more challenging for health providers to gather evidence about which public health measures are most likely to reduce new lung cancer cases and which treatments are most effective in different populations,” the Report said.

The EIU Scorecard

The EIU has designed a policy scorecard to access the policy and performance in five major areas, on an evidence-based approach. They are (1) Lung cancer is a strategic priority: focusing on national cancer control plans and clinical guidelines (2) Lung cancer is a public health issue: covering aspects of public health, including health literacy, tobacco control and screening (3) Lung cancer is a race against time: reviewing fast-track referral systems and rapid referral to treatment (4) Lung cancer is at a crossroads: assessing effective treatment and quality care (5) Lung cancer is a focus for research: appraising registries and research.

Indicators within each domain were selected based on evidence of their association with improved outcomes.

“After drafting scores for indicators within these five domains from the published and grey literature, the research team attended national workshops in selected markets to validate their scores and flesh out opportunities for improvement in each country,” it said.

“While the picture was somewhat mixed across the region as a whole, the five domains provide a basis with which to target particular challenges for each country, with the aim to improve lung cancer prevention, detection, referral and treatment,” the Report said.

Six areas of action

The EIU has called for action in six major areas.

They are (1) Fill gaps in cancer policymaking and formalise policy implementation (2) Strengthen action on smoking and air pollution (3) Improve data quality and establish national cancer registries (4) Demonstrate the benefits that widespread population-based screening can have to the Asian-Pacific region (5) Improve provision of rapid diagnosis and tackle inequalities in access to care (6) Expand support for patients by involving them in decision-making and supporting them through the entire care journey

The EIU has also published a country profile for each of the ten countries, detailing national data on epidemiology, scores for each indicator and a list of recommendations.

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