Lung cancer survival is a postcode lottery, with rates at New Zealand’s worst-performing health boards up to four times lower than those in the best areas, a new report reveals.
The Cancer Control Agency’s report into New Zealand’s biggest cancer killer found “marked variation” in survival rates between district health boards.
Agency boss Diana Sarfati said the disparity was unacceptable and an April meeting with DHBs would unpick the reasons and devise an action plan.
The report also found more cancers were going undetected. Almost half (45 per cent) were only picked up when the patient turned up to a hospital emergency department, compared with 36 per cent in 2004.
Lower survival rates can indicate late diagnosis, or poorer treatment after diagnosis. Seven out of 10 lung cancers could be curable if caught early.
Southern DHB had the worst one-year survival rate, at 34.2 per cent, compared to 46.9 per cent at top-performing Counties Manukau DHB. That was the difference between life and death for 54 Southern patients diagnosed from 2015-2017.
Patients in the West Coast, Southern, Lakes and Waikato DHB areas had worse survival rates at one, two and three years. Only 6.7 per cent of West Coast patients survived three years – almost one quarter of Auckland’s 26.2 per cent survival rate. However, small patient numbers make the 3-year survival rates volatile.
Patients in Hawke’s Bay and Whanganui had low two and three-year survival, with about half as many Hawke’s Bay patients surviving to two years compared to patients in Counties Manukau. Survival rates were also worse for Māori and poorer areas.
The April meeting would investigate what high survival areas were doing right, and what was going wrong in low-performing areas, Sarfati said.
“It’s not acceptable to have major variation in survival and that’s why we’re measuring it and that’s why we’re taking action on it.”
“Patients are being fobbed off. It is really unacceptable … We have got a lot of work to do.”
College of GPs medical director Bryan Betty previously said family doctors were alert to lung cancer risks, but some struggled to quickly access diagnostic chest x-rays.
West Coast DHB had the highest proportion of patients diagnosed via the emergency department, at 63 per cent. Nationwide, Pasifika were most likely to be diagnosed at ED, followed by Māori.
Waikato University Professor Ross Lawrenson’s research investigating barriers to early diagnosis among Māori found the ambiguity of lung cancer symptoms, cumulative costs of doctor’s visits, problems accessing diagnostic tests and long waiting times all delayed diagnosis.
Lawrenson said New Zealand survival rates were behind those of similar countries and action was needed.
While some geographic variation related to the population makeup, rural cancer patients faced extra hurdles, he said. Some areas had one third as many GPs per person as Australia. Rural residents also had to travel for tests and treatment, upending their lives for 6 to 8 weeks to undergo radiation therapy.
“One of the challenges for the Cancer Agency is to end the postcode lottery and make sure that transport and access to diagnostics is equal for our rural populations.”
Southern DHB chief medical officer Nigel Millar was concerned by the report’s figures. It was not clear why survival was worse at the DHB, as it provided similar levels of surgery, chemotherapy and radiotherapy.
Lower survival could be due to late diagnosis, but further investigation was needed, Millar said. The DHB will install a second CT scanner in 2022, which should reduce diagnosis delays.
Lung Cancer started as a ‘weird cough’, survivor says
A lung-cancer survivor based in Tauranga said she was diagnosed at just 43-years-old.
The woman, who did not want to be named, said it took the Bay of Plenty District Health board a total of nine months to diagnose her with lung cancer in 2008.
The year before, the woman had been supporting a friend who had brain cancer, and later died. It was after her friend’s death the woman started to feel unwell.
“I thought I was suffering from grief at first, so at the end of 2007 I went to the doctor and said ‘I know my body, something’s wrong’. But my GP just told me it was probably stress.”
In January the woman noticed she was losing “quite a lot of weight” and had a “weird cough,” and diarrhoea.
“One night I woke up with a really awful pain in the middle of my chest, which later turned out to be pneumonia.”
The woman was transported to Tauranga Hospital where doctors discovered a spot on her left lung.
Thankfully, the woman had medical insurance and was able to have a CT scan within two days.
“I could see the faces of these people when they looked at the result, and I said ‘what is it?’ They said I’d have to go back to my doctor.”
The woman said she had multiple blood tests and biopsies, but was told she didn’t have cancer.
“I knew I had cancer, I just knew. For anyone who went through the things that I did, they’d be terrified.”
After not getting any answers for months, the woman sent her test results to a nurse friend in San Francisco, who showed her results to a specialist.
“She rang me and told me I had lung cancer. So I went back to the doctor in Tauranga and I said ‘what are you doing to do about it’.”
After performing another scan to make sure the cancer hadn’t reached her bones, the woman was then told she’d be operated on in two days at Waikato Hospital.
“They told me most people got lung cancer in their late 70s. I’ve never smoked in my entire life. My parents were smokers and when I was younger I worked in a real estate office, and they all smoked.”
She was later operated on and the cancer removal was a success.
The woman remained in hospital for 31 days before she was released and remains cancer free.
Source— Cancer Control Agency