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Radiation therapy may turn into luxury

Cate Macintosh

Radiation therapy to treat cancer will be completely out of reach for New Zealanders who cannot afford private medical insurance a decade from now unless urgent action is taken to invest in machines and staff, oncologists say.

A stocktake of radiation oncology services from 2011 to 2019 reveals a growing gap between recommended treatment and what can be delivered for patients as a result of staff and machine shortages.

At least half of all cancer patients can benefit from radiation treatment but in New Zealand only about a third have the potentially life-saving therapy, the recently published study by the Australian and New Zealand College of Radiology found.

During the period examined, radiation was provided to 37% of cancer patients on average, with regional variations from a low of 22% to a high of 44%.

Radiation oncology services were already being rationed for many patients, said study author Melissa James, a radiation oncologist.

Patients should receive radiation therapy within two to eight weeks of a referral, depending on the type and location of the cancer. But some patients were waiting longer than 12 weeks, James said.

The therapy can offer a cure for some cancers, including lung and prostate cancer. For others it provides protection against recurrence, or spread, or is used to relieve pain for terminally ill patients.

‘‘We know that once you start waiting, your risk of the cancer coming back increases every week beyond that eight weeks.’’ In some cases, opportunities to cure or slow cancer through treatment was lost when timely access was not possible, James said.

‘‘The bottom line is that there has been very little growth in the whole radiation sector in terms of workforce and the machines but . . . the cancer numbers are increasing. So the gap between what is ideal and what is actually in practice has just widened further and further apart over that 10 years.’’

James said the situation was ‘‘absolutely a crisis’’. ‘‘We are so far behind, unless we do something now we are not going to have a radiation oncology service in the public health system in the future.’’

The review of services over the study period found:

Only one new radiation machine was installed in the public health system and three in private facilities

■ There was no increase in the radiation therapist workforce but the workload increased by 20%

■ New cancer diagnoses increased by 2.4% each year

■ Only two additional radiation facilities were built – both in the private sector

■ Radiation oncology trainee positions increased by four but these would not keep pace with rate of retirements.

There were 64 radiation oncologists in New Zealand but if there was no increase in the number of trainees, the workforce would reduce to 59 by 2029, James said.

Medical physicists, who keep the radiation machines functioning, are also in short supply, with a majority employed from overseas.

In 2019 the Government announced funding for 12 medical linear accelerators – machines used to deliver radiation therapy – but James said the majority were to replace existing older machines.

Funding has been approved for new facilities in Northland, Taranaki and Hawke’s Bay, but they won’t be ready to treat patients until 2025, said Professor Diana Sarfati, chief executive of Te Aho o Te Kahu, the Cancer Control Agency.

Sarfati said Te Aho modelling showed traineeships needed to double – from five to 10 per year. A plan to address the issue was being developed and was expected to be completed by June. This year’s Budget set aside $107 million for the health workforce.

‘‘We are working with the interim Health NZ to identify the highest priority areas, including radiation oncology,’’ Sarfati said.

The agency was also working on a plan with the Ministry of Health and Health NZ ‘‘for potential additional linear accelerator

machines’’. ‘‘More detail on this work will be shared publicly in the future.’’

Of $165m set aside for the linear accelerators three years ago, $25m has been spent so far – on six new machines which have been installed in the MidCentral, Capital and Coast, and Canterbury health board areas. Six more are to come, of which three will serve Taranaki, Northland and Hawke’s Bay.

Auckland woman Christine RobertsWhitcombe was diagnosed with stage four lung cancer five years ago and quickly received radiation treatment for tumours in her spine at a private health service.

The mother of two teenagers said the treatment, alongside medication, worked to stop the growth of cancer in her spine.

But cancer was later detected in Roberts-Whitcombe’s brain and again she received radiation therapy alongside the drug Osimertinib, which is not subsidised by the Government’s drug-buying agency Pharmac.

Her husband, Brent Whitcombe, said his wife received timely cancer care as she had medical insurance and believes she would not be alive today without this.

The couple said people would continue to die early from cancer because they could not access treatment.

‘‘People who don’t have health insurance that are going to be left in the public system, I’m concerned for those people. They are not going to get the timely treatment, it is going to cost lives.’’

Christchurch radiation therapist and APEX union delegate Carolyn Gunn said therapists help develop a detailed treatment plan for each patient and operate the machines. They were trying to keep up with increased demand by working longer, including weekends. ‘‘We are working harder, and people are burnt out and exhausted.’’

Staff were aware they were not meeting Ministry of Health guidelines for timely access to treatment and were seeing more patients with advanced disease, Gunn said.

This was ‘‘sad and exhausting and draining’’, but staff coped by trying to focus on what was within their control and ‘‘do our best for the patient that is in front of us’’.

General practice doctors are also aware patients struggle to get timely access to radiation oncology services and other cancer care treatment, Royal New Zealand College of GPs medical director Bryan Betty said. The long-term under-investment in machinery, infrastructure and health workforces was the most critical issue for the incoming Health NZ, he said.

‘‘There has been no sustained, strategic investment in the workforce, and it has been a total failure of the health system, and we are now seeing the results of that.

‘‘Unless we start to think strategically longer term, these problems are just going to continue and be recurrent.’’

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2022-05-28T07:00:00.0000000Z

2022-05-28T07:00:00.0000000Z

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