Pacific women receiving less breast cancer care
The cost of breast cancer treatment is increasing as results continue to vary between Pacific and non-Pacific women, two studies have found.
The studies, published today in the New Zealand Medical Journal, show that each breast cancer patient is now receiving an average of nearly $45,000 in treatment.
The number of cases is also rising, although 80 per cent of breast cancer patients are now surviving for more than ten years. The greatest costs were for women with advanced disease and costs were greater in younger women. One of the biggest costs were for immunotherapy such as for trastuzumab (Herceptin).
The studies also show that treatment of metastatic breast cancer is varying by age and between European, Māori and Pacific patients. While Māori and European patients had good access to systemic treatments for metastatic breast cancer, Pacific women with metastatic breast cancer were less likely to receive chemotherapy and Herceptin than non-Pacific women.
Professor Ross Lawrenson from the University of Waikato is the senior author on both studies and says they are a signal New Zealand needs more funding for cancer treatments as survival rates improve and more personalised treatments become available.
He says it also shows New Zealand has work to do to ensure Pacific patients receive equitable care.
“The study shows that with regards the treatment of metastatic breast cancer we have achieved equity of access for Māori women, but this study shows we are lagging well behind with our Pacific community and we have a lot of work to do. Pacific women are more likely to have HER2+ (positive) disease, and the study shows the beneficial impact of Herceptin on outcomes.”
The incidence of breast cancer in New Zealand has increased 28 percent between 2009 and 2018, and while new personalised drugs and diagnostic tools have improved patient outcomes, they have also led to much higher costs.
“New Zealand has one of the highest rates of breast cancer in the world, but we also have an over 80 percent survival rate as increased screening rates and new treatments have helped to improve patient outcomes. The study shows that using Herceptin has had an impact. This study is a signal that New Zealand is going to need more funding for cancer services in the future,” he says.
A 2008 study suggested breast cancer treatments cost New Zealand around $76.8 million a year. The most recent study found for 22,948 breast cancer patients between July 1 2010 and June 30 2018 the mean cost of treatment was NZ$44,954.
The costs decreased substantially with age, from $69,121 for women younger than 45 years old, to $23,805 for those aged 80 or over.
“We are often more aggressive in our treatments with younger women who have breast cancer, and we tend to be quite conservative in treating older patients which accounts for the difference in the spend,” says Professor Lawrenson.
The figures for treating those with advanced disease with immunotherapy are likely to be mirrored in the costs of treating advanced melanoma where Keytruda was funded in 2016 and where pressure is mounting to fund immunotherapy for treating patients with advanced lung cancer.”
Professor Lawrenson has also been on the board of Pharmac for the past five years and says there is always a real tension between the cost of cancer drugs and the need to treat other diseases.
“We spend about one third of what they spend in the UK on medications for the public health system. There have been a lot of calls to say we should be spending more, and this includes spending more on cancer drugs.”
The study found the treatment phase for breast cancer patients accounted for 70 per cent of the cost and the follow-up phase accounted for the remaining 30 per cent.
During the treatment phase, surgery costs accounted for the biggest proportion 35 per cent, followed by immunotherapy costs 18 per cent, radiotherapy 17 per cent and costs of diagnostic tests, scans, and biopsies 16 per cent.
The study on costs of cancer was funded jointly by the Health Research Council and the NZ Breast Cancer Foundation while the study on metastatic breast cancer was entirely funded through a New Zealand Breast Cancer Foundation fellowship.
The results are the first step in understanding the costs associated with breast cancer treatment and will eventually assist in assessing different therapies in the future, says Professor Lawrenson.