The New Zealand Cancer Control Strategy: Action Plan 2005-2010

Objectives

The 2005–2010 Action Plan operationalises the New Zealand Cancer Control Strategy across the full cancer-control continuum, seeking to reduce cancer incidence and impact while reducing inequalities, particularly for Māori, Pacific peoples, people on low incomes and populations facing geographical barriers to care.[1][2][3]It promotes timely, high-quality, evidence-based and person-centred services that respect community diversity and involve consumers in planning and delivery.[4]

• Strengthen primary prevention by addressing tobacco and second-hand smoke, physical inactivity, obesity, nutrition, ultraviolet radiation, infectious diseases, alcohol and occupational carcinogens.[5][6]
• Ensure effective screening, familial-risk assessment, surveillance and early detection, with particular attention to inequities in breast and cervical screening participation and delays in diagnosis.[7][8][9]
• Provide optimal diagnosis and treatment through defined standards, prompt referral and treatment, multidisciplinary care, consistent clinical guidelines and improved access for Māori and Pacific peoples.[10][11][12][13]
• Improve quality of life through integrated supportive care, rehabilitation, survivorship services, accessible information and comprehensive palliative care for people with cancer and their family and whānau.[14][15][16][17][18]
• Strengthen service delivery through co-ordinated planning, workforce development, consumer participation, research, surveillance and nationally consistent cancer data collection and reporting.[19][20][21][22][23][24]

Prevention priorities include reducing tobacco use, smoking initiation and exposure to second-hand smoke, with targets to reduce adult smoking prevalence to 20% or below and tobacco sales to 1,000 cigarette equivalents or below per adult by the end of Phase 2.[25]The Plan also aligns nutrition, healthy-weight and physical-activity action with Healthy Eating — Healthy Action, prioritising Māori, Pacific peoples and people on low incomes.[26][27]

Quality and equity objectives extend beyond treatment to patient navigation, culturally appropriate communication, Māori-led initiatives, case management, consumer representation and ethnicity-disaggregated monitoring.[28][29][30][31]Research and surveillance are intended to improve cancer-control effectiveness, reduce morbidity and mortality, and improve quality of life for people living with, recovering from or dying from cancer.[23]

Implementation

The Plan uses phased, objective-specific implementation templates that set desired outcomes, actions, stakeholders, milestones, measures and timeframes.[32]Phase 1 generally covers the first one to two years and Phase 2 years three to five, although phasing may change in response to new evidence or additional resources.[32]It builds on existing activity while addressing service gaps, reducing duplication, improving co-ordination and using finite resources efficiently.[2]

• Lead implementation through an independent Cancer Control Council, supported by a dedicated secretariat, to provide leadership, monitor and review Strategy implementation, and foster sector-wide collaboration and co-ordination.[3][33]
• Coordinate implementation through the Ministry of Health and its Principal Advisor Cancer Control, who is to drive action, report progress to the Council and link the Council, Ministry and wider sector.[33]
• Require District Health Boards to fund and manage services, include cancer-control activities in annual district plans, and report progress through formal accountability arrangements.[34]
• Establish national and regional collaboration through a Cancer Control Collaborative and regional cancer networks that bring together providers and consumer organisations, co-ordinate service planning and address referral, access and service concerns.[33]
• Engage government and non-government agencies, health-service managers and providers, Māori and Pacific organisations, hospices, charities, professional bodies, researchers, consumers, people with cancer and their family and whānau.[2][34]

Delivery mechanisms include national standards and accreditation, multidisciplinary teams and case conferences, referral guidance and waiting-time monitoring, regional service planning, patient-journey mapping, electronic record-sharing, service directories and integrated care pathways.[11][12][13][15][35]Regional and national structures are intended to support consistency where rurality, small patient numbers or workforce constraints limit locally available specialist expertise.[13]

Equity is embedded through use of the Reducing Inequalities Intervention Framework and Health Equity Assessment Tool, Māori involvement in governance and priority setting, culturally competent services, Māori and Pacific provider participation, and scrutiny of whether policies and funding decisions create differential effects.[3][36][29][37]District Health Boards have a statutory responsibility to reduce health inequalities under the New Zealand Public Health and Disability Act 2000.[4]

Operational actions include expanding culturally appropriate smoking cessation, health-promotion and prevention programmes; improving screening coverage; planning diagnostic and treatment capacity; developing supportive-care, rehabilitation and palliative-care networks; piloting childhood and adolescent cancer survivorship services; strengthening the workforce; and establishing a national cancer information set linked to clinical, pathology and palliative-care data.[25][8][38][39][40][41][21][24]

Monitoring combines ongoing data collection with periodic independent review to assess whether the Plan reduces cancer incidence, impact and inequalities, whether actions achieve intended outcomes and whether milestones are met.[32]The Council is to oversee progress, with monitoring results reported annually to the Minister of Health and Parliament and used to inform periodic revision of objectives.[32]National data development includes a standardised clinical cancer data set, Cancer Registry linkages, improved ethnicity data and collection of information on prevention, standards, treatment and workforce actions.[32][24]

The Plan identifies capital planning for equipment, drugs and new initiatives, as well as the need to review palliative-care costing models and address workforce and service-resource pressures.[42][41]It does not specify an overall budget, numerical funding allocations or a quantified financing gap.[32][41]

Monitoring & Evaluation

Monitoring and evaluation are integral to service delivery, research and surveillance, with oversight centred on the Cancer Control Council, Ministry of Health, District Health Boards and national information systems. The framework combines routine monitoring, annual reporting, periodic independent review, action-specific milestones and data-system development to assess progress in reducing cancer incidence, impact and inequalities.[3][34][32][24]

• Assess whether the Action Plan reduces cancer incidence, cancer impact and inequalities, whether individual actions achieve expected outcomes, and whether scheduled milestones are met.[34][32]
• Use ongoing monitoring and periodic independent review to provide credible accountability to government and non-government stakeholders.[34][32]
• Require the Cancer Control Council to monitor and review Strategy implementation, oversee progress towards its purposes, and report monitoring results annually to the Minister of Health and Parliament.[3][32]
• Require District Health Boards to report progress through formal accountability measures, include cancer-control activities in annual district plans, and report cancer-treatment waiting times monthly for surgery, chemotherapy and radiotherapy.[34][38]
• Collect and analyse routine data through the New Zealand Health Information Service, and use findings to inform periodic review and modification of objectives where research identifies more effective approaches.[32]
• Develop a nationally consistent cancer information system by establishing a core clinical cancer data set, linking Cancer Registry data with clinical, pathology and palliative-care data, and improving ethnicity-data collection and provider training.[32][24]
• Monitor equity by collecting and publishing ethnicity-disaggregated data, tracking access and outcomes across the cancer continuum, and assessing service responsiveness to Māori.[30][24]
• Apply the Reducing Inequalities Intervention Framework and Health Equity Assessment Tool to consider who benefits from actions, potential unintended effects, required safeguards and how inequality reductions will be measured.[3][37]
• Track prevention measures including adult smoking prevalence, tobacco sales, smoke-free settings, second-hand-smoke exposure, smoking initiation, physical-activity participation, nutrition initiatives, school sun-protection measures and infectious-disease prevention outcomes.[43][25][27][44][45]
• Monitor screening participation and inequalities, especially BreastScreen Aotearoa coverage for Māori, Pacific women and North Island women, alongside treatment access, quality and waiting times.[7][8][38]
• Use national minimum palliative-care data, benchmarking, local audit and cancer-service accreditation to monitor access, service gaps, minimum service levels and integration, with a target of at least 80% of services accredited.[41][20]
• Monitor workforce capacity through a comprehensive stocktake, annual recruitment and retention monitoring, international benchmarks, training-post establishment and Māori and Pacific participation measures.[21][46][47]
• Review research delivery through a cancer research funders forum, biennial meetings, two-yearly review of a five-year rolling research plan, and tracking of Māori research capacity and new behavioural, social, cultural and psychosocial research projects.[48]
• Use action-specific pilots, stocktakes, working groups, service plans, guidance, standards, audits and implementation milestones where detailed quantitative indicators or reporting schedules are not specified.[15][16][49][50]

Costing & Financing

The Action Plan identifies substantial resource pressures and several areas requiring investment or costing development, but it does not provide an overall budget, quantified programme allocations, funding-gap estimate, financing framework or economic assumptions.[32][51][24]

• Plan capital expenditure for cancer-control equipment, drugs and new initiatives, while allowing implementation phasing to be adjusted if additional resources become available.[42][32]
• Address increasing cancer-treatment demand, treatment delays and insufficient growth in treatment resources, including the capital investment required for some high-cost cancer services.[10][51]
• Allocate resources to agreed priority areas and appropriately fund Māori- and Pacific-led cancer-control initiatives, palliative-care positions, Māori capacity and interventions addressing access inequalities.[11][38][47][29]
• Increase investment in nutrition, healthy-weight and physical-activity initiatives, including Māori-led and community-based programmes, and in child sun-safety social marketing.[27][44]
• Address inequitable and variable access to travel, accommodation, disability support, equipment, household assistance, home visits, respite, carer support, residential care and financial assistance, which may depend on diagnosis rather than need.[52][53]
• Identify the financial and workforce resources required to provide minimum essential and specialist palliative care, and review and extend the hospice palliative-care costing model to primary health care, hospital care and support care.[54][41]
• Seek funding for practical assistance with travel, accommodation, household tasks and childcare for people with cancer and their families and whānau.[28]
• Recognise mixed financing of non-government and palliative-care services: some organisations operate through government contracts, while hospices may also depend on donations, fundraising and voluntary assistance; some cancer charities receive no government funding.[34]
• Improve cost-effectiveness in screening and familial-risk assessment, and use national co-ordination to deploy scarce resources efficiently, but no quantified economic analysis is provided.[2][7]
• Support greater investment in cancer-control research, including Māori doctoral and postdoctoral awards and social and behavioural research, without specifying monetary amounts or funding sources.[23][48]