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

Objectives

The New Zealand Cancer Control Strategy and Action Plan 2005–2010 provide an integrated national framework to reduce cancer incidence and impact, improve quality of life, and reduce cancer-related inequalities, particularly the poorer outcomes experienced by Māori, Pacific peoples and people with lower socioeconomic status.[1][2][3]The framework covers the full continuum from prevention and screening to diagnosis, treatment, rehabilitation, supportive care, palliative care, workforce development, research and surveillance.[2]

• Reduce cancer incidence through tobacco control; healthier nutrition, physical activity and weight; ultraviolet-radiation protection; infectious-disease prevention; alcohol-risk reduction; and reduced occupational exposure to carcinogens.[4][5][6][7][8][9][10][11]
• Improve screening, familial-risk assessment and early detection through national strategic oversight, culturally appropriate services, equitable participation and assessment of cancers for which earlier diagnosis can improve outcomes.[5][12][13][14]
• Ensure timely, effective and equitable cancer diagnosis and treatment through defined standards, referral pathways, multidisciplinary care, patient-centred integration, access to modern treatments and action on delays.[5][15][16][17][18][19]
• Improve quality of life through accessible supportive care, rehabilitation, survivorship services, high-quality consumer information and integrated palliative care for people with cancer and their family and whānau.[20][21][22][23][24]
• Strengthen service delivery through coordinated planning, integration, consumer participation, workforce development, monitoring and evaluation across the cancer-control continuum.[25][26][27][28][29]
• Improve cancer-control effectiveness through research, surveillance, consistent national data collection and reporting, including more complete ethnicity data to monitor inequalities.[25][30][31][32]

Equity is a cross-cutting objective. Cancer planning and service delivery are intended to apply the Reducing Inequalities Intervention Framework and Health Equity Assessment Tool, address socioeconomic, ethnic, gender and geographic disparities, and support Māori-led services alongside culturally competent mainstream provision.[33][34][35]The initial implementation period is five years, with priority Phase 1 actions generally scheduled for the first one to two years and Phase 2 actions for years three to five.[36]

Implementation

Implementation combines national leadership, regional collaboration and locally delivered services. The Action Plan is intended to guide government and non-government agencies, service managers and providers, professional bodies, researchers, consumer organisations, and people with cancer and their family and whānau, while building on existing activity, closing service gaps, reducing duplication and using resources efficiently.[2]Delivery is to be adjusted according to priority, likely impact, evidence and available resources.[36]

• Provide leadership through an independent Cancer Control Council, responsible for leadership, monitoring and review of Strategy implementation, and for fostering collaboration and coordination across the sector.[1][37]
• Coordinate implementation through the Ministry of Health, including the Principal Advisor Cancer Control, accountability and operating frameworks, and oversight of District Health Boards and health and disability support providers.[37][38]
• Establish national and regional collaboration through a Cancer Control Collaborative and regional cancer networks that link primary, secondary and tertiary services, providers, consumer organisations and planning against national standards.[1][37]
• Require District Health Boards to fund and manage services, especially diagnosis and treatment, include cancer-control activity in annual district plans, and report progress through formal accountability measures.[38]
• Develop integrated service models through multidisciplinary teams, agreed protocols, referral guidance, regional linkages, patient-journey mapping, case management and, where needed, inter-regional services or teleconferencing.[15][17][18][39]
• Engage Māori, Pacific, consumer, hospice, community, voluntary, professional and non-government organisations in prevention, advocacy, care delivery, workforce development, research and service design.[38][35][29]

Operational priorities include regional cancer networks; smoking-cessation services for Māori women; improved breast-screening coverage; national standards for timely access to cancer services; multidisciplinary care; patient-pathway pilots; survivorship programmes; palliative-care strategy implementation; workforce and capital planning; Māori-led and culturally appropriate services; a five-year research plan; and a standardised clinical cancer data set.[36]Supportive care and rehabilitation are to use national committees, intersectoral groups and regional plans to assess needs, clarify government and non-government responsibilities, address unequal access and identify funding implications.[40][41][42]

Monitoring is intended to assess whether actions achieve expected outcomes, milestones and reductions in cancer incidence, impact and inequalities.[43]The Cancer Control Council is to monitor overall progress and report annually to the Minister of Health and Parliament, supporting periodic independent review and potential changes to actions or objectives.[43]Routine data collection and analysis are supported by the New Zealand Health Information Service, with planned linkage of the Cancer Registry to clinical, pathology and palliative-care information and expansion of consistent ethnicity data.[43][32]The Plan also specifies targeted measures in several areas, including smoking prevalence, screening coverage, treatment waiting times, workforce recruitment, palliative-care access and clinical-trial participation.[44][13][45][26][46][19]

The source specifies many milestones and responsible institutions, but does not provide a complete, uniform set of quantitative indicators, evaluation methods or reporting timetables for every action area.[25][47]

Monitoring & Evaluation

The Action Plan establishes a monitoring and accountability architecture centred on the Cancer Control Council, Ministry of Health, District Health Boards (DHBs), routine national data systems, phased milestones and periodic independent review. It is intended to assess progress in reducing cancer incidence, impact and inequalities, whether actions achieve expected outcomes, and whether implementation milestones are met.[43][37][38]

• Monitor overall Strategy implementation through the Cancer Control Council, supported by the Ministry of Health’s accountability and operating frameworks and its monitoring of DHBs and health and disability support providers.[37][38]
• Require DHBs to report through formal accountability measures, include cancer-control activity in annual district plans, and report selected treatment waiting-time data monthly.[38][45]
• Report monitoring results annually to the Minister of Health and Parliament, using findings to inform periodic reviews and potential amendments to actions or objectives.[43]
• Strengthen surveillance through a nationally consistent clinical cancer data set, Cancer Registry links to clinical, pathology and palliative-care information, and more complete ethnicity data.[43][32]
• Use cancer incidence, mortality, survival, disability, service access and screening participation data to understand cancer burden and inequalities between population groups.[3][33]
• Monitor service quality through national standards, accreditation, multidisciplinary-care arrangements, protocols, referral guidance, clinical-trial participation and treatment-service performance.[17][18][19]
• Track screening oversight, BreastScreen Aotearoa coverage and breast-cancer mortality outcomes for Māori, Pacific women and North Island women aged 55–74 years.[13]
• Measure prevention through tobacco prevalence and sales, second-hand-smoke exposure, smoke-free settings, nutrition and physical-activity programme participation, sun-safety implementation, infectious-disease measures and alcohol-policy milestones.[6][44][7][48][49][50]
• Use population-specific indicators for equity, including routine ethnicity-disaggregated reporting, Māori and Pacific workforce participation, Māori access to cancer services, and evaluation of culturally appropriate interventions.[51][35][27]
• Establish palliative-care data collection, service-gap benchmarking, local audit and monitoring, population-based standards, and accreditation requirements for integration with palliative care.[52][46]
• Maintain research governance through a cancer research funders forum, a five-year rolling research plan reviewed every two years, and additional data collection to support periodic Strategy review.[31]

Many action areas specify milestones, phases, working groups, audits, reviews or data-collection activities rather than comprehensive performance frameworks. Quantified indicators, reporting timetables, surveillance definitions and formal accountability arrangements are therefore not consistently specified across all components.[21][53][42][47][54]

Costing & Financing

The Action Plan recognises that cancer control requires efficient use of scarce resources, capital planning, workforce development and investment in services, research, data systems and equity-focused initiatives. However, the supplied material provides no overall cancer-control budget, quantified funding allocation, explicit financing gap, or stated economic assumptions.[2][36][30]

• Plan capital expenditure for cancer control, including equipment, medicines and new initiatives, as a Phase 1 priority; implementation phasing may change in response to available additional resources.[36]
• Address resource pressures arising from projected growth in cancer incidence and demand, including treatment delays associated with cancer-treatment resources not growing sufficiently to meet demand.[3][15]
• Use national and regional collaboration, partnerships and pooled resources to improve efficiency, reduce duplication and focus effort where health gain is greatest.[2][37]
• Fund and plan Māori- and Pacific-led initiatives, culturally responsive services, workforce participation and capacity, although no monetary commitments are specified.[16][45][55][35]
• Resource workforce stocktakes, training posts, postgraduate education, scholarships and professional development, including 12 nursing training posts annually, without stating associated costs or funding sources.[26][51][56]
• Review and extend the hospice palliative-care costing model to primary, hospital and support care, and identify the financial and human resources required to meet minimum essential and specialist service levels.[57][52]
• Assess the funding implications of improving consistency and targeting of support, rehabilitation, travel, accommodation and other practical assistance for people with cancer and their families and whānau.[22][42]
• Increase investment in nutrition, healthy-weight, physical-activity, sun-safety and cancer-research initiatives, particularly for Māori, Pacific peoples and low socioeconomic groups, without quantified amounts.[7][48][30]
• Recognise mixed funding arrangements for hospices and community organisations, which may receive partial government funding alongside donations, fundraising and voluntary support; some cancer charities receive no government funding.[38]
• Identify tobacco and alcohol taxation as possible policy instruments, but provide no revenue estimates or financial assumptions.[6][10]

Cost-effectiveness is an intended consideration for cancer screening and familial-risk assessment, but the extract does not provide cost-effectiveness estimates, programme unit costs or comparative economic analysis.[11][12]