The New Zealand Cancer Control Strategy

Objectives

The New Zealand Cancer Control Strategy provides an overarching, population-based framework to reduce the incidence and impact of cancer and cancer-related inequalities, while improving quality of life for people with cancer and their families and whānau. It spans the full cancer-control continuum and is guided by the Treaty of Waitangi, equity, timely access, quality, sustainability, evidence-based practice, cultural respect, person-centred care, consumer participation, and planned, integrated delivery.[1][2][3]

• Prevent cancer through primary prevention, reducing exposure to tobacco, unhealthy diet, physical inactivity, obesity, ultraviolet radiation, infectious agents, alcohol and occupational carcinogens.[3][4][5][6]
• Improve screening and early detection through organised, evidence-based programmes that demonstrate population benefit, minimise harm and support timely follow-up, diagnosis and treatment.[3][6][7]
• Ensure effective diagnosis and treatment through timely access to evidence-based interventions, multidisciplinary management, skilled services, national standards and patient-centred integrated care.[8][9]
• Improve quality of life through support, rehabilitation and palliative care that address physical, psychological, emotional, social, cultural, spiritual, practical, nutritional and vocational needs.[3][10][11][12]
• Strengthen planning, co-ordination, integration, monitoring and evaluation across cancer-control services and resources.[3][13]
• Improve effectiveness through fundamental and intervention research, surveillance, national data collection, analysis and knowledge translation.[3][14][15][16]

Reducing inequities is a central purpose. The framework seeks equitable outcomes for Māori, Pacific peoples, socioeconomically disadvantaged groups and geographically isolated communities, while recognising Māori concepts of hauora, whānau and whānau ora. It requires both Māori and mainstream providers to improve service acceptability, accessibility and cultural responsiveness, safeguard Māori cultural concepts and practices, and support Māori provider development.[17][18][19][2]

Primary prevention is identified as offering the greatest health gain and as the most cost-effective form of cancer control. Prevention is intended to combine health protection, health promotion, disease prevention, healthier environments and healthier lifestyles rather than relying solely on individual education.[20][4]Screening is limited to defined populations and tests for which effectiveness has been demonstrated, while early-presentation activity should focus on cancers where earlier detection improves outcomes.[21][7][22]

The strategy also prioritises comprehensive supportive and palliative care. Palliative care is framed as improving quality of life for people and families facing life-threatening illness through early identification and relief of physical, psychosocial and spiritual suffering, alongside disease-directed treatment where appropriate.[23]

Implementation

Implementation is intended to be systematic, planned and co-ordinated across prevention, screening, diagnosis, treatment, follow-up, rehabilitation, palliative care, research and surveillance. It relies on collaboration among government and non-government agencies, District Health Boards, health professionals, service providers, researchers, community groups, consumers, people with cancer and families and whānau.[24][17][20]The implementation phase was to identify evidence-based priorities, allocate responsibilities, distinguish activities achievable with existing resources from those needing additional investment, and establish processes for management, monitoring and review.[1][25]

• Coordinate services through District Health Boards across primary care, hospital oncology and surgery, palliative care, community and allied-health services, hospice, Māori and Pacific services, residential care and voluntary-sector support.[13]
• Strengthen workforce capacity through a nationally co-ordinated strategy covering workforce stocktakes, current shortages, future demand, specialist disciplines, recruitment, training, retention and increased Māori and Pacific health-professional participation.[13][26]
• Deliver prevention through multifaceted national, regional and local action, applying the Ottawa Charter for Health Promotion and linking work with wider health, tobacco-control, nutrition and physical-activity policies.[4][27]
• Oversee screening through national mechanisms and the Ministry of Health National Screening Unit, including strategic review of current and potential programmes, quality monitoring, referral guidance for familial-risk assessment and surveillance, and attention to Māori and Pacific participation.[7][22]
• Organise diagnosis and treatment around multidisciplinary collaboration, national and regional guidelines and protocols, systematic assessment of new drugs and technologies, and a minimum data set for performance and outcomes.[8][9]
• Develop integrated supportive-care, rehabilitation and palliative-care programmes with clear leadership, culturally responsive provision, appropriate local and specialist services, and support for families, whānau and carers.[10][28][12]

Governance and development involved the Ministry of Health, the New Zealand Cancer Control Trust, the Cancer Control Steering Group, a secretariat and five expert working groups. The Trust was established by the Cancer Society of New Zealand and the Child Cancer Foundation to facilitate strategy development in partnership with the Ministry.[29][18][30][31][32]Strategy development also drew on public forums, hui, fono, written submissions and consultation with stakeholders.[33][30][34][35]

The delivery model requires active Māori participation in planning and service delivery, partnerships with iwi, hapū, whānau and Māori communities, and use of Māori-provided services where appropriate alongside culturally competent mainstream provision. The Ministry of Health Intervention Framework and Health Equity Assessment Tool are identified as mechanisms for adapting activities to reduce inequities and assess potential unintended effects.[18][36][14][37]

Research and information infrastructure are integral operational mechanisms. Priorities include expanding clinical, public-health, epidemiological, social, behavioural, environmental and health-services research; developing Māori research capacity; establishing a continuing process to identify research gaps and connect findings with policy and practice; and strengthening the Cancer Registry and linked clinical, pathology, palliative-care and primary-care data.[15][16][31]Monitoring is intended to support quality assurance, assess performance and outcomes, and permit periodic revision of objectives as evidence develops.[2][3]The supplied material does not specify a consolidated set of quantitative targets, reporting timetable or overall programme budget.[3][13]

Monitoring & Evaluation

The Strategy establishes monitoring, evaluation, research and surveillance as core functions for improving cancer-control effectiveness, service quality, equity and outcomes across prevention, screening, diagnosis, treatment, supportive care, rehabilitation and palliative care.[2][3]It envisages ongoing monitoring and periodic review so that objectives and priorities can be revised as evidence identifies more effective approaches to reducing cancer incidence, impact and inequalities.[38][3]

• Monitor cancer-control activities, services and performance continuously, including whether standards for assessment, diagnosis, treatment and care are achieved.[17][9]
• Develop standards, guidelines, protocols and key performance measures for diagnosis, treatment and care, supported by a nationally consistent minimum data set for performance and outcome measurement.[2][9]
• Maintain routine cancer surveillance on incidence, prevalence, mortality, diagnostic methods, stage at diagnosis, treatment, survival and aspects of care received.[39][16]
• Strengthen the Cancer Registry, including medical and scientific capability, links with clinical, pathology, palliative-care and primary-care data, and nationally standardised data definitions and information systems.[16][31]
• Improve ethnicity data collection and analysis to identify disparities affecting Māori, Pacific and Asian populations and to inform targeted action.[39][16]
• Collect and analyse information on waiting times, survival, treatment patterns and outcomes to identify geographic and ethnic inequalities in access and treatment effectiveness.[31]
• Evaluate organised screening programmes through routine quality monitoring, including participation, coverage, test sensitivity, benefits, harms, cultural appropriateness and cost-effectiveness.[6][7][22]
• Assess early-detection delays, identify affected groups and causes, implement corrective interventions and evaluate their effects on survival and quality of life, particularly for Māori and Pacific peoples.[22]
• Undertake research spanning biomedical, epidemiological, clinical, behavioural, psychosocial, public-health, health-system and health-policy fields, including intervention research on what works across the cancer-control continuum.[39][14][15]
• Monitor the effectiveness of tobacco-control programmes, research emerging nutrition issues, improve reporting of occupational cancers and maintain surveillance for people assessed as having familial cancer risk.[27][6]
• Collect prospective national data on adolescent cancer incidence, treatment and outcomes, and evaluate alternative systems for cancer-care co-ordination and oversight.[40][10]
• Implement and monitor policies addressing Māori needs, while improving mainstream-provider accountability for Māori health outcomes.[14]

The supplied material does not set out a consolidated quantitative indicator framework, numerical targets, routine reporting timetable, evaluation design or a single formal accountability body for the Strategy as a whole.[38][3][13]District Health Boards have statutory responsibilities to assess regional health and disability needs, manage resources and deliver services, and are identified as implementation partners.[30][41]

Costing & Financing

The Strategy presents cancer control as requiring sustainable and efficient use of limited resources, with planning and prioritisation intended to maximise health gain and reduce inequalities.[24][2]Primary prevention is characterised as the greatest health gain and the most cost-effective form of cancer control, while organised screening and familial-risk assessment are expected to be assessed for effectiveness and cost-effectiveness.[4][7][22]

• Use existing resources carefully, identify activities requiring additional resources and prioritise actions that can achieve the greatest effect under constrained capacity.[17][25]
• Recognise that adequate human and other resources are needed to sustain high-quality cancer control, including prevention, integrated services, workforce development, research and data infrastructure.[20][2][26]
• Address insufficient service funding and staff capacity, which are linked to delayed access to essential technologies and, in some cases, travel to Australia for radiation treatment.[8]
• Plan for resourcing implications arising from new clinical standards and protocols, specialised treatment units, inter-regional patient flows and expanded cancer-service capacity.[8][9]
• Address inequitable travel and accommodation funding for people receiving specialist care outside their region, as well as unclear funding boundaries that can restrict access to rehabilitation for people with cancer.[28]
• Fund research and workforce training in under-investigated clinical, public-health, epidemiological and related fields, including Māori cancer-research capacity.[15][16]
• Support palliative-care provision through a systematic and informed approach to funding and service delivery, although no specific funding model is supplied.[12]

The Ministry of Health and the New Zealand Cancer Control Trust funded Strategy development, and the Trust received funding from the Cancer Society of New Zealand and the Child Cancer Foundation.[30][18]The Health Research Council is identified as the largest cancer-research funder, followed by the Cancer Society of New Zealand and other cancer-related charities.[15]No overall programme budget, currency-denominated allocation, quantified funding gap, unit cost, financing formula or economic assumption is specified in the supplied material.[8][16]