That's one of many key findings in a major study released today
highlighting gaps in bowel cancer treatment in New Zealand.
Another is that less than half of patients with advanced, or
stage four, disease receive life-prolonging chemotheraphy.
As well, only 60 percent of patients with bowel cancer that has
spread to nearby lymph nodes receive chemotherapy - compared with
74 percent in Australia.
Bowel cancer is the most commonly diagnosed cancer in New
Zealand and the second-leading cause of cancer-related death,
killing 1200 New Zealanders a year. The incidence, with 3030 new
diagnoses in 2011, is one of the highest in the developed world,
with survival rates worse than in Australia.
The three-year study -- known as the PIPER project -- received
$1 million in funding from the Health Research Council and the
Ministry of Health, and was led by Auckland University Professor of
Oncology Michael Findlay. It involved a national review of patient
notes and databases for 5600 patients diagnosed with bowel cancer
in 2007 and 2008, and Maori and Pacific cases.
It said 34 percent of patients with bowel cancer presented to
the emergency department, compared with 21 percent in Britain, and
that further work was needed to understand why; 22 percent already
had a blockage when they reached hospital.
The proportion of patients diagnosed with colon cancer and
rectal cancer which had spread - 24 percent and 19 percent
respectively - in New Zealand was higher than the 17 percent for
both in Britain, and the 19 and 17 percent respectively in
Rates were particularly high for Maori and Pacific patients, at
32 percent and 35 percent respectively.
The study said this "stage distribution" seen in New Zealand was
one of a population which is not screened for bowel cancer.
Professor Findlay toldRadio New Zealandthat, for comparison,
preliminary data from the pilot bowel cancer screening programme at
Waitemata District Health Board showed just 8 percent of patients
presented there with advanced, or stage four, disease.
"So it does make one wonder whether we are missing up to 15
percent of patients that are presenting with late stage disease
with poor outcome, whether they could be picked up earlier."
Project clinical leader Christopher Jackson, an oncologist,
toldRadio New Zealand: "I think everyone who looks after people
with bowel cancer is hoping that the national screening programme
is rolled out nationally.
"And for those of us who look after people with bowel cancer and
those of us affected by bowel cancer, that decision can't come soon
Dr Jackson said chemotherapy could extend life up to four-fold
in patients where the cancer had spread.
"This may represent another area where we can focus to further
improve outcomes for bowel cancer."
Bowel Cancer New Zealand said the findings about uptake of
chemotherapy were the biggest surprise for it in the 432-page
Chairwoman Mary Bradley said the report showed the Government
was failing New Zealanders by "continuing to stall on implementing
a national screening programme".
"People are dying from a preventable, treatable and beatable
cancer because they are not being diagnosed early enough."
She said there needed to be an immediate start to a staged
roll-out of national screening.
Health Minister Jonathan Coleman said he expected to take a
business case to Cabinet by the end of the year which would
consider a potential staged roll-out of a national bowel screening
programme in 2017. He said delivering better cancer services was a
top priority for the Government.
"The PIPER study is a significant piece of research which will
help inform ongoing improvements in the way we approach cancer
detection and treatment in New Zealand."
Dr Coleman said there were likely to be a number of factors at
play in terms of the percentage of patients diagnosed with cancer
after presenting at hospital. It needed to be explored, and the
PIPER report would help with that.
Other findings from the project included that rates of
discussion of bowel cancer cases at multi-disciplinary team
meetings were low compared to international standards, and that a
high proportion of pathology reports reviewed for the study were
not in a structured format.
Professor Findlay said this involved details of the number of
lymph nodes removed during surgery for bowel cancer.
"It may be that 100 percent of people are having exactly the
right operation and the number of lympth nodes taken out but we can
only find evidence in the report of the presence or counting of
lymph nodes in roughly half the patients," he said.
As well, more investigation was needed to find the reasons for
the poor uptake of chemotherapy -- whether patients were declining
to have it, or considererd not serious enough, or whether services
were not providing it to older people.
The study said Maori had lower registration and death rates than
non-Maori for bowel cancer but the difference was reducing, and
Maori and Pacific who did get bowel cancer tended to have worse
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