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A Northland-based cancer specialist says fancy new drugs and the so-called “faster treatment times” will not do any good to his patients, who are missing out on the basics now.

It was a story in The Northern Advocate this week, which that spurred medical oncologist Edmond Ang to speak publicly.

“Reading it, I suffered like a post-traumatic stress attack. My blood pressure probably hit the ceiling, I was nauseated and really distressed.

“What really infuriated me was the hypocrisy and the spin by upper management.”

The story quoted Health New Zealand’s director of operations for Te Tai Tokerau, Alex Pimm, as saying “staff vacancies had affected wait times for initial cancer treatments but patients were prioritised based on their clinical urgency, so those more urgent were seen more quickly”.

Dr Ang said Northland’s medical oncology team got the go-ahead to recruit another specialist last year.

With the funding of new immunotherapies 18 months ago, money had been put aside to employ new staff to deliver them.

The role was advertised internationally, and after several months, two applicants applied and one was keen.

This was “a major win”, especially given the global shortage of medical oncologists, and the difficulty in attracting specialists to work in rural areas like Northland.

“But then we took that case to upper management, and they disclosed they did not sign off on that position in the first place.”

Clinical managers were instructed to make another business case.

“Unfortunately a few weeks ago we received the final result of all the appeals and all the business cases that we’ve submitted, and we’ve been told that role will not be signed off.

“And so, that person who we’ve been trying to recruit for a year, has finally taken up a different position.”

The case was rejected as he and his colleagues were meeting their KPIs (key performance indicators), Dr Ang said.

“Management says we’ve managed in the past, and we will continue to manage within our existing resource.

“[But] we have to see a patient with small cell lung cancer as soon as possible or they will die, we need to see a young patient with breast cancer early to deliver new adjuvant chemotherapy because otherwise the cancer will become stage four.

“We do these acrobatics in our own time, we basically burn the midnight oil and do extras, but we do these things to our peril because basically it appears on the KPIs – the blunt tool that they use – that we’re actually doing quite well.”

Have you been affected by wait times for cancer diagnosis or treatment? Share your story at: ruth.hill@rnz.co.nz

‘Faster cancer treatment times’ may not mean better patient care

The problem with KPIs – including the Government’s new target of faster cancer treatment times – was they just gave “a snapshot in time in a really complex process”, Dr Ang said.

They did not capture waiting for scans, reporting on scans, treatments after surgery to wipe out rogue cancer cells lurking somewhere in the body, patient follow-ups, managing treatment side-effects and other symptoms, and all the other parts of the treatment “journey”.

“If we do very well at faster cancer treatment and fail on all the rest of the cancer journey, we are basically failing our patients. And this is my concern – the fixation with the KPIs and big announcements on faster cancer treatments is it doesn’t provide the whole picture.”

Dr Ang expected to be disciplined by upper management for speaking publicly, but said his contract with his patients came first.

“I love my job as a medical oncologist, I care for my patients … if my patient dies, a little part of me dies.

“The difference between us and the upper echelons of management is that we see faces.

“When I close my eyes, when I try to sleep, I think about the patients who the delays in appointments for treatment [or] for scans have harmed. I think about that and I feel the hurt or the pain they feel.

“I don’t think our managers see those faces. They see numbers – but we see people.

“We don’t expect them to carry the burden we carry as clinicians. But we just want them to acknowledge us and hear us and support us, rather than trying to obstruct what we’re trying to achieve for patients.”

Te Whatu Ora response

In a written response to questions by RNZ, Te Whatu Ora group director of operations for Te Tai Tokerau Alex Pimm said it was “not correct” that recruitment of additional oncologists had been declined because KPI targets had already been met.

Decisions on additional recruitment would be made once the 2024/25 budget was available, and Te Tai Tokerau district was “working with the national office to determine the need and the level of funding available”.

The service currently employs four full-time equivalent medical oncologists.

“While staff vacancies and absence have impacted Te Tai Tokerau during the past year, we prioritise patients based on their clinical urgency, and they will be reassessed should their condition change.

“This does mean that some patients may be waiting longer than they, or we, would like but we do need to triage patients due to urgency and are working hard to keep waiting times as short as possible, whilst ensuring all patients receive care within appropriate timeframes.”