NZ Herald has reported on Mandy Grantley’s cancer story. After Mandy was first diagnosed with bowel cancer she underwent chemo for six months. After finding out that the cancer had spread to her lungs, an additional six months of chemo and an unfunded drug, Cytoxan was recommended by three oncologists working within the public health sector. Mandy was informed that she could have her chemo at her local DHB hospital. She was told that she had to pay $64,000 for the drug herself and was redirected to a private clinic to have the drug administered. The drug was intended to simply prolong her life. With a young family, a struggling business, and an existing mortgage Mandy and her friends decided to set up a Givealittle page to raise funds. The experience made Mandy reassess the public health system. National deputy leader Shane Reti is seeking MPs to support his bill that will allow privately-funded cancer medicines to be administered through DHBs. In response, Finance Minister Grant Robertson has said that Labour wouldn’t support the bill as it would be adding to existing inequalities. Instead, the Government would focus on funding more cancer treatments through Pharmac.

“A woman battling cancer says heartbreak has turned to anger at the way she was forced to pay $64,000 for treatment advised by public health oncologists.

Mandy Grantley was given two years to live after bowel cancer spread to her lungs last year.

"They found a tumour in my bowels and removed it, which was all good," she told RNZ. "I had six months worth of chemo. After that I had a scan and it all looked good. It wasn't until last year during lockdown I was told over the phone it had spread to my lungs."

Grantley said she was then told by three different oncologists working within the public health system that her best course of action would be another six months of chemo alongside being administered unfunded drug, Cytoxan.

She was told she would need to go to a private clinic to have the drug administered after paying for the drug herself, and then go to get chemo at her local DHB hospital. The news was traumatic and overwhelming.

"The chemo was bad enough, but then being told you had to pay $64,000 for a private drug, which won't cure me but will prolong my life, and a better quality of life, I just thought, I can't do this.

"I have three young kids and a husband with a struggling business, we don't have $64,000. We would be remortgaging the house, which we already had a huge mortgage on."

Concerned for her family, Grantley persevered and two friends set up a Givealittle page and managed to raise the money.

The private drug cost her $27,000. To get it administered she had to pay a private clinic $36,000.

Grantley says she knows how lucky she is, but remains angry others will not be able to access money or credit to save their own lives.

"It makes me sick to my stomach that others out there don't have that opportunity ...  those poor families behind me - it's just wrong," she said.

Having to go to two different medical facilities was also stressful and time-consuming, with Grantley relying on people to drive her to and from the clinic and public hospital, she added.

To add insult to injury Grantley had to pay $8000 GST on her treatment. The experience has made her reassess the merits of the public healthcare system and the Government's priorities.

"They're making money out of me dying. So much for a free health system. When you really need it, you're on your own and you don't know what it's like until someone close to you goes through it. I was really upset, I was heartbroken. But now I'm just damn well angry."

Grantley finished her treatment in November and her scans since have come back clear, the latest a scan in February. She has another scan this month and remains hopeful.

"I've never felt so good, never felt so healthy."

She said her health outcome so far had proved the efficacy of Cytoxan as an anti-cancer drug.

National deputy leader Shane Reti is asking MPs to support his bill seeking to allow privately-funded cancer medicines to be administered through DHBs, to reduce the financial burden on those with cancer.

However, Finance Minister Grant Robertson told RNZ the Government would not be supporting the bill when it comes before Parliament because it would only add to existing health inequalities.

"It is a challenging area where people are self-funding the drugs because obviously for the most part what we want to do is fund people's treatment through the public system and then all of the costs and so on associated with it are managed that way," he said.

"The reason that we're not looking to move in this area is because what effectively it would mean is that somebody who does have enough resources to fund their own treatment would end up taking up space in the public health system that would otherwise go to people whose cancer treatment is publicly funded.

"So actually it would have the effect of exacerbating inequality rather than creating fairness."

He said the Government was instead focused on funding more cancer treatments through its Crown entity Pharmac. Click here to read more

AIA has announced the introduction of AIA Cancer Care. AIA highlights that the Ministry of Health reported that 23,000 New Zealanders are diagnosed with cancer each year. AIA is offering customers the option of purchasing AIA Cancer Care. AIA Cancer Care will cover the medical expenses relating to diagnosis, treatment and recovery. Benefits of AIA Cancer Care include unlimited cancer surgical benefit, access to specialist consultations, diagnostic tests and Pharmac as well as non-Pharmac Medsafe indicated cancer chemotherapy drugs. Customers with eligible policies will be able to join AIA Vitality and earn Airpoints from premiums paid.

Key benefits include:

• $500,000 extensive cover for cancer treatment and recovery
• Access to Pharmac and non-Pharmac Medsafe indicated cancer chemotherapy drugs
• Options to have treatments overseas

“In New Zealand 23,000 people are diagnosed with cancer each year¹. While this is an alarming statistic, many cancers can be successfully treated if diagnosed early. In the unfortunate event that you’re diagnosed with cancer, having more choice and control over your treatment plan can make your journey to recovery much easier.

AIA Cancer Care will take care of medical expenses associated with the diagnosis, treatment and recovery of cancer. This includes access to an unlimited cancer surgical benefit, access to specialist consultations, diagnostic tests and Pharmac and non-Pharmac Medsafe indicated cancer chemotherapy drugs.​

With eligible policies you also get the added benefit of earning Airpoints Dollars™ for premiums paid, and have the opportunity to join AIA Vitality, a science-backed health and wellbeing program that rewards your healthy choices.” Click here to read more

In other news

Generate: From FMA to Generate

Kiwi Adviser Network: Make running your advice business effortless

nib environmental and waste report

Stephen Dubner, and economist, talks with Ned Sharpless, director of the National Cancer Institute (USA) about cancer research and how to fix the incentives to achieve better outcomes. The podcast includes a great discussion about what progress has been made, recent breakthroughs, and the big gaps in treatment development along the way. At this link: https://freakonomics.com/podcast/cancer/ 

Although it might appear that journalists love to bash insurers, it is easy to forget that there is some surprisingly useful coverage:

Last year the high-profile owner, Gabrielle Mullins of the Auckland performance venue The Powerstation, died of cancer. She was fundraising to pay for Keytruda, a chemotherapy drug not yet funded by Pharmac. https://www.stuff.co.nz/entertainment/music/122701023/gabrielle-mullins-the-owner-of-aucklands-powerstation-venue-dies-of-cancer. Earlier this year Michael Kooge, a radio show host, also hit the headlines with his cancer story, saying "It's all pretty unlucky, if I had medical insurance when I was in my early 20s, before I got sick, I would be able to get this treatment covered, but because I didn't I'm being left to die.” At the same time Stuff linked to coverage by Tim Fairbrother of Rival Wealth discussing which type of medical insurance would be best. https://www.stuff.co.nz/business/81385630/what-type-of-medical-insurance-works-for-you-will-depend-on-your-circumstances

Each story is a tragedy. Also, the insurance industry could hardly hope for better promotional coverage. I draw your attention to what is implicit the first article and explicit in the second: that an unfunded drug would have helped, and that insurance would have funded this. In stories like these, it seems, the media believe in insurance. At other times, it appears that they ignore the vast volume of claims paid and believe that insurers are solely focused on denying the payment of claims. Is the glass actually half full?

Cancer is the single largest cause of death in New Zealand, but what causes cancer? The link between drinking alcohol and the disease is stronger than ever. New Guidelines from the United States suggest that no alcohol is the best option for cancer prevention. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21591 

The BBC features this story pondering the impact of slower detection and delayed treatment on expected numbers of cancer deaths. The shorter period of restrictions on movement should make it possible for us to avoid quite the same experience - although it will take time for us to understand exactly what the impacts have been, and whether New Zealanders are back seeking tests, examinations, and treatment at the same levels that they were. 

About a five minute read, this article covering concerns about catching up on delayed cancer diagnosis caused by the lock-down is well worth the read. I expect that we will not know the full impact (or which of the views in the article is more correct) for some time - possibly years. It is worth considering that the options were grim - without a strong response to COVID-19 then many people with cancer, who are immune compromised, would have died from COVID-19. The choice made may well have been the best possible choice, which still doesn't make it any easier for people concerned about the impact on their cancer prognosis of a delayed diagnosis. 

UK Doctors say in this article that over half of melanoma patients are now surviving the disease that was considered untreatable a decade ago. Immunotherapy drugs are making a big impact on survival rates and quality of life. A clinical trial was done and had side effects like fatigue, rashes and diarrhoea, and after the trial the decision to make these drugs available worldwide was one of the fastest in NHS history. It is paying dividends. 

Aflac, a Japanese insurer has developed new technology in cooperation with Fujitsu and Nok Nok Labs which allows customers with cancer insurance the ability to use biometric authentication on their mobile devices to request immediate payment service for their cancer treatments. Click here to read more. 

Breast cancer patient Kingna Yu tells her story of struggling financially as she loses money on her Auckland business due to City Rail works taking place in front of her store. She has put breast reconstruction surgery on hold while she waits to see if there is a chance to get compensation for the decline in business. Click here to read more.

This is a desperately sad situation which shows the value of having a buffer against events - and if that buffer cannot be cash, it could be insurance. Of course, there is no way of knowing exactly what this person's situation was - so just to acknowledge that may not have been possible for them.