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Cancer control has been defined as: “a planned, systematic and organised approach that aims to reduce the number of people diagnosed with and dying from cancer, as well as improving the quality of life for those who develop cancer” (Ministry of Health, 2003, p. 5).

This approach covers a broad continuum from cancer prevention, screening, diagnosis and treatment, to palliative care and survival. Additionally, planning, co-ordination, integration of resources and activities, monitoring and evaluation, and research and surveillance are all key components of cancer control.

Cancer Control New Zealand (CCNZ) was a committee made up of the Cancer Control New Zealand Board, the Palliative Care Council of New Zealand and

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Cancer Control New Zealand Secretariat. CCNZ was established in 2005 under section 11 of the New Zealand Public Health and Disability Act 2000. The structure of the CCNZ followed cancer councils already established in the United Kingdom, Canada and Australia. CCNZ provided independent expert advice to the health sector on cancer control developments and successful initiatives. By providing leadership and promoting collaboration within the sector, CCNZ helped improve access to cancer care, as well as the quality of care. (Gavin, Marshall & Cox, 2001).

One of the contributions CCNZ made to cancer control in Aotearoa was to identify the myriad of organisations and individuals involved in cancer control. These include: the Ministry of Health; District Health Board (DHB) staff including funding and planning, operational management and hospital specialists, and other clinical staff; primary care providers; public health specialists; non‐ government and Māori and Pacific organisations; hospices, private providers; researchers; and consumers and carers (Herbert & Peel, 2010). CCNZ recognised the need for all of these organisations to work together in order to facilitate an integrated approach to cancer control. CCNZ was disestablished in August 2015. A press release from the Minister of Health explained that CCNZ was no longer considered necessary due to the progress made in improving cancer services (Minister of Health, 2015).

The Palliative Care Council of New Zealand was established by CCNZ in 2008. It was an independent body with a multi-disciplinary membership whose role was to report and provide strategic advice to the Minister of Health about palliative and end-of-life care (Palliative Care Council of New Zealand, 2012). The Palliative Care Council, like the CCNZ, was disestablished in 2015. It is to be replaced by an advisory group which, at the time of writing, has not yet been established.

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The New Zealand Cancer Control Strategy Action Plan 2005-2010 (Cancer Control Taskforce, 2005) (which has been superseded by the NZ Cancer Plan (Ministry of Health, 2014c)), informed by CCNZ, identified the need to develop formal regional structures that would enhance co-operation and collaboration for cancer control. In 2006, four regional cancer networks were established across Aotearoa. Their role is to work with DHBs to bring together health providers, consumers, NGOs, palliative care providers and Māori, in order to improve service planning and delivery of cancer care. Establishing networks between all the different organisations and individuals involved in cancer care seeks to promote relationship-building, co-operation and integration of services. By working together, it is intended that the different providers of cancer care will plan and co-ordinate services in line with national standards of treatment (Herbert & Peel, 2010).

An evaluation of Regional Cancer Networks identified connecting with primary health care providers as an area where the networks are challenged. The

authors focussed on the importance of bringing primary health care providers into the cancer control loop (Herbert & Peel, 2010). Indeed, it appears that there are barriers to primary care services being able to fulfil a central role in cancer control, including a lack of information technology infrastructure to support a robust communication network between primary care services and other specialist care areas.

Primary care is the first level of contact and entry point to the health system with the most obvious primary care involvement in terms of cancer care services being through GP practices and PHOs. Overseas studies have recognised that primary care practitioners should play a greater role in co-ordination across the primary-secondary-tertiary-palliative service interface since cancer patients are required to interact with numerous services and staff but experience fractured

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co-ordination of care (Burge et al, 2003; Dahlhaus et al, 2014; Earle & Neville, 2004; Halkett et al, 2015; Kendall et al, 2006; Weller & Harris, 2008).

Additionally, the importance of strategic policy to direct practical and effective community-based cancer care has been identified (National Institute of Clinical Excellence, 2004; Scottish Executive Health Department, 2005).

Management of cancer is complex, requiring specialised skills and knowledge, access to diagnostic and treatment facilities, and often long-term management of symptoms and recurrences (Campbell et al, 2002). Nevertheless, as Weller and Harris (2008)point out, when asked about how their care could be improved, the requests of cancer patients are modest and include: knowing who is in charge of their overall care, obtaining ready access to care , and feeling reassured that specialist services are available if required.

Primary care plays an important role in caring for patients following a cancer diagnosis, including managing side-effects from cancer therapy when patients return home (Campbell et al, 2002; Murchie et al, 2010). Integration of specialist and primary care services can also benefit patients by cutting down on travel and waiting times in hospitals (ibid). Management of co-morbidities while undergoing cancer treatment is often done by primary health care providers. Co-morbid conditions not only impair quality of life for cancer patients, but also impact on their treatment options (Campbell et al, 2002; Sarfati et al, 2014).

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