New Zealand lags in early de­tec­tion and treat­ment of sec­ondary breast can­cer.

New Zealand Listener - - CONTENTS - By Nicky Pel­le­grino

Claire McLin­tock was di­ag­nosed with ad­vanced can­cer on her el­der daugh­ter’s 21st birth­day. It had been 14 years since her suc­cess­ful treat­ment for breast can­cer, but then came the con­stant tummy nig­gles that she knew needed to be checked out. McLin­tock is a med­i­cal pro­fes­sional, a haema­tol­o­gist spe­cial­is­ing in ob­stet­rics. At a scan to check her symp­toms, when she saw a large build-up of fluid in her stom­ach, she re­alised im­me­di­ately it was go­ing to be dev­as­tat­ing news. The can­cer was back and spread­ing.

“It’s like I’ve got lit­tle seedlings of it all over my tummy,” she ex­plains.

Pre­vent­ing those seedlings from grow­ing any fur­ther, so she can live as well and for as long as pos­si­ble, was now McLin­tock’s pri­or­ity. She is for­tu­nate to have con­nec­tions in the med­i­cal world so last year trav­elled to Lon­don, where spe­cial­ists said her best op­tion was a rel­a­tively new drug, Ibrance (pal­bo­ci­clib), taken along­side the oe­stro­gen sup­pres­sant letro­zole.

“There had been a big clin­i­cal trial that showed women with ex­actly what I’ve got lived 40% longer be­fore the dis­ease pro­gressed when they were tak­ing this com­bi­na­tion of drugs,” McLin­tock says.

At that stage, Ibrance wasn’t reg­is­tered for use in New Zealand, never mind funded. There was a stress­ful time try­ing to ac­cess the drug but fi­nally McLin­tock paid £10,000 for an ini­tial sup­ply and, once back home in Auck­land, started to take it.

She and her hus­band, artist John Reynolds, weren’t sure how they were go­ing to af­ford Ibrance longer term, with McLin­tock re­luc­tant to leave her fam­ily with moun­tains of debt. Again, she was for­tu­nate with the peo­ple she knows. Her friends or­gan­ised an epic fundrais­ing art auc­tion that has meant McLin­tock, 53, has enough money to pay for her med­i­ca­tion for the fore­see­able fu­ture.

“It’s been hum­bling,” she says. “I keep meet­ing friends who say, ‘Claire, if you need it again then we’ll do it again.’”

She has been on the drug regime since May last year. While pre­vent­ing the over-pro­lif­er­a­tion of can­cer cells, Ibrance also low­ers the white blood-cell count, leav­ing pa­tients at higher risk of in­fec­tion, but so far

she is do­ing well. She cy­cles to work to see her pa­tients, of­ten trav­els in her role as pres­i­dent of the In­ter­na­tional So­ci­ety of Throm­bo­sis and Hae­mosta­sis, and spends lots of qual­ity time with her daugh­ters, Hart, 22, and Vita, 19.

“I wouldn’t say I’ve slowed down.”

Pre­vi­ous treat­ments for sec­ondary can­cer could in­volve in­ten­sive chemo­ther­apy that left peo­ple weak, nau­se­ated and of­ten hos­pi­talised. With the new gen­er­a­tion of drugs, pa­tients feel well enough to con­tinue lead­ing the life they had be­fore the di­ag­no­sis.

“I’m able to be the per­son I am,” says McLin­tock.

She is painfully aware oth­ers aren’t as for­tu­nate. Although Ibrance is now reg­is­tered in this coun­try, it re­mains un­funded, so pa­tients must pay thou­sands of dol­lars a month to ex­tend their time with­out the can­cer pro­gress­ing. Some travel to Malaysia to buy it more cheaply.

“But, for many, it’s just not on the radar of what they could raise money for,” says Adele Gau­tier, re­search and com­mu­ni­ca­tions man­ager at the NZ Breast Can­cer Foun­da­tion.

Ibrance is one of a hand­ful of new drugs the foun­da­tion has iden­ti­fied as pri­or­i­ties for fund­ing. It is seen as par­tic­u­larly cru­cial be­cause the pa­tient group – those with ad­vanced ER+ (oe­stro­gen re­cep­tor pos­i­tive) breast can­cer – is large and the drug has been her­alded as a game changer.

Last month, 200 peo­ple marched on Par­lia­ment to pe­ti­tion Phar­mac to fund these life-ex­tend­ing can­cer medicines.

How­ever, as Gau­tier points out, Pfizer, the man­u­fac­turer of Ibrance, has ap­plied only for first-line fund­ing, mean­ing even if Phar­mac does de­cide in its favour – and the govern­ment agency has a capped bud­get and pres-

With the new drugs, pa­tients can con­tinue lead­ing the life they had be­fore di­ag­no­sis.

sure to fund other drugs – those who have re­ceived pre­vi­ous treat­ments for ad­vanced can­cer won’t be eli­gi­ble for it.

Care for pa­tients with ad­vanced breast can­cer gen­er­ally isn’t good enough, Gau­tier says. A re­cent re­port by the foun­da­tion showed that New Zealand’s me­dian sur­vival af­ter a di­ag­no­sis is just 16 months, as op­posed to two to three years in com­pa­ra­ble coun­tries.

Apart from ac­cess to in­no­va­tive new drugs, slow di­ag­no­sis and de­layed treat­ment are con­cerns.

“We hear a lot from pa­tients who go to their GP with a sore back or per­sis­tent cough and are treated for sci­at­ica or bron­chi­tis when the first call should have been to re­fer them to on­col­ogy for a check-up,” Gau­tier says. “Pa­tients tell us it seems so dif­fer­ent sec­ond time around. They feel the sys­tem has given up on them and they feel for­got­ten and ig­nored.”

Claire McLin­tock, right, with daugh­ters Hart and Vita. Above, Adele Gau­tier.

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