Melanoma incidence and death rates remain a serious health issue in New Zealand.
With melanoma registrations predicted to rise over the next few years the public health system will be stretched to cope, placing increased burdens on dermatologists, surgeons, oncologists, other health professionals.
Affordability of skin checks remains a concern for many New Zealanders, and as early detection is key to reducing the thickness of melanoma there needs to be better mechanisms to enable this to happen. Primary care education is paramount in this process of identifying patients at risk and identification of suspicious lesions.
Drug treatments for advanced melanoma have received breakthrough status over the last 5 years and patient access to these agents has been expedited in comparable nations such as Australia and the United Kingdom.
Specifically, two classes of novel drugs, immune checkpoint and kinase inhibitors, are now available and have the potential to radically alter the prognosis for patients with advanced melanoma. However, the dilemma for New Zealanders is the lack of subsided access to these drugs.
Chemotherapy remains the only funded therapy, but is futile for most. This is unacceptable for patients who could enjoy longer life expectancy, as well as improved quality of life, with these drugs.
This will undoubtedly have societal benefits, because melanoma affects a young population and its associated illness and mortality burden prevents those people from contributing to familial and economic aspects of New Zealand life.
As more information from clinical trials becomes available, the funding challenges will become even more prominent - for example, the introduction of combinations and sequences of high cost therapies will add major complexity to the situation. However, without access to these new therapies it is inevitable that the death rate from melanoma in New Zealand, which is already four times the world average, will increase.
New Zealanders with melanoma are further disadvantaged, compared to their Australian and British counterparts, because access to melanoma clinical trials is limited in New Zealand.
Clinical trials must be part of the treatment paradigm and an available option for all patients.
Patients should not have to travel outside of New Zealand to access clinical trial treatment, as it is often the only way that patients can access innovative therapies that are not currently funded.
In the current public healthcare system, clinical trials seem to be viewed as an 'optional extra' - this culture must change if we are to utilise clinical research as a more affordable means of patient access to new therapies.
Melanoma New Zealand has identified "access to effective therapies" as key to achieving its goal of reducing melanoma deaths in NZ, and we intend to remain on this mission.