Cancer is a leading cause of morbidity, disability and death for New Zealanders, and is a priority issue for the New Zealand health system. In 2003 the New Zealand Cancer Control Strategy was launched and in 2005 the Action Plan for 2005–2010 was published, setting objectives for implementation of the Strategy.
This paper describes the pattern of cancer incidence and survival among New Zealand adolescents and young people. It is an important paper, not only because of it's comprehensive overview, but also because it's scholarship and timeliness enables it to inform the work of the Paediatric/Adolescent subgroup of the New Zealand Cancer treatment working party. The paper utilises the International Classification of Childhood Cancer which permits direct comparison between New Zealand and published overseas data.
Dr Greg Williams undertook this work, as part of his advanced training in paediatrics, during a six-month attachment to the Ministry of Health. The content of this paper does not necessarily represent the Ministry of Health’s viewpoint, but is intended to guide policy regarding adolescent cancer treatment and prevention. The intended audience for this paper includes policy makers within the Ministry of Health and other relevant government departments, District Health Board funders and planners, and clinicians working in the field of cancer control.
Disclaimer: This document was prepared by Greg Williams while he was working as a paediatric registrar in the Ministry of Health. The copyright in this article is owned by the Crown and administered by the Ministry. The views of the author do not necessarily represent the views or policy of the New Zealand Ministry of Health, but it is an important deliverable of the Cancer Control Strategy Action Plan. The Ministry makes no warranty, express or implied, nor assumes any liability or responsibility for use of or reliance on the contents of this document.
Purpose
This study aims to describe the pattern of cancer incidence and survival among New Zealand adolescents and young people, discuss the importance of adolescent development, and discuss the future of adolescent cancer management in light of current literature.
Methodology
Data were extracted from the New Zealand Cancer Registry, along with matched mortality data, for new cases of cancer diagnosed among those aged between 10 and 24 years over a 15-year period from 1988-2002.
These cases were analysed and grouped using the International Classification of Childhood Cancer (ICCC), with further analysis using an adolescent-specific classification scheme. Cases were also analysed based on gender, ethnicity and deprivation.
Five-year survival was calculated. International comparisons were made where possible.
Key Results
Results
The study included 2917 cases of cancer and a total of 12,452,820 person-years at risk, giving a crude incidence rate for 10.24-year-olds of 234 per million person-years. The patterns of cancer were broadly similar to those reported internationally in this age group, except for a higher incidence of malignant melanoma than most countries with which comparisons were made, apart from Australia. Females had a slightly lower incidence of cancer than males. Overall incidence in Māori was lower than that in non-Māori. At older ages this difference was partly due to lower rates of melanoma among Māori. The study was not able to demonstrate differences in incidence based on deprivation.
Conclusions and recommendations
The high incidence of melanoma emphasises the importance of primary preventative measures to reduce ultraviolet radiation exposure.
The absence of an adolescent-focused cancer service in New Zealand has led to current work to develop such a service. Ideally this service will take account of both the medical and developmental needs of adolescents and young people.
A service of this nature will include access to appropriately supported and networked clinicians able to deliver adolescent-specific care, facilities appropriate for adolescents, developmentally appropriate psychosocial support,assistance with care co-ordination, access to adolescent-appropriate clinical trials, culturally supportive services, and long-term follow-up services. In addition, moves to improve access to primary health services may assist in early diagnosis, with subsequently improved outcomes.
Monitoring progress is also vital. An extension of the Children.s Cancer Registry to include older adolescents and young people would be a pragmatic way to achieve this.
Finally, the legislation could be amended to include surveillance of benign central nervous system tumours. These tumours are not currently included under the legislation, although some cases probably do get entered into the Registry. Due to their location, their effect can be as devastating as that of a malignant tumour.