Norwegian healthcare model may be key to improving NZ’s ovarian cancer survival rates

Healthcare models in other high-income countries such as Norway may be key to improving NZ’s ovarian cancer survival rates and require more investigation, according to the head of gynaecological cancer foundation Talk Peach.

The call to learn from the success of other international healthcare models comes as Te Whatu Ora - Health New Zealand and Te Aho o Te Kahu - the Cancer Control Agency, prepare to establish the new Cancer National Clinical Network - designed to improve health outcomes and reduce variations in access to cancer care in NZ.^[1]

The new network, which is set to have its first meeting early this year, aims to tackle critical challenges in cancer care, including expanding workforce capacity to meet rising demand, creating sustainable and equitable care models and addressing disparities in access and outcomes.^[2][3]

Maori, Pacific peoples, disabled individuals, and those living in poverty are disproportionately affected, facing higher rates of cancer diagnoses and poorer outcomes. The initiative will focus on reducing variations in care to ensure more coordinated and effective cancer treatment across the health system.^[4]

Tash Crosby, cancer survivor and founder of Talk Peach Gynaecological Cancer Foundation says the success of oncology treatment models in parts of Scandinavia and Australia could provide insights that New Zealand can emulate as it looks to improve survival rates associated with the disease and launches the new national network.^[5]

In 2014 Norway’s ovarian cancer survival rate was the highest of six countries in the International Cancer Benchmarking Partnership (ICBP), which includes Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK, a collaboration of clinicians, policymakers, researchers and data experts, seeking to explain survival differences between high-income countries with comprehensive cancer registries, similar health system expenditure, and universal health care.^[6][7]

Data shows Norway, which is similar in population size to NZ, increased its five-year survival rates for ovarian cancer from 34.1% to 46.1% in the almost two decades from 1995. In contrast, New Zealand’s five-year survival rates remained relatively static - moving from 34.6% to 36.3% over the same period.^{[8], [9],[10]}

Figures from the Cancer Registry of Norway published in 2023 show their ovarian cancer survival rates have since increased to 50.3%.^[11]

Crosby says while the available data does not take into account any improvements made to New Zealand’s healthcare model following its publication, the current redesign of our national approach to cancer care by government health agencies is an opportunity to adopt current global best practices in this space.

She says early diagnosis is key to improving outcomes and is calling for the development of more culturally relevant and targeted resources to support disease awareness levels of Maori wahine and Pacific women who are generally at higher risk of ovarian cancer, compared to those of the European/other ethnic groups.* ^[12]

According to data from Te Aho o Te Kahu, ovarian cancer is the sixth most common cause of cancer death for New Zealand women. Every 32 hours approximately one Kiwi woman is diagnosed with ovarian cancer and around every 60 hours one dies from the disease during this time.^{[13],[14], [15]}

Data from the WHO shows the incidence of the disease in New Zealand is projected to grow 19% by 2035.^[16]

Researchers found Scandinavian countries such as Denmark and Norway, which have higher survival rates for ovarian cancer, utilise national databases to track treatment patterns and inform quality improvement initiatives. This approach allows for the identification of treatment variations, leading to better patient outcomes. In contrast, New Zealand currently lacks a comprehensive national auditing system for ovarian cancer treatment, however, Te Aho o Te Kahu is building the technology to securely share the relevant data from hospital information systems to a new national chemotherapy database.^[17][18]

Until 2019, New Zealand was the only ICBP country without access to a class of medicines known as PARP inhibitors that help prevent cancer cells from repairing their DNA, causing the cells to die.^[19][20][21]

Following the funding of the country’s first PARP inhibitor in 2020, another PARP inhibitor known as Zejula (niraparib) was funded in 2024 with over 100 people living with advanced ovarian cancer estimated to benefit from the maintenance treatment, regardless of whether or not they have a BRCA mutation. New Zealand now has two Government funded PARP inhibitors - which is now more closely aligned with other countries in the benchmarking partnership.^{[22][23][24],[25],[26]}

Crosby says while variations in our healthcare systems may mean New Zealand faces more inherent barriers when compared to countries like Norway, it is crucial that we work towards continuing to improve outcomes for Kiwi women with ovarian cancer.

“Building trust is crucial when working with Maori and Pacific communities, who are disproportionately affected by ovarian cancer. However more needs to be done to focus on fostering partnerships with Maori and Pacific organisations, building those relationships, and ensuring that life-saving information is delivered in a way that resonates with their cultural values and needs.^[27]

“In many cases, ovarian cancer can be asymptomatic until it advances to the later stages. Some ovarian cancer subtypes may be faster growing, causing symptoms such as significant bloating or abdominal pain to present earlier, however, every individual case is different, a large proportion of women are diagnosed when ovarian cancer is advanced,” she says.^[28][29]

Crosby says symptoms of the disease may include persistent bloating, feeling full quicker, discomfort, pressure, or pain in the abdomen or pelvic area, change in bowel habits, fatigue, back pain, needing to urinate often or urgently, abnormal vaginal bleeding, indigestion, nausea, or unexplained weight changes.^[30][31][32]

She says community and charitable organisations need to work together to help decrease the stigma surrounding the issue of gynaecological health and ovarian cancer.

“I’d like to see organisations having ovarian cancer information at their workplaces, on notice boards, in bathrooms, wherever women can see it and familiarise themselves with the symptoms.

“This kind of community awareness where women see it at multiple touch points could have a trickle-down effect where they receive the information and pass it on to friends and whanau also.

“In Australia, which had the second highest five-year survival rates of ICBP countries, we’ve also seen large corporates and fashion brands being involved in ovarian cancer awareness, these brands often have large social media followings and it would be great to see some New Zealand companies jump on board and make a similar commitment,” she says.^[33]

Brett Marett, GSK medical director, says with the burden of ovarian cancer expected to increase within New Zealand and globally, the development of treatment options and raised awareness of the disease is critical.^[34],[35]

He says PARP inhibitors are a targeted maintenance therapy that may increase the length of time before cancer progresses.^{[36],[37],[38], [39][40]}

“The access to funded PARP inhibitor treatment options for ovarian cancer may offer hope for the many Kiwi women and their whanau that are impacted by this disease each year,” he says.^[41][42]