New Zealanders with blood cancer are reportedly being advised by their doctors to move to Australia, as funding shortfalls hamper access to contemporary therapeutics in the country.

Actor Sam Neil is just the most famous Kiwi to head across the ditch to access treatment for haematological malignancy, with the story of another patient urged to migrate by his clinicians making headlines only last week.

Local media reported Toby Fuller, 25, who has multiple myeloma, has been advised his best option on relapse will be daratumumab, which is available in Australia under the PBS.

However, the monoclonal antibody is not funded by the New Zealand government, meaning Mr Fuller would need to personally cover an expected $200,000 (NZD$220,000) in costs for the first year.

Instead, on the advice of one of his doctors, he is seriously considering a move to Australia or the UK, where he was born but left at age six, reported Kiwi news site Stuff (link here).

“It would be really hard to leave my family and friends [if I were to move overseas]… but I’m keen to live a bit longer,” he told the publication.

It breaks my heart too Jake as NZ slips further behind. The gulf is now a chasm as many dual citizens like #SamNeill are forced to leave home for care. Not only is it depriving NZ patients it is making it harder for NZ clinicians to stay, & for the NZ medical diaspora to return. https://t.co/K6kZpO7o7B

— Judith Trotman (@JudithTrotman1) January 7, 2024

The paucity of funding for modern haematology-oncology drugs in has been described as “beyond fair” by experts, who say there is now an “appalling gulf” between New Zealand and nations such as Australia.

In July 2023, Kiwi haematologist Dr Rodger Tiedemann wrote an open letter to health officials calling for the end to the “unconscionable” delay in funding daratumumab (link here).

“[This issue] has snowballed over the past decade into a substantive failing in this important component of our healthcare system,” he wrote.

“The current state of affairs is undermining haematology-oncology care in New Zealand and is preventing the reasonable pursuit of wellbeing by cancer patients in this country.”

“Delays in the funding of new haematology-oncology drugs have reached such a crisis point that we feel that we must now advocate on our patients’ behalf and ask that they be afforded justice by the government, and be enabled to receive modern cancer treatments that are widely regarded as a standard of care across the Western world.”

Dr Tiedmann, an Auckland Hospital haematologist and senior academic at University of Auckland, said affected disorders included:

• acute myeloid leukaemia (venetoclax, azacitidine, midostaurin),
• acute lymphocytic leukaemia (inotuzumab),
• chronic lymphocytic leukaemia (ibrutinib),
• Hodgkins lymphoma (pembrolizumab)
• multiple myeloma (daratumumab, pomalidomide, carfilzomib).

“In asking your attention, we are not asking for daratumumab to be treated as a special case,” he added.

“Instead, the case for providing daratumumab access is very strong and already established. Yet New Zealanders continue to be let down by undue delays at the government’s drug-funding agency.”

Bureaucratic barriers

Professor Jake Shortt, a Kiwi-Australian haematologist at Monash Health and Monash University, stressed there were major bureaucratic hurdles for anyone relocating for Medicare access.

Nevertheless, it was understandable why some patients might take such a drastic step, he said.

“It certainly does happen,” he told the limbic.

“As a dual-citizen myself, my reluctance to return to practice in New Zealand is partly driven by this problem of not being able to access contemporary medicines for my patients.”

“Also, as I approach the age of 50, I’m genuinely concerned that if I was to develop one of these diseases, I’d be on the first plane back. I’ve had family and friends over in New Zealand who have had haematological diseases, and it brings it into sharp focus.”

New Zealand had fallen so far behind that clinical trials were now affected because local comparators were often on treatments that were no longer considered standard of care in other countries, Professor Shortt added.

“It really does impact patient outcomes, which is why groups like the ALLG are now advocating strongly on the issue,” he said.

“I think the extent of the gap would surprise a lot of people who weren’t familiar with it.”