1. Midland Cancer Network 2012 Clinical Performance Conference

2. The Midland Cancer Burden Gynaecological cancers make up approximately 10% of all cancer cases and 10% of all cancer deaths in New Zealand. In 2008 there were 987 gynaecological cancers registered nationally. Endometrial cancer is the most common gynaecological cancer in the country, followed by ovarian and cervical cancers. In 2007 there were 402 deaths due to gynaecological cancers.

3. The Midland Cancer Burden The overall population for the Midland region is expected to increase from approx. 750,000 in 2014/15 to nearly 850,000 by 2032 (and over 785,000 by 2019/20) There are a number of key features of the Midland region population compared to New Zealand as a whole: » The highest proportion of Māori. » A low proportion of the population identifying as Asian or Pacific peoples. » A higher number of people living in rural areas. » A relatively higher proportion of people living in areas identified as high deprivation (deprivation quintiles 4 and 5). Longstanding and significant inequalities exist between Māori and non - Māori in terms of the incidence of cancer morbidity and mortality, access to cancer services, the stage at which cancer is first diagnosed and survival rates (Cormack et al 2005; Robson et al 2006). Inequalities are also evident for Pacific peoples and lower socioeconomic groups (Ministry of Health 1999a; Ministry of Health and Ministry of Pacific Affairs 2004). This pattern also exists for the high deprivation population in terms of higher registration and mortality levels. One notable example is in uterine cancer registrations, where there is a clear correlation between deprivation and cancer registrations.

4. The Midland Cancer Burden Female population The female population for the Midland region is expected to increase by 13% between 2013/14 and 2032/33. This increase is not spread uniformly across age groups, with an increase of 27% in the 45 years and over group (i.e. those with highest incidence of gynaecological cancer). In terms of ethnicity there is a slightly greater increase in Maori females than other ethnic groups (15% increase versus 13% increase overall). Gynaecological cancer is evidenced mainly in women aged between 20 and 75. This group is expected to increase to approx. 275,000 (a 10% increase) by 2033

5. Gynaecological cancer registrations and projections

6. The data above and in the table below indicates there will be approx 190 new gynaecological cancer cases occurring in the Midland region by 2023. This suggests there would be sufficient caseload to commence the establishment of a regional service at Waikato Hospital. However, given the marginality of the service in the first few years, any service would be best developed as part of a wider super-regional service covering both the Northern and Midland regions. This would allow for co-ordinated appointment of consultants, appropriate supervision and opportunities for training posts.

7. Gynaecological cancer registrations and projections As both regions are expected to continue increase in population over 15-20 year timeframe, irrespective of cancer incidence, growth would be expected in both services. The projected increase in cancer registrations between 2022/23 and 2032/33 has been based on the average percentage increase in the relevant female population and the increase in cancer registrations over the previous 10 year period.

8. Gynaecological cancer registrations and projections

9. How services are currently configured

10. Questions

11. Midland population projections Total Midland population projection by DHB by gender to 2033

12. Midland population projections

15. Table 1: Cancer Registrations for the Midland DHB region – for ICD 10 codes C51-C58 Data Source: Ministry of health (Cancer Registry – Cancer data mart).Data extracted on: 14 May 2015 There is no significant change in the cancer registrations over the years (9 years) for Midland DHBs. Fiscal YearBay of PlentyLakesTairawhitiWaikatoTotal 2004/055717 84175 2005/0657241184176 2006/0751161369149 2007/085226794179 2008/095424983170 2009/1058251185179 2010/1151181474157 2011/1251291169160 2012/1355231477169 Total4862021077191514

16. Table 2: Mortality data for the Midland DHB region Data Source: Ministry of health (Cancer Registry – Cancer data mart). Data extracted on: 14 May 2015 The numbers are gradually decreasing in small increments. Fiscal YearBay of PlentyLakesTairawhitiWaikatoTotal 2004/053110114395 2005/06321084797 2006/07321082979 2007/08191224679 2008/09211664184 2009/10311064390 2010/11181162459 2011/128841939 2012/1312432342 Total2049154315664

17. Midland domicile patients that have surgery in Auckland from June 2014 to May 2015(with a diagnosis of cancer): By DHB: Please Note: The data for May 2015 is not complete.

18. Midland domicile patients that have surgery in Auckland from June 2014 to May 2015(with a diagnosis of cancer): By tumour Type: The top two tumour types for Midland region were; 14 patients diagnosed with C54 (Malignant neoplasm of endometrium) 10 patients were diagnosed with C56 (Malignant neoplasm of ovary). By Ethnicity: The top two ethnic groups for Midland were; 29 NZ European and 7 Māori patients who were diagnosed with gynaecological cancer from C51-C58 There were 4 patients with other ethnicity and there was one patient where ethnicity was not known.

19. Midland domicile patients that have surgery in Auckland from June 2014 to May 2015(with a diagnosis of cancer): By Type of Surgery: The main types of surgery for Midland region were:

20. Numbers of Midland women presented at Waikato MDM, for Gynaecological tumour stream (C51-C58) June 2014 to May 2015 Please Note: The data for May 2015 is not complete. The data may include women with benign conditions who are not put forward to surgery. By DHB By Ethnicity There were total 186 NZ European patients and 64 Māori Patients in Midland region. Tumour Type: Of the main tumour type there were 10 patients with ICD C54 (Malignant neoplasm of endometrium) and 6 patients with C56 (Malignant neoplasm of ovary)

21. Numbers of Midland women presented at Auckland MDM, for Gynaecological tumour stream (C51-C58) By DHB *Others are private patients from Tauranga and Hamilton. By Ethnicity There were 77 NZ European and 21 Māori patients Note: We could not source ethnicity information for 23 patients. By Tumour type There were 52 out of 137 where tumour type could be identified. 52 patients were newly diagnosed cancers. The rest could include recurrent or metastatic gynaecological cancer. Some cases in the cohort will be metastatic related to non-gynaecological cancers and benign.

22. Numbers of Midland women presented at Auckland MDM, for Gynaecological tumour stream (C51-C58) The breakdowns of 52 patients by ICD code were: