6. Cancer Services—Intraoperative RadiotherapyDAVID SEYMOUR (Leader—ACT) to the Minister of HealthCancer Services—Intraoperative Radiotherapy6. DAVID SEYMOUR (Leader—ACT) to the Minister of Health: Has he seen the TARGIT study of 3451 women in 11 countries with breast cancer which found that intraoperative radiotherapy has similar survival and recurrence rates and significantly fewer mortalities from other complications after 5 years than external beam radiotherapy and what progress is being made introducing intraoperative radiotherapy into the New Zealand Public Health Service?Hon Dr JONATHAN COLEMAN (Minister of Health): Yes I am aware of the TARGIT study. An initial assessment examining the clinical safety and effectiveness of intraoperative radiotherapy (IORT) was published by the National Health Committee in 2015. Following this an assessment examining the potential impacts of introducing IORT in New Zealand was published in April this year. Having considered these reports the Ministry of Health has concluded that there is insufficient evidence to introduce IORT into the New Zealand public health system at this time. I am advised that the key issue is that clinical equivalency between IORT and external beam radiotherapy (EBRT) has not yet been established. Further clinical trials are under way internationally with the results expected to be available after 2020.David Seymour: Why then did the tier 3 report from the Ministry of Health say: The TARGIT-A trial provided sufficient evidence to carry out work on the National Health Committee's other domains and there is reasonably good evidence that the follow-up period is sufficient and that non-inferiority has been demonstrated."?Hon Dr JONATHAN COLEMAN: This is essentially a debate between clinicians and scientists as to the most effective treatment. The best advice is that the evidence around IORT is still emerging—that it is not conclusive. Ministers getting involved in this situation would be a bit like reaching into Pharmac and directing that certain drugs be funded. The fact is that we have to take the best expert advice and that is what I am going on.David Seymour: What did the Deloitte report commissioned by the Ministry of Health find in respect of the cost-effectiveness of IORT versus conventional breast cancer treatments?Hon Dr JONATHAN COLEMAN: It may well be cost-effective in certain cases but I can tell you directly what that report does say and here it is: "… extant evidence for the efficacy and safety of the IORT compared to EBRT remains equivocal."David Seymour: Why were the authors of that Deloitte report not provided with the tier 3 report that I mentioned in my earlier supplementary question?Hon Dr JONATHAN COLEMAN: I am not aware that they were not.David Seymour: Is it not the case that new technology in the form of IORT could save enormous inconvenience and pain to a thousand women per year who are diagnosed with early-stage breast cancer but that the Ministry of Health is dragging its heels on its introduction when comprehensive studies with 5 years of evidence have been published internationally in reputable journals and those thousand women a year will continue to miss out because the ministry is dragging its heels?Hon Dr JONATHAN COLEMAN: No it is not the case. Actually the ministry is up to date with the latest evidence and the best advice is that the evidence is equivocal and there is no clear benefit of IORT versus EBRT.Marama Fox: Given that of the 120 women who have received this treatment because they have paid for it only one of them was Māori surely the disparity in the system needs to be addressed? Can the Minister tell us what he will do to correct the disparity for Māori and Pasifika and the opportunity to receive this treatment?Hon Dr JONATHAN COLEMAN: Look it is very important that people in New Zealand get access to the very best treatments regardless of their ethnic background and that is absolutely what the Government is committed to doing.David Seymour: Can the Minister give any indication to New Zealand women of when he expects this new technology already used in Australia Canada the UK the US and even China to be available in New Zealand's public health system?Hon Dr JONATHAN COLEMAN: If the member thinks back to the primary answer I said that further clinical trials are under way internationally with results expected to be available after 2020.Marama Fox: Given that women who live rurally have to have ongoing radiotherapy over a period of months and given the inconvenience to them and their families—the majority of them women; the No. 1 cause of death in this country by cancer for women—will the Minister ensure that those trials are done speedily and this implemented?Hon Dr JONATHAN COLEMAN: I do not actually have any power as Minister of Health to speed up international trials."