1. Cancer Deaths in New Zealand 2000 to 2010 October 2014

2. Ministry of Health MORT Data Data collected continuously; cause of death added. Based on year of registration of death, with around 3% of deaths recorded after year of death. Publications produced annually with a delay: 2010 released October 2013 Detailed data requested, with one record for each death. De-identified data received for 311,212 deaths including underlying cause of death, contributory causes and place of death.

3. Context

4. Neoplasms Neoplasm (Ancient Greek from neo- "new" and plasma "formation, creation") - an abnormal mass of tissue as a result of abnormal growth or division of cells. Benign neoplasms Premalignant neoplasms (carcinoma in situ) Malignant neoplasms (cancer). Secondary neoplasms - metastatic offshoot of a primary tumour, or an apparently unrelated tumour.

5. Cause of Death 2000-2010 29.1 % of deaths are from neoplasms, which includes malignant and benign neoplasms. 90,585 deaths from neoplasms over the 11 year period, or 8,235 each year on average. Source: Analysis of Ministry of Health MORT data 2000 to 2010

6. Cause of Death 2000-2010 Females account for 49.9% of deaths from all causes. Source: Analysis of Ministry of Health MORT data 2000 to 2010

7. Cause of Death 2000-2010 Females account for 49.9% of deaths from all causes. Source: Analysis of Ministry of Health MORT data 2000 to 2010

8. Cause of Death 2000-2010 Neoplasms Females account for 47.3% of deaths from neoplasms. Source: Analysis of Ministry of Health MORT data 2000 to 2010

9. Historic Cause of Death 2000-2010 Neoplasms Small but steady increase in total number of deaths from neoplasms each year. Source: Analysis of Ministry of Health MORT data 2000 to 2010 Smoothing of the under 24 age bands as there is very little data.

10. Historic Cause of Death 2000-2010 Neoplasms Small but steady increase in total number of deaths from neoplasms each year. Proportion of deaths from neoplasms variable around 29.1% for the whole period. Source: Analysis of Ministry of Health MORT data 2000 to 2010 Smoothing of the under 24 age bands as there is very little data.

11. Age, Gender and Ethnicity

12. Cause of Death 2000-2010 Neoplasms Females account for 47.3% of deaths from neoplasms. Source: Analysis of Ministry of Health MORT data 2000 to 2010

13. Deaths in New Zealand 2000-2010 Neoplasms Females account for 47.3% of deaths from neoplasms. Distinctive pattern by age with more female deaths from age 30 to 55 and over age 85. Source: Analysis of Ministry of Health MORT data 2000 to 2010

14. Deaths in New Zealand 2000-2010 Neoplasms Females account for 47.3% of deaths from neoplasms. Distinctive pattern by age with more female deaths from age 30 to 55 and over age 85. Source: Analysis of Ministry of Health MORT data 2000 to 2010

15. Deaths in New Zealand 2000-2010 30.1% of all deaths are over age 85; 60.1% are over age 75 and 77.4% are over age 65. Source: Analysis of Ministry of Health MORT data 2000 to 2010

16. Deaths in New Zealand 2000-2010 Neoplasms Only 15.8% of neoplasm deaths are over age 85; 55.9% are between age 65 and 84; and 28.4% are under age 65. Only 2.6% of deaths from neoplasms are under age 40. Source: Analysis of Ministry of Health MORT data 2000 to 2010

17. Deaths in New Zealand 2000-2010 Neoplasms There is a gradual increase in the age at death, with deaths over age 85 increasing from 17.4% to 20.4% for women and from 11.3% to 15.3% for men. Source: Analysis of Ministry of Health MORT data 2000 to 2010

18. Deaths in New Zealand 2000-2010 Neoplasms For all ethnicity groups, women have proportionately more deaths under age 64 and more deaths over age 85. There are proportionally more deaths of Māori, Pacific and Asian people at younger ages compared to the Other group. Source: Analysis of Ministry of Health MORT data 2000 to 2010

19. Ethnicity of Deaths 2000-2010 Total Deaths Māori make up 9.8% of total deaths Source: Analysis of Ministry of Health MORT data 2000 to 2010

20. Ethnicity of Deaths 2000-2010 Neoplasms Very similar to all causes. Slightly fewer Māori and Pacific deaths than for all causes; slightly more Other deaths. Māori make up 9.5% of deaths from neoplasms. Source: Analysis of Ministry of Health MORT data 2000 to 2010

21. Ethnicity of Deaths 2000-2010 Neoplasms Very strong pattern by age with very few Māori, Pacific or Asian deaths at older ages. Related to the population structure. Source: Analysis of Ministry of Health MORT data 2000 to 2010 Smoothing of the under 29 age bands where there is very little data.

22. Ethnicity of Deaths 2000-2010 Neoplasms A small but steady increase in the proportion of deaths amongst Māori, Pacific and Asian lives. Source: Analysis of Ministry of Health MORT data 2000 to 2010

23. Analysis by Cancer Site

24. Average Deaths from Neoplasms 2000-2010 Using the IARC groupings, “Trachea, bronchus and lung” is the largest site (18.4%), followed by Colorectum (14.5%). Together, the two groupings ACCOUNT for one third of all deaths (32.9%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

25. Deaths from Neoplasms 2000-2010 Using the IARC groupings, “Trachea, bronchus and lung” is the largest site (18.4%), followed by Colorectum (14.5%). Together, the two groupings account for one third of all deaths (32.9%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

26. Annual Average Deaths from Neoplasms Females 2000-2010 Lung cancer is the largest group, followed by Breast and Colorectum. Source: Analysis of Ministry of Health MORT data 2000 to 2010

27. Annual Average Deaths from Neoplasms Males 2000-2010 Lung cancer is the largest group, followed by Colorectum and Prostate. Source: Analysis of Ministry of Health MORT data 2000 to 2010

28. Deaths from Neoplasms 2000-2010 Gender Overall, 47.3% of deaths from neoplasms are women. Source: Analysis of Ministry of Health MORT data 2000 to 2010

29. Deaths from Major Neoplasms by Age, 2000-2010 The major groupings by site have very different age patterns. Source: Analysis of Ministry of Health MORT data 2000 to 2010

30. Deaths from Select Neoplasms 2000-2010 Increases in deaths from Lung cancer, Colorectum and Pancreas cancer are noticeable over the period. Source: Analysis of Ministry of Health MORT data 2000 to 2010

31. Deaths from Neoplasms 2000-2010 Age Bands Overall, 28.4% of deaths from neoplasms are under age 64 but this is concentrated in certain cancer sites. Source: Analysis of Ministry of Health MORT data 2000 to 2010

32. Deaths from Neoplasms 2000-2010 Ethnicity Linked to age bands at which certain cancers more likely. Source: Analysis of Ministry of Health MORT data 2000 to 2010

33. Annual Average Deaths from Neoplasms Māori 2000-2010 Lung cancer is by far the largest group (32.0% of Māori deaths from neoplasms), followed by Other cancers and Breast cancer (9.0%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

34. Annual Average Deaths from Neoplasms Pacific Peoples 2000-2010 Lung cancer is the largest group (19.7%), followed by Breast (10.3%) and then Other cancers. Source: Analysis of Ministry of Health MORT data 2000 to 2010

35. Annual Average Deaths from Neoplasms Asian 2000-2010 Lung cancer is by far the largest group (20.1%), followed by Colorectum (10.9%), Other cancer and then Breast cancer (8.8%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

36. Annual Average Deaths from Neoplasms Other Ethnicity 2000-2010 Lung cancer is the largest group (16.8%), closely followed by Colorectum (15.7%), then Other cancers, Prostate (7.6%) and Breast (7.5%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

37. Neoplasms Under Age 40

38. Deaths Under Age 40 Neoplasms Very few at the youngest ages but rises steadily. Large increase for females from age 30 onwards. Females account for 54.6% of deaths Source: Analysis of Ministry of Health MORT data 2000 to 2010

39. Neoplasm Deaths 2000-2010 Under Age 40 But strong differences by age group. Source: Analysis of Ministry of Health MORT data 2000 to 2010

40. Neoplasm Deaths 2000-2010 Under Age 15 Brain and CNS account for 34.5% of deaths from neoplasms in this age group; Leukemia for 25.3%. Source: Analysis of Ministry of Health MORT data 2000 to 2010

41. Neoplasm Deaths 2000-2010 Age 15-24 Leukemia accounts for 20.3% of deaths from neoplasms in this age group; Brain and CNS for 15.1%. Source: Analysis of Ministry of Health MORT data 2000 to 2010

42. Place of Death

43. Place of Death 2000-2010 All Causes 34.2% in hospital, 30.7% in residential care and 22.3% in private residence. Note that this seriously undercounts hospice involvement as only hospice inpatient unit available as a place of death. Source: Analysis of Ministry of Health MORT data 2000 to 2010

44. Place of Death 2000-2010 Neoplasms The largest proportion died in a private residence (28.2%), followed by hospital (26.5%), residential care (24.1%) and hospice inpatient unit (18.6%). Source: Analysis of Ministry of Health MORT data 2000 to 2010

45. Place of Death 2000-2010 Neoplasms Later in life, residential care is a significant place of death from neoplasms. Hospital becomes a less likely place of death as age increases. Source: Analysis of Ministry of Health MORT data 2000 to 2010 Smoothing of the under 24 age bands where there is very little data.

46. Place of Death 2000-2010 Neoplasms Marked increase in residential care as the place of death for those with neoplasms – by 2010 equivalent to deaths in hospital. Source: Analysis of Ministry of Health MORT data 2000 to 2010

47. Deaths from Neoplasms 2000-2010 Place of Death Higher proportion of deaths in hospital for some cancer sites. Source: Analysis of Ministry of Health MORT data 2000 to 2010

48. Place of Death 2000-2010 Neoplasms Women are more likely to die in residential care than men of the same age. Men are slightly more likely to die in a private residence. Source: Analysis of Ministry of Health MORT data 2000 to 2010

49. Need for Palliative Care

50. Palliative Care All palliative care classifications include malignant neoplasms. All researchers except Murtagh (2013) include benign neoplasms and those of uncertain or unknown behaviour. There seems no good reason to exclude deaths from benign neoplasms and those of uncertain or unknown behaviour from palliative care. Expect for planning purposes that all deaths from neoplasms needed palliative care. However this data set does not show the age at diagnosis to be able to determine the period over which palliative care might be needed. As people live longer with a cancer diagnosis, so the period over which palliative and supportive care is needed is increasing.

51. Prof Heather McLeod Senior Analyst, Palliative Care Cancer Control New Zealand Office of the Chief Medical Officer Ministry of Health www.cancercontrolnz.govt.nz/palliative-care Email: Heather_McLeod@MOH.govt.nz Mobile: 0210 279 7425

52. Dr Naomi Brewer Senior Analyst, Cancer Cancer Control New Zealand Office of the Chief Medical Officer Ministry of Health www.cancercontrolnz.govt.nz/palliative-care Email: Naomi_Brewer@MOH.govt.nz Tel: 04 815 9240