Vaping was introduced as a means of quitting smoking by slowly reducing nicotine dose to wean smokers of their carcinogenic habit. In this setting the risks of vaping likely outweigh the benefits of eliminating the carci...Vaping was introduced as a means of quitting smoking by slowly reducing nicotine dose to wean smokers of their carcinogenic habit. In this setting the risks of vaping likely outweigh the benefits of eliminating the carcinogenic risk associated with smoking cigarettes. Soon after the introduction of vaping it caught on as a trendy alternative to smoking, particularly among young people. This means that the risk-benefit profile changed considerably because the benefit of smoking cessation was no longer part of the risk-benefit equation. Since vaping has now become a primary means of taking nicotine, a risk assessment of vaping per se is necessary to determine its potential effects on vapers' health. In this viewpoint, we use our knowledge of the chemistry of the production of "vape smoke" to identify its key toxic components. Then, using published animal toxicity data for these chemicals and estimates of vapers' exposure levels, we assess the magnitude of carcinogenic risk. We conclude that vaping is carcinogenic, but that the risk is likely lower than for smoking cigarettes. Therefore, someone taking up vaping not as a tool for smoking cessation is adding carcinogenic risk to their daily risk profile.
New Zealand's rising rates of early-onset colorectal cancer (EOCRC), particularly among Māori, underscore the growing concern about the role of metabolic dysregulation in disease development. There is increasing evidence...New Zealand's rising rates of early-onset colorectal cancer (EOCRC), particularly among Māori, underscore the growing concern about the role of metabolic dysregulation in disease development. There is increasing evidence suggesting that metabolic dysregulation associated with excessive dietary sugar intake may play a central role in colorectal carcinogenesis. Childhood obesity, impaired glucose metabolism and high consumption of sugar-sweetened beverages (SSBs) are prevalent among New Zealand youth, suggesting early metabolic dysfunction may precede and contribute to EOCRC risk. Given this, routinely measured metabolic biomarkers, including glucose and glycated haemoglobin (HbA1c), may offer early risk stratification within primary care settings. This viewpoint also considers whether reductions in SSB consumption could represent a simple and potentially impactful strategy to reduce long-term metabolic disease burden and, consequently, the incidence of EOCRC.
AIM: This article aims to review the role of neoadjuvant systemic therapy (NAST) in the management of clinical stage III or IV resectable melanoma. The review focusses on the evidence behind neoadjuvant systemic therapie...AIM: This article aims to review the role of neoadjuvant systemic therapy (NAST) in the management of clinical stage III or IV resectable melanoma. The review focusses on the evidence behind neoadjuvant systemic therapies and on developing a protocol for widespread implementation within the New Zealand health system. We outline suggested future directions for this evolving treatment. METHODS: A detailed literature review was conducted, examining the rationale, mechanisms of action and recent clinical trial data supporting the use of NAST in melanoma management. RESULTS: NAST provides notable immunological advantages by harnessing tumour antigen presence in situ, enhancing immune response and improving event-free survival (EFS) rates. Recent randomised phase II and III controlled trials have demonstrated significant improvements in EFS rates with NAST compared to standard adjuvant therapy alone. The SWOG-S1801 trial reported a 2-year EFS rate of 72% with neoadjuvant-adjuvant pembrolizumab compared to 49% for adjuvant-only therapy. The NADINA trial found a remarkable increase in 1-year EFS with neoadjuvant ipilimumab and nivolumab (83.7%) compared to adjuvant nivolumab alone (57.2%). CONCLUSION: Current evidence strongly supports incorporating NAST into standard clinical practice for resectable clinical stage III and IV melanoma, promising substantial improvements in patient outcomes with acceptable safety profiles.
Colhoun S, Schaapveld T, Bartholomew K
… +10 more, Parker K, McNeill R, Wikaire E, McCook S, Haggie A, Baty B, Maxwell A, Chambers E, Richards J, Crengle S
AIM: As part of a broader lung cancer screening (LCS) research programme, this study explored Māori views on providing blood samples for LCS to inform future development in Aotearoa New Zealand. METHODS: Two groups (pote...AIM: As part of a broader lung cancer screening (LCS) research programme, this study explored Māori views on providing blood samples for LCS to inform future development in Aotearoa New Zealand. METHODS: Two groups (potential "screenees", and their whānau tautoko [support people]) from Te Tai Tokerau (Northland) and Tāmaki Makaurau (Auckland) completed surveys about LCS design, including comfort with blood donation and key factors in blood collection and use. Descriptive statistics and Fisher's tests were used to analyse responses and demographic differences. RESULTS: Most participants (83.7% screenees; 81.4% whānau) were at least "comfortable" donating blood. Key priorities were clear information about blood use (35.0%; 35.8%), protecting the health of future generations (24.1%; 23.8%) and being able to consent to specific uses (23.6%; 27.6%). Participants from Te Tai Tokerau were less comfortable donating blood than those in Tāmaki Makaurau, with additional demographic differences noted. CONCLUSIONS: Māori participants generally supported using blood samples in LCS but with regional differences. Future LCS initiatives should uphold Māori principles, including community partnership, return of benefit to whānau, management of potential harms and protection of Indigenous data and tissue sovereignty through transparent, culturally safe and trusted engagement processes.
AIM: Timely access for orthopaedic spine consultation remains a challenge due to increasing demand and workforce constraints. Integrating advanced physiotherapy consultation models within orthopaedic services is an emerg...AIM: Timely access for orthopaedic spine consultation remains a challenge due to increasing demand and workforce constraints. Integrating advanced physiotherapy consultation models within orthopaedic services is an emerging strategy to streamline care. While common in New Zealand's tertiary care sector, comparable models in secondary care are lacking. This study evaluated the outcomes of a novel physiotherapist-integrated orthopaedic consultation model in secondary care. METHODS: A retrospective review of patients seen from March to July 2023 was conducted using a five-step physiotherapist-integrated orthopaedic consultation model to assess management decisions, patient satisfaction, impact on consultation wait times and service capacity, and diagnostic concordance. RESULTS: Among 233 patients (mean age 46.8 years; 53.6% male), 73.4% presented with lower back and associated lower limb symptoms. Most (74.7%) were managed non-operatively, 25.3% underwent surgical workup and 10.7% proceeded to surgery. Patient satisfaction was high (overall mean 91.3%), with highest scores for quality of care (92.3%) and explanation of treatment/expected outcomes (91.7%). While mean consultation wait times were longer than the 2021 pre-model cohort (63 vs 47.4 days), service capacity increased by 32%. Across three magnetic resonance imaging variables, diagnostic concordance was substantial (overall agreement: 78.1%; mean kappa: 0.65 [0.63-0.68]). CONCLUSION: A physiotherapist-integrated orthopaedic consultation model in secondary care is highly accepted by patients, increases service capacity and broadens multidisciplinary decision-making capacity. While a model as such is theoretically positioned to reduce consultation wait times, this was not observed in the present analysis-reflecting a growing unmet need for orthopaedic consultation in secondary care.
AIM: Helicobacter pylori (H. pylori) infection is the principle modifiable risk factor for gastric cancer and a key driver of ethnic disparities in gastric disease within Aotearoa New Zealand. Increasing antibiotic resis...AIM: Helicobacter pylori (H. pylori) infection is the principle modifiable risk factor for gastric cancer and a key driver of ethnic disparities in gastric disease within Aotearoa New Zealand. Increasing antibiotic resistance threatens eradication success, yet secondary resistance patterns have not previously been described in New Zealand. This study aimed to describe, for the first time, secondary H. pylori antibiotic resistance rates in New Zealand and identify demographic predictors to inform eradication strategies. METHODS: A retrospective review was conducted of H. pylori isolates referred for antibiotic susceptibility testing in Auckland between January 2018 and December 2023. Testing was performed at Middlemore Hospital Laboratory using gradient diffusion minimum inhibitory concentration (MIC) strips for amoxicillin, clarithromycin, metronidazole and tetracycline. Demographic data were obtained from the Auckland TestSafe database and analysed using univariate and multivariable logistic regression. RESULTS: Of 3,234 patients tested, 644 (20%) were culture positive. Resistance rates were clarithromycin 68%, metronidazole 68.5%, amoxicillin 2.5% and tetracycline 0%. Male sex was associated with lower odds of metronidazole resistance (p<0.001). Māori and Pacific peoples had lower odds of both metronidazole and clarithromycin resistance compared with Europeans (p<0.05), while Asian ethnicity was associated with higher clarithromycin resistance (p=0.02). CONCLUSION: This first-in-New Zealand description of secondary H. pylori resistance shows high rates of clarithromycin and metronidazole resistance. These findings lend support to use of non-clarithromycin-based salvage regimens. Future prospective studies of secondary and also, most importantly, primary resistance data are essential to inform testing and treatment guidelines and improve eradication outcomes.
AIM: Our aim was to analyse how New Zealand's 2025 restriction on initiating puberty blockers for people aged <18 was translated into delegated medicines regulation and whether the public record reflects a differential e...AIM: Our aim was to analyse how New Zealand's 2025 restriction on initiating puberty blockers for people aged <18 was translated into delegated medicines regulation and whether the public record reflects a differential evidentiary and governance standard. METHODS: We assembled a 67-document policy corpus and extracted a 32-field matrix from 12 core documents (statutory instruments, the Ministry of Health - Manatū Hauora evidence brief and key institutional/stakeholder texts). Using a seven-pillar "Regulatory Exceptionalism" framework, we analysed evidentiary framing, process signals and rights/equity treatment. RESULTS: The restriction was made by regulation under section 105 of the Medicines Act 1981 (signed on 17 November 2025; announced on 19 November 2025; gazetted on 20 November 2025; scheduled to commence on 19 December 2025). The record treats evidentiary uncertainty as a categorical trigger for restricting initiation, bypassing routine governance tools used to manage off‑label prescribing (professional standards, service governance, monitoring and auditing). Executive texts provide limited explicit engagement with proportionality, discrimination and equity obligations, and leave review criteria and decision thresholds under-specified. CONCLUSION: The decision is consistent with Regulatory Exceptionalism: higher evidentiary and governance standards are applied to a discrete population/indication than elsewhere in paediatrics. If uncertainty is the operative concern, proportionate alternatives include published multidisciplinary team thresholds, registry-based monitoring and time-limited policy with explicit review triggers rather than categorical prohibition.
AIM: Lung cancer is the leading cause of cancer-related death in Aotearoa New Zealand and a major contributor to health inequities, particularly among Māori and Pacific peoples. Despite declines in smoking prevalence, lu...AIM: Lung cancer is the leading cause of cancer-related death in Aotearoa New Zealand and a major contributor to health inequities, particularly among Māori and Pacific peoples. Despite declines in smoking prevalence, lung cancer incidence remains high. Detailed projections are needed to inform future cancer service planning and support cancer control strategies. METHODS: An age-period-cohort Poisson regression model was fitted to national cancer registry data (2001-2022), stratified by sex, prioritised ethnicity, age group and Health New Zealand - Te Whatu Ora region. Time-based weighting and non-parametric bootstrapping were used to derive projections and uncertainty intervals to 2045. RESULTS: Annual lung cancer cases are projected to increase by 38.3%, from 2,544 in 2020-2022 to 3,519 in 2045 (95% uncertainty interval [UI] 3,275-3,771), despite a decline in the age-standardised rate from 28.2 to 23.6 per 100,000 (95% UI 21.6-25.7). Substantial ethnic inequities persist. Māori cases are projected to rise from 570 to 1,063 (an 86.5% increase), and Pacific cases from 129 to 245 (an 89.9% increase). Although rates are projected to fall across all groups, Māori are expected to continue to experience the highest rates. Regional variation is also evident, with the Northern Region projected to experience the largest increase in case numbers, from 872 to 1,280 by 2045. CONCLUSION: Although age-standardised incidence rates are expected to decline, rising case numbers indicate growing demand for diagnostic and treatment services. These projections support the need for equitable implementation of lung cancer screening and sustained investment in culturally responsive prevention and cessation support.
AIM: This paper describes the development of an Indigenous-informed paediatric palliative care framework for Aotearoa New Zealand. Te Whare Kaiao (the living whare) builds upon the foundational framework of Te Whare Tapa...AIM: This paper describes the development of an Indigenous-informed paediatric palliative care framework for Aotearoa New Zealand. Te Whare Kaiao (the living whare) builds upon the foundational framework of Te Whare Tapa Whā, recognising the core components integral to the delivery of quality paediatric palliative care. METHODS: Te Whare Kaiao was developed in partnership with health professionals, whānau/lived experience experts and the Te Ārai Kahui kaumātua, using Kaupapa Māori community participatory research principles. RESULTS: We identified the importance of highlighting that paediatric palliative care is about supporting children to live and reach their full potential. This is reflected in the symbolism used to depict Te Whare Kaiao. CONCLUSION: Te Whare Kaiao will be utilised in multiple different ways to inform clinical care delivery, empower communities and support research in children's palliative care within Aotearoa.
AIM: Tamariki (children) in Aotearoa New Zealand suffer high rates of respiratory morbidity. There are also geographic, socio-economic and ethnicity inequities, with tamariki Māori and Pacific children, experiencing the...AIM: Tamariki (children) in Aotearoa New Zealand suffer high rates of respiratory morbidity. There are also geographic, socio-economic and ethnicity inequities, with tamariki Māori and Pacific children, experiencing the highest rates. Our aim was to survey New Zealand respiratory health services and identify gaps in delivery. METHODS: We invited health practitioners from all districts to respond to an online survey and separately contacted individuals known to deliver paediatric respiratory care. We included medical, nursing and allied health staff and collated responses. FINDINGS: There were 23 responses from 17 hospitals. Respiratory- and sleep-specialist senior medical officers (SMOs) were employed in only three major centres. Full time equivalent (FTE) for paediatricians with an interest (PWI) in respiratory care was evenly distributed with low numbers reported in the Northern region, Wellington and Canterbury. Senior nurse FTE was fairly constant across the country, except in the Northern region. Allied health staffing was inconsistent across the country with many districts in the Te Manawa Taki region reporting little or no respiratory physiotherapy staffing. More than half of districts reported limited or no access to videofluoroscopic swallow studies. There is poor access to chest computed tomography (CT) scanning under general anaesthetic in more than half of centres. CONCLUSION: Despite high levels of respiratory disease and morbidity, with serious disparities, there is inadequate staffing and provision of services. There is an urgent need for better co-ordination of care but a lack of both national and regional frameworks despite respiratory health being a current health target.
From 1938, Aotearoa New Zealand health policy committed to providing free universal access to secondary healthcare. This approach initially worked for all citizens except Māori and Pacific peoples, who had different unme...From 1938, Aotearoa New Zealand health policy committed to providing free universal access to secondary healthcare. This approach initially worked for all citizens except Māori and Pacific peoples, who had different unmet needs. From the 1980s, as a neoliberal agenda spread, it became clear that action was needed to protect the population from the scourge of health as a commodity. Those who could afford to buy healthcare already had better social determinants of health; however, ultimately inadequate legal processes failed to protect many people from the damage to our healthcare systems. The focus should have been on the ultimate goal of universal equity of health outcomes. To rebalance, we define health as a collective and individual legal right. The required laws to thus refresh the social contract should: i) bind rights and responsibilities of government and governed and protect all citizens; and ii) be enshrined against future whims of politicians. We suggest ways forward, including: i) open physician advocacy, starting with the medical colleges; ii) honouring the right of New Zealanders, individually and collectively, to health; iii) adhering to relevant international agreements and national laws; and iv) advancing a codified constitutional legal structure for Aotearoa New Zealand.
AIM: Our aim was to determine the incidence of delirium in a tertiary intensive care unit (ICU) in Auckland, New Zealand compared to other Australasian ICUs. To determine the incidence of delirium among different ethnici...AIM: Our aim was to determine the incidence of delirium in a tertiary intensive care unit (ICU) in Auckland, New Zealand compared to other Australasian ICUs. To determine the incidence of delirium among different ethnicities and identify risk factors and outcomes of patients experiencing delirium. METHODS: The design was a retrospective observational study. The setting was a single-centre, 24 bed, tertiary ICU in Auckland, New Zealand. The participants were two hundred and twenty-two patients admitted to the ICU over 10 months in 2019. The main outcome measures were incidence of delirium, identified using the Confusion Assessment Method - ICU (CAM-ICU) screening, antipsychotic prescription, 12-month mortality, and ICU discharge disposition. RESULTS: Fifty of the 222 (23%) patients had delirium. There was no association between the incidence of delirium and ethnicity (p=0.39). The risk of delirium increased with ICU duration of stay (odds ratio [OR]: 1.003, 95% CI, 1.001-1.005, p=0.004), days on vasopressors (p<0.001) and days on mechanical ventilation (p<0.001). Thirty-three of the 50 (66%) patients received at least one antipsychotic medication. Twelve-month mortality was not associated with delirium (OR: 0.97, 95% CI 0.73-1.22, p=0.81). Delirium was not associated with ICU discharge disposition (p=0.20). CONCLUSIONS: The incidence of delirium in this single-centre, tertiary Auckland ICU was comparable to other Australasian ICUs. There was no difference in the incidence of delirium between different ethnicities. Positive associations to delirium included length of stay in ICU, number of days on vasopressors and duration of mechanical ventilation. Delirium was not associated with an increased risk of 12-month mortality and was not associated with ICU discharge disposition.
AIM: Aotearoa New Zealand has experienced declining eye donation rates despite high levels of corneal disease and strong capacity to perform corneal transplantation. Demand for donor corneal tissue far exceeds supply. Th...AIM: Aotearoa New Zealand has experienced declining eye donation rates despite high levels of corneal disease and strong capacity to perform corneal transplantation. Demand for donor corneal tissue far exceeds supply. This study explored public attitudes toward eye donation, which have not previously been evaluated in New Zealand. METHOD: Ten semi-structured focus groups were conducted, recorded and transcribed. Participant opinions were analysed using saturation and sentiment approaches. Transcripts were manually coded in NVivo15, with iterative thematic analysis until saturation was achieved. RESULTS: A total of 44 participants were interviewed. Overall sentiment toward eye donation was positive, with 40 (90%) supporting donation for themselves or family. Barriers to donation included poor awareness (42, 96%), cultural considerations (41, 93%), feelings of disgust (23, 52%) and religious beliefs (13, 30%). Among Māori and Pacific participants (16, 44%), the absence of established tikanga (customary values/practices) around eye donation emerged as a key theme. Baseline knowledge was low: only 13 (30%) had prior awareness, and just two (5%) understood New Zealand's donation infrastructure. CONCLUSION: Most focus group participants supported eye donation; however, poor awareness, cultural uncertainty and limited infrastructure remain barriers. New Zealand has the population and capacity to achieve self-sufficiency, but system-level changes are needed to improve eye donation rates.
AIM: Gastric cancer incidence and mortality are higher among Māori compared with non-Māori. Here we address a gap in the literature by examining changes in gastric cancer survival over time, and how this varies by socio-...AIM: Gastric cancer incidence and mortality are higher among Māori compared with non-Māori. Here we address a gap in the literature by examining changes in gastric cancer survival over time, and how this varies by socio-demographic factors among Māori and non-Māori over two decades. METHODS: Records in the New Zealand Cancer Registry (NZCR) for Māori (N=1,452) and non-Māori (N=6,402) diagnosed with gastric cancer between 2002 and 2021 were linked to death and socio-demographic data within Stats NZ Tatauranga Aotearoa's Integrated Data Infrastructure. Gastric cancer survival was examined among Māori and non-Māori by age, sex, socio-economic deprivation and rurality over the 2002-2017 (gastric cancer-caused mortality) or 2002-2021 (all-cause mortality) period, and by 5-year periods. Clinical characteristics and data missingness by diagnosis year were also documented. RESULTS: There was ethnic inequity in gastric cancer mortality in all time periods but this disparity appeared smaller in more recent periods, particularly for 1-year age-standardised mortality. Differences in mortality rates by socio-demographic and clinical characteristics were minimal. Higher risk of mortality from gastric cancer for Māori compared with non-Māori was most pronounced for those aged 45-64 years. There were no clear trends in survival across different diagnosis periods for other socio-economic characteristics. CONCLUSION: Mortality risk was higher for Māori compared with non-Māori with gastric cancer diagnoses between 2002 and 2021. However, age-standardised rate ratios between Māori and non-Māori were lowest in more recent years.