Aotearoa New Zealand public strongly support investment in cancer treatment and care services: findings from a national survey

Cancer remains one of the leading causes of illness and death in Aotearoa New Zealand, with substantial impacts on individuals, whānau, communities and the health system.^1,2 Over recent years, public discussion has increasingly focussed not only on cancer prevention and treatment, but also on how cancer services are funded, accessed and delivered.^3–7 Decisions about cancer diagnostic testing, treatment availability, health service infrastructure, workforce capacity and end-of-life care are highly visible to the public and often shape people’s experiences of care, trust in the health system and perceptions of fairness.⁸

There are well-reported and key pressures on Aotearoa New Zealand’s cancer care system: rising numbers of cancer diagnoses are putting pressure on healthcare services;^2,9,10 it is more difficult and takes longer to obtain diagnostic tests or specialist opinion about suspected cancer than other countries;¹¹ many diagnoses are made late (after emergency admissions rather than early through screening or primary care);^12,13 compared with other countries we have access to fewer cancer medicines, lower levels of cancer-treatment (radiotherapy) equipment and much higher caseloads per clinical oncologist;^11,14 workforce capacity overall remains an ongoing challenge contributing to longer wait times and reduced access to care;^2,9,15 and there are marked inequities in cancer survival, especially for Māori.² Furthermore, primarily due to an ageing and growing population, Aotearoa New Zealand is facing a projected 50–76% rise in cancer diagnoses over the next two decades.^2,10 This, coupled with increasing treatment complexity and the price of cancer medicines and technologies, means that the economic and social costs of cancer care will continue to rise in the future.^9,16 A 45% increase in per capita health spending on cancer is predicted between 2023 and 2050 in Aotearoa New Zealand.¹⁷ However, one in six cancer deaths in Aotearoa New Zealand could be prevented if we were to improve cancer screening, diagnosis and treatment to achieve the best survival rates observed in the Organisation for Economic Co-operation and Development (OECD).¹⁷

While not cancer specific, Aotearoa New Zealand’s per capita total health expenditure has been consistently between 76% and 86% of the average of 16 OECD comparator countries for decades,¹⁸ and our pharmaceutical spend is only 4.9% compared with the OECD average of 13.3%.¹⁹ This ongoing and marked health system underinvestment comes at a cost. In terms of cancer, underinvestment translates into poorer cancer outcomes than might be expected compared with other OECD countries.¹¹ Studies have shown that compared with Australia, Aotearoa New Zealand has had consistently higher rates of cancer deaths over decades.^20,21 Most recently, this was estimated as 1,061 excess deaths in Aotearoa New Zealand annually—that is 1,061 Aotearoa New Zealanders (780 women and 281 men) a year who would not have died from their cancer had Australia’s death rates also applied to Aotearoa New Zealand.²¹ This discrepancy is despite lower cancer incidence rates in Aotearoa New Zealand, and the authors largely attribute the discrepancy to later diagnosis and treatment differences.^11,21 Investment in cancer care is essential if Aotearoa New Zealand is to change this trajectory.

This paper presents findings from a public opinion survey exploring views on several key areas of cancer treatment and care services funding, access and delivery in Aotearoa New Zealand. These areas reflect ongoing national debates and policy priorities across the cancer continuum, from detection through to palliative care. Understanding public perspectives in these domains provides important context for decision makers, advocates and service planners, particularly as the health system continues to adapt to rising cancer incidence, workforce pressures and fiscal constraints.^2,10,15

Methods

This study presents results from a national cross-sectional online survey examining public support for evidence-informed cancer-related policies in Aotearoa New Zealand. Detailed methods are reported elsewhere in a study methodology paper,²² and only essential details are presented here. In brief, adults aged 18 years and older were recruited through a commercial online research panel using quota-based sampling to achieve national representation by age, gender and ethnicity with additional oversampling of Māori and Pacific people.

Data collection took place between November and December 2025 using a structured questionnaire that consisted primarily of closed-ended questions addressing cancer prevention, early detection, treatment, supportive care and associated policy areas.²² Within a dedicated questionnaire subsection, 10 questions related specifically to government-provided cancer treatment services (Appendix A). Eight questions focussed on cancer detection and treatment funding, while two focussed on the health workforce and taxation respectively.

Questions assessed support for increased public investment in: i) cancer testing/diagnostic services and genomic testing; ii) treatment travel assistance (National Travel Assistance scheme); iii) funding of cancer medicines (including medicines for blood cancers); iv) radiation treatment services and the radiation workforce; and v) hospice funding. These policy support items were measured on a six-point scale from strongly support to strongly oppose, with a do not want to answer option.

Perceptions of government support for the long-term health workforce overall (vi), were measured using a five-category agreement scale from yes, definitely to no, definitely not, including do not know. Additionally, there was a do not want to answer response category.

Willingness to pay additional tax to increase healthcare funding (vii) was assessed with categorical response options (yes; yes, if earmarked for healthcare; no; do not know).

Total (design and poststratification) weighting was applied to align the sample with 2023 New Zealand Census benchmarks for age groups, gender and Māori ethnicity. Analyses produced survey-adjusted estimates and were undertaken both for the total population and separately for age group, gender, prioritised ethnicity and voting intention sub-groups (Appendix B). The worst-case margin of error for a population percentage estimate is approximately ±2.9% (based on an effective sample size of 1,161 after adjusting for weighting).

Ethical approval

Ethical approval processes and Māori consultation procedures are detailed in the methodology publication.²² Ethical approval was granted by the University of Otago Human Ethics Committee (25/1184).

Results

All eight cancer treatment funding proposals received majority public support in Aotearoa New Zealand, with estimated total support exceeding 90% for every proposal (Table 1). Overall support ranged from 91.4% for increased funding to support treatment-related travel to 94.4% for improved funding for cancer testing (diagnostic) services. For five of the eight proposals, more than half of the population strongly supported the proposed funding increases.

By age group, Aotearoa New Zealanders aged 50 years and over consistently expressed the highest levels of support across all eight funding proposals, with support levels predominantly exceeding 95% among both the 50–64 and 65+ age groups. By ethnicity, support for the funding proposals remained high overall (generally >90%); however, those classified within the “Other” ethnicity grouping reflected comparatively lower levels of support for four of the proposals (76.5% to 84.3%).

When examined by voting intention (Table 2), estimates for those in Aotearoa New Zealand intending to vote for ACT, the Green Party, Labour, National or NZ First demonstrated very high levels of support (>90%) for the majority of the eight funding proposals. Although support among Te Pāti Māori and Do not know voters was slightly lower, levels remained high overall, with support typically ranging between 85% and 90%.

View Table 1–2.

Fewer than one-third of the population (29.4%) considered that the government was doing enough to support the long-term future of the health workforce in Aotearoa New Zealand, including 6.9% who responded yes, definitely—the government is taking strong and effective action and 22.5% who responded yes, somewhat—there are positive steps, but more could be done. A further 16.1% indicated that they did not know.

Support for the view that the government was doing enough generally declined with age. Those in Aotearoa New Zealand aged under 40 years were more likely to agree than older age groups, with the proportion who definitely agreed decreasing steadily from 16.6% among those aged 18–20 years to 3.3% among those aged 65 years and over. By ethnicity, Aotearoa New Zealanders identifying as Asian expressed the highest level of agreement (47.1%), which was at least 15 percentage points higher than that observed in any other ethnic group. Agreement was also higher among males than females (36.3% versus 23.0%).

When public perception of whether the government was doing enough to support the future health workforce was examined by voting intention, the percentage who responded yes, definitely was very low across the board. It ranged from 4.6% (Te Pāti Māori) to 11.1% (ACT), with most of the difference by voting intention arising in the yes, somewhat responses (11.8–42.6%). Individuals intending to vote for parties in the current governing coalition reported higher levels of agreement. However, this pattern was not uniform: agreement was reported by a minority of NZ First and ACT voters (34.4% and 43.6%, respectively), compared with a majority of National voters (53.2%).

A clear majority of the public indicated a willingness to pay more tax to fund healthcare, with 62.3% expressing support overall, including 49.9% who preferred that additional tax revenue be directed exclusively to healthcare funding.

Willingness to pay more tax varied by ethnicity, with those in the Middle Eastern, Latin American, and African (MELAA) group reporting the lowest level of willingness (37.0%) and Māori the highest (66.9%) relative to other groups. By voting intention, people in Aotearoa New Zealand intending to vote for the Green Party or Te Pāti Māori demonstrated the highest willingness to pay more tax to increase healthcare funding (both exceeding 70%), compared with those intending to vote for other parties. Willingness was lower among ACT voters (48.9%) and those who did not know their voting intention (45.8%). Notably, ACT voters showed the narrowest margin between agreement and opposition of any group, with 48.9% willing to pay more tax and 46.9% opposed.

Discussion

This survey found overwhelming cross-party public support (>90% overall, >85% cross-party) for the government prioritising and investing in cancer care services, including diagnosis, treatment, supportive care and end-of-life care (diagnostic and genomic testing services, cancer medicines, radiation, hospice care and travel support to access treatment). Among those aged over 50 years, support was even stronger, with generally more than 95% in favour. Importantly, a majority of Aotearoa New Zealand (62.3%) was also supportive of paying more in taxes to fund increased healthcare investment, although this differed by voting intention. However, of note, nearly 50% of ACT voters would be willing to pay more tax for greater investment into Aotearoa New Zealand’s healthcare, despite intending to vote for a party that values keeping taxes low.²³

“Cancer continues to be one of the most pressing public health challenges, with far-reaching consequences for health systems, economies, and societies”,¹⁶ including for Aotearoa New Zealand.¹⁷ Currently, just over 29,000 people are diagnosed with cancer each year in Aotearoa New Zealand; however, this is projected to rise substantially to around 45,000 by 2040 as the population grows and ages.^2,10 Aside from the incalculable costs these new cancer diagnoses will place on individuals and their whānau, additional pressures will be placed on government-funded cancer care services, which are already under pressure to meet current demand^11,24 and lag behind comparable countries in many aspects.^11,12,15,24 While population ageing will increase cancer incidence and associated service demand, it will also constrain Aotearoa New Zealand’s taxation-based health system funding, as a proportionally smaller working-age population supports rising health expenditure.²⁵ Other impacts, such as improvements in cancer survival, will also likely increase service demand. Investment in prevention, screening and early diagnosis—along with changes to models of care—will be increasingly important to reduce treatment costs and service burden. Alongside increased taxation, which is supported by the majority of Aotearoa New Zealanders, fiscal changes across policy portfolios outside of health may also be required. Otherwise, public expectations of universal access to high-quality cancer care will not be achieved. The burden of cancer across all facets of Aotearoa New Zealand’s society now, and in the future, cannot be overstated.

The survey also identified public concern about the level of government support for the health workforce. Fewer than one-third of the population (29.4%), believed the government was doing enough. Concerns about the sustainability of the cancer workforce, particularly in radiation oncology, have also been well documented in the media.^6,26 An insufficient workforce can negatively affect patient waiting times, access to diagnosis and treatment and the overall quality of care.^2,27,28 For every new investment in cancer care, investment in the workforce required to deliver that care is essential. While the recent announcement of expanded cancer infusion services²⁹ will undoubtedly be seen as positive, especially by those who must travel long distances to access treatment, access to treatment is not only about having more medicines delivered in facilities closer to home.² Rather, it needs a whole-of-system approach to cancer care, including an adequate workforce.¹³

The general strengths and limitations of the project as a whole are discussed in the accompanying methodology article.²² These include reasonable overall precision of estimates, as well as the potential for selection and participation biases associated with the use of a commercial marketing panel. In addition, there are strengths and limitations specific to the cancer treatment component of this study. The survey did not distinguish between funding for medicines and funding for treatment delivery capacity (such as workforce, facilities or infusion infrastructure), and respondents may therefore have interpreted the concept of “treatment funding” differently.

Furthermore, although support for treatment funding was overwhelming, the findings do not capture public understanding of implementation constraints or trade-offs, including available resources, workforce shortages, regional variation in service availability or the time required to scale treatment capacity. We acknowledge that the survey questions do not address these realities, and that presenting each proposal independently allowed respondents to support multiple funding proposals simultaneously, which may therefore have produced higher levels of support than would be observed if respondents were required to make trade-offs between competing priorities. However, the main objective of the present study was to determine support for individual policies, rather than potential trade-offs. These could be investigated in future research.

The issue of investment or underinvestment across Aotearoa New Zealand’s cancer care services is critical. It represents human illness and death. It is the 81 people diagnosed with cancer, and the 29 who die from it, each day in Aotearoa New Zealand.³⁰ It is also the 1,000+ Aotearoa New Zealanders a year who would not die from their cancer had they lived in Australia.²¹ That the authors attribute this to differences in our health system’s governance, funding, workforce and performance should back up the concerns of the public and strengthen the argument for better access to the high-quality and equitable cancer care that Aotearoa New Zealanders deserve.

Conclusion

This survey clearly demonstrates that the public is highly concerned about the level of funding for cancer diagnosis, access and treatment in Aotearoa New Zealand. There is strong cross-party support for increasing investment in cancer services and for strengthening and protecting the health workforce. Additionally, and importantly, there was majority support (62.3%) for paying additional tax to help fund the delivery of healthcare. These results should serve as a call to action for politicians and policymakers to prioritise investment in cancer treatment and care services in Aotearoa New Zealand.

View Appendix.