ACC has confirmed it will fund Keytruda for Leonie Metcalfe in the future if her oncologist recommends it. Photo: RNZ / Angus Dreaver
A 70-year-old woman in remission from incurable cancer has won a promise from ACC that she won't have to battle for treatment when the disease inevitably comes back.
Leonie Metcalfe has pre-approval for immunotherapy drug Keytruda should chemotherapy prove too harsh or ineffective.
It's a decision her lawyer hopes will apply to other people in similar circumstances, although ACC says it will continue to assess cases on their merits.
Such is the aggressive nature of mesothelioma, the last thing Metcalfe wants is to battle ACC about her treatment options when she's sick again.
Instead, she wants a funded treatment plan in place - something she has now won.
Leonie Metcalfe is relieved she won't have to battle for treatment when she's not feeling well. Photo: SUPPLIED
"In my past dealings with ACC, it's been quite difficult to navigate," she said.
"I know my application for funding had been declined and I did not want to be going through that again - to be declined, trying to debate, argue about that again when I was not feeling well, while I was having further chemo treatment."
Metcalfe has already successfully fought ACC for occupational exposure cover for the disease, which is nearly always caused by inhaling asbestos fibres.
A nurse for more than 50 years until her retirement last year, Metcalfe can't be sure exactly when she was exposed to asbestos, but thinks it could be from hospital renovations or pipe cladding.
She received her devastating diagnosis in July 2020, and went through chemotherapy.
"I am in remission, as they call it, at the moment. I haven't had any treatment at all, or needed any treatment, since I finished my chemo in December 2020, nearly two years ago.
"That's a good result for me and I'll take that at the moment."
Chemotherapy is funded to treat mesothelioma.
However, Metcalfe didn't react well to later rounds of this so her oncologist recommended Keytruda, which is not covered, as a second-line treatment if necessary.
ACC wouldn't agree to fund this, saying the drug wasn't needed now and it would determine Metcalfe's claim if the need arose.
This was overturned on review, to Metcalfe's relief.
In his decision, independent reviewer Peter Barker ruled that Metcalfe not needing the drug now didn't prevent ACC from considering to fund it when it was required.
"It would be a similar situation where a surgeon proposes two surgeries, one after the other, that are aimed at restoring a claimant's health.
"There would be no bar to ACC approving both surgeries, even though one is proposed for a future time."
Barker ruled Metcalfe should be "afforded whatever treatment will give her the best chance of further survival".
ACC's chief clinical officer and head of health partnerships Dr John Robson confirmed Keytruda would be funded for Metcalfe if her oncologist recommended it.
RNZ asked ACC if the decision would have ramifications for other claimants.
"ACC considers all requests for treatment on a case-by-case basis," he said in a statement.
"We use the most up-to-date clinical information to assess these requests and engage with oncology specialists to understand the latest information and developments in cancer care and treatment."
Metcalfe's lawyer Bea Woodhouse, of Wellington firm Barristers.Comm, would like to see ACC do more than that.
"The decision is really great for Leonie, but it would be good if ACC, going forward, would fund Keytruda as a matter of practice, because it's rather unfortunate that claimants have to go through litigation in order to access funding for Keytruda."
Woodhouse said the average life expectancy from diagnosis was only about a year.
Metcalfe is outliving that and is taking some comfort from the fact that she won't face another battle with ACC.