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Henningham M, Gilroy J, McGlone J, Meehan D, Nila F, McAtamney A, Buchanan T. Utilising the CREATE quality appraisal tool to analyse Aboriginal and Torres Strait Islander peoples' involvement and reporting of cancer research in Australia. Aust N Z J Public Health 2024; 48:100142. [PMID: 38574430 DOI: 10.1016/j.anzjph.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE We aimed to evaluate Aboriginal and Torres Strait Islander involvement in research focusing on cancer experiences using an Aboriginal and Torres Strait Islander quality appraisal tool (the QAT). METHODS We conducted a systematic review of the peer-reviewed literature on Aboriginal and Torres Strait Islander peoples' experiences associated with cancer, recently published elsewhere. We then appraised articles for the inclusion of Aboriginal and Torres Strait Islander-led research, community consultation, and involvement. RESULTS 91 articles were appraised. A lack of Aboriginal and Torres Strait Islander-led research and consultation was reported in the majority of articles, only 10 (11%) demonstrated success across seven (50%) or more questions of the QAT. CONCLUSIONS This review underscores the need for anti-racist research and publication practices that actively engage Aboriginal and Torres Strait Islander peoples and researchers. This approach is vital to enhance cancer outcomes within these communities. IMPLICATIONS FOR PUBLIC HEALTH To advance and prioritise appropriate involvement of Aboriginal and Torres Strait Islander peoples in cancer research, the onus must be on 'systems owners,' including academic journals and institutions, to require and report genuine engagement as standard practice. Researchers will produce higher-calibre research with a strengths-based focus, advancing the cause of equitable research.
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Affiliation(s)
- Mandy Henningham
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - John Gilroy
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Farhana Nila
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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Christie V, Green D, Skinner J, Riley L, O'Shea R, Littlejohn K, Pyke C, McCowen D, Rambaldini B, Gwynne K. "Everyone needs a Deb": what Australian indigenous women say about breast cancer screening and treatment services. BMC Health Serv Res 2023; 23:672. [PMID: 37344905 DOI: 10.1186/s12913-023-09633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Breast cancer continues to be the second most diagnosed cancer overall and the most diagnosed cancer for women in Australia. While mortality rates overall have declined in recent years, Indigenous women continue to be diagnosed at more marginal rates (0.9 times) and are more likely to die (1.2 times). The literature provides a myriad of reasons for this; however, the voices of Indigenous women are largely absent. This study sets out to understand what is happening from the perspectives of Australian Indigenous women with a view to charting culturally safer pathways that improve participation in screening and treatment by Indigenous women. METHODS This co-design study was conducted using semi-structured, in-depth interviews and focus group discussions. Recruitment of study participants was via snowball sampling. Participants were subsequently consented into the study through the Aboriginal Health Service and the research team. Interviews were audio recorded and transcribed verbatim, and data coded in NVivo12 using inductive thematic analysis. RESULTS A total of 21 Indigenous women and 14 health service providers were interviewed predominantly from the same regional/rural area in NSW, with a small proportion from other states in Australia. Six major themes were identified: Access, Awareness, Community and Family, Lack of control, Negative feelings and associations and Role of services. CONCLUSION To improve access and participation of Indigenous women and ultimately improve mortality rates, breast cancer services must explicitly address cultural and community needs.
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Affiliation(s)
- Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia.
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Lynette Riley
- Indigenous Studies & Aboriginal Education, The University of Sydney, Camperdown, NSW, Australia
| | - Ross O'Shea
- Foundation for Breast Cancer Care, Brisbane, Australia
| | | | | | - Debbie McCowen
- Armajun Aboriginal Health Service, Armidale and Inverell, NSW, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Macquarie Park, Australia
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Dasgupta P, Harris VM, Garvey G, Aitken JF, Baade PD. Factors associated with cancer survival disparities among Aboriginal and Torres Strait Islander peoples compared with other Australians: A systematic review. Front Oncol 2022; 12:968400. [PMID: 36185181 PMCID: PMC9521397 DOI: 10.3389/fonc.2022.968400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background While cancer survival among Aboriginal and Torres Strait Islander peoples has improved over time, they continue to experience poorer cancer survival than other Australians. Key drivers of these disparities are not well understood. This systematic review aimed to summarise existing evidence on Aboriginal and Torres Strait Islander cancer survival disparities and identify influential factors and potential solutions. Methods In accordance with PRISMA guidelines, multiple databases were systematically searched for English language peer-reviewed articles on cancer survival by Aboriginal and Torres Strait Islander status published from 1/1/2008 to 4/05/2022. Observational studies presenting adjusted survival measures in relation to potential causal factors for disparities were included. Articles were screened independently by two authors. Included studies were critically assessed using Joanna Briggs Institute tools. Results Thirty population-based and predominantly state-level studies were included. A consistent pattern of poorer unadjusted cancer survival for Aboriginal and Torres Strait Islander peoples was evident. Studies varied widely in the covariates adjusted for including a combination of socio-demographics, cancer stage, comorbidities, and treatment. Potential contributions of these factors varied by cancer type. For lung and female breast cancer, adjusting for treatment and comorbidities reduced the survival disparity, which, while still elevated was no longer statistically significant. This pattern was also evident for cervical cancer after adjustment for stage and treatment. However, most studies for all cancers combined, or colorectal cancer, reported that unexplained survival disparities remained after adjusting for various combinations of covariates. Conclusions While some of the poorer survival faced by Aboriginal and Torres Strait Islander cancer patients can be explained, substantial disparities likely to be related to Aboriginal determinants, remain. It is imperative that future research consider innovative study designs and strength-based approaches to better understand cancer survival for Aboriginal and Torres Strait Islander peoples and to inform evidence-based action.
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Affiliation(s)
- Paramita Dasgupta
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Veronica Martinez Harris
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joanne F. Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Peter D. Baade
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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Christie V, Rice M, Dracakis J, Green D, Amin J, Littlejohn K, Pyke C, McCowen D, Gwynne K. Improving breast cancer outcomes for Aboriginal women: a mixed-methods study protocol. BMJ Open 2022; 12:e048003. [PMID: 35074807 PMCID: PMC8788241 DOI: 10.1136/bmjopen-2020-048003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer affecting Australian women, and the second highest cause of cancer death in Australian women. While the incidence of breast cancer is lower in Aboriginal women than non-Aboriginal women, the mortality rate for Aboriginal women is higher, with Aboriginal women 1.2 times more likely to die from the disease. In New South Wales, Aboriginal women are 69% more likely to die from their breast cancer than non-Aboriginal women.Co-design is a research method recognised to enhance collaboration between those doing the research and those impacted by the research; which when used with Aboriginal communities, ensures research and services are relevant, culturally competent and empowers communities as co-researchers. We report the development of a new protocol using co-design methods to improve breast cancer outcomes for Aboriginal women. METHODS AND ANALYSIS Through a Community Mapping Project in 2018, we co-designed an iterative quantitative and qualitative study consisting of five phases. In Phase 1, we will establish a governance framework. In Phase 2, we will provide information to community members regarding the modified parts of the screening, diagnosis, treatment and follow-up processes and invite them to partake. In Phase 3, the research team will collect data on the outcomes of the modified processes and the outcomes for the women who have and have not participated. The data shall be analysed quantitatively and thematically in Phase 4 with Aboriginal community representatives and reported back to community. Lastly, in Phase 5, we evaluate the co-design process and adapt our protocol for use in partnership with other communities. ETHICS AND DISSEMINATION This study has ethics approval of the Aboriginal Health and Medical Research Council ref:1525/19. The findings will be published in the literature, presented at conferences and short summaries will be issued via social media.
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Affiliation(s)
- Vita Christie
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - MacKenzie Rice
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jocelyn Dracakis
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Deb Green
- Armajun Aboriginal Health Service, Armidale, New South Wales, Australia
| | - Janaki Amin
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Littlejohn
- Foundation for Breast Cancer Care, Sydney, New South Wales, Australia
| | - Christopher Pyke
- Foundation for Breast Cancer Care, Sydney, New South Wales, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Lindsay D, Bates N, Diaz A, Watt K, Callander E. Quantifying the hospital and emergency department costs for women diagnosed with breast cancer in Queensland. Support Care Cancer 2021; 30:2141-2150. [PMID: 34676449 DOI: 10.1007/s00520-021-06570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE With increasing rates of cancer survival due to advances in screening and treatment options, the costs of breast cancer diagnoses are attracting interest. However, limited research has explored the costs to the Australian healthcare system associated with breast cancer. We aimed to describe the cost to hospital funders for hospital episodes and emergency department (ED) presentations for Queensland women with breast cancer, and whether costs varied by demographic characteristics. METHODS We used a linked administrative dataset, CancerCostMod, limited to all breast cancer diagnoses aged 18 years or over in Queensland between July 2011 and June 2015 (n = 13,285). Each record was linked to Queensland Health Admitted Patient Data Collection and Emergency Department Information Systems records between July 2011 and June 2018. The cost of hospital episodes and ED presentations were determined, with mean costs per patient modelled using generalised linear models with a gamma distribution and log link function. RESULTS The total cost to the Queensland healthcare system from hospital episodes for female breast cancer was AUD$309 million and AUD$12.6 million for ED presentations during the first 3 years following diagnosis. High levels of costs and service use were identified in the first 6 months following diagnosis. Some significant differences in cost of hospital and ED episodes were identified based on demographic characteristics, with Indigenous women and those from lower socioeconomic backgrounds having higher costs. CONCLUSION Hospitalisation costs for breast cancer in Queensland exert a high burden on the healthcare system. Costs are higher for women during the first 6 months from diagnosis and for Indigenous women, as well as those with underlying comorbidities and lower socioeconomic position.
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Affiliation(s)
- Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Abbey Diaz
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Surgical Services for Breast Cancer Patients in Australia, is There a Gap for Aboriginal and/or Torres Strait Islander Women? World J Surg 2021; 46:612-621. [PMID: 34557943 DOI: 10.1007/s00268-021-06310-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in Aboriginal and/or Torres Strait Islander women. When compared to other Australians, Aboriginal and/or Torres Strait Islander women have a higher breast cancer mortality rate. This systematic literature review examined disparities in breast cancer surgical access and outcomes for Aboriginal and/or Torres Strait Islander women. METHODS This systematic literature review, following the PRISMA guidelines, compared measures of breast cancer surgical care for Aboriginal and/or Torres Strait Islander people and other Australians. RESULTS The 13 included studies were largely state-based retrospective reviews of data collected prior to the year 2012. Eight studies reported more advanced breast cancer presentation among Aboriginal and/or Torres Strait Islander women. Despite the increased distance to a multidisciplinary, specialist team, there were no disparities in seeing a surgeon, or in the time from diagnosis to surgical treatment. Two studies reported disparities in the receipt of surgery and two reported no variations. Three studies reported disparities in the receipt of mastectomy versus breast conserving surgery, whilst four studies reported no variations. No studies examined postoperative surgical outcomes. CONCLUSIONS Aboriginal and/or Torres Strait Islander women present with more advanced breast cancer. There may be disparities in the receipt of surgery and the type of surgery. However, the metrics tested were not related to optimal care guidelines, and the databases utilised contain limited data on individual factors contributing to surgical care decisions. It is therefore difficult to determine whether the reported differences in the receipt of surgical care reflect disparate or appropriate care.
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7
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Christie V, Green D, Amin J, Pyke C, Littlejohn K, Skinner J, McCowen D, Gwynne K. What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6073. [PMID: 34199955 PMCID: PMC8200222 DOI: 10.3390/ijerph18116073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
The aim was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries. We conducted a systematic review in accordance with PRISMA guidelines of peer-reviewed articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Proquest Sociology and Informit Rural health database and Indigenous collection databases. Key inclusion criteria were: adult female patients with breast cancer; high income country setting; outcome measure, including screening, diagnosis, treatment and follow up care. A total of 15 were selected. We developed a Community Engagement assessment tool in consultation with aboriginal researchers, based on the National Health and Medical Research Councils' community engagement guidelines, against which studies were appraised. This novel element allowed us to evaluate the literature from a new and highly relevant perspective. Thematic analysis of all 15 studies was also undertaken. Despite limited literature there are evidence-based strategies that are likely to improve outcomes for Indigenous women with breast cancer in high income countries and indicate that culture makes a positive difference. It is also clear that strong Indigenous community leadership and governance at all stages of the research including design is an imperative for feasibility.
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Affiliation(s)
- Vita Christie
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
| | - Debbie Green
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Janaki Amin
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
| | - Christopher Pyke
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - Karen Littlejohn
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
| | - Deb McCowen
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Kylie Gwynne
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
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8
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Horrill TC, Dahl L, Sanderson E, Munro G, Garson C, Taylor C, Fransoo R, Thompson G, Cook C, Linton J, Schultz ASH. Comparing cancer incidence, stage at diagnosis and outcomes of First Nations and all other Manitobans: a retrospective analysis. BMC Cancer 2019; 19:1055. [PMID: 31694679 PMCID: PMC6836370 DOI: 10.1186/s12885-019-6296-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Globally, epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. Although historically cancer among First Nations (FN) peoples in Canada was relatively unknown, recent epidemiological evidence reveals a widening of cancer related disparities. However evidence at the population level is limited. The aim of this study was to explore cancer incidence, stage at diagnosis, and outcomes among status FN peoples in comparison with all other Manitobans (AOM). Methods All cancers diagnosed between April 1, 2004 and March 31, 2011 were linked with the Indian Registry System and five provincial healthcare databases to compare differences in characteristics, cancer incidence, and stage at diagnosis and mortality of the FN and AOM cohorts. Cox proportional hazard regression models were used to examine mortality. Results The FN cohort was significantly younger, with higher comorbidities than AOM. A higher proportion of FN people were diagnosed with cancer at stages III (18.7% vs. 15.4%) and IV (22.4% vs. 19.9%). Cancer incidence was significantly lower in the FN cohort, however, there were no significant differences between the two cohorts after adjusting for age, sex, income and area of residence. No significant trends in cancer incidence were identified in either cohort over time. Mortality was generally higher in the FN cohort. Conclusions Despite similar cancer incidence, FN peoples in Manitoba experience poorer survival. The underlying causes of these disparities are not yet understood, particularly in relation to the impact of colonization and other determinants of health.
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Affiliation(s)
- Tara C Horrill
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada.
| | - Lindsey Dahl
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Garry Munro
- Cree Nation Tribal Health Centre, The Pas, Canada
| | - Cindy Garson
- Interlake Reserves Tribal Council, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada
| | - Catherine Cook
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Janice Linton
- Indigenous Health Librarian, University of Manitoba, Winnipeg, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, R3T 2N2, Canada
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Banham D, Roder D, Eckert M, Howard NJ, Canuto K, Brown A. Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19:771. [PMID: 31665005 PMCID: PMC6820943 DOI: 10.1186/s12913-019-4534-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. METHODS Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. RESULTS Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63. CONCLUSION The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia North Terrace, Adelaide, Australia
| | - Natasha J Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
- Aboriginal Health Research Group, Cancer Research Institute, University of South Australia, Adelaide, Australia
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10
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Banham D, Roder D, Keefe D, Farshid G, Eckert M, Howard N, Canuto K, Brown A. Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death: a retrospective, matched cohort of aboriginal and non-aboriginal women with breast cancer. BMC Health Serv Res 2019; 19:387. [PMID: 31200700 PMCID: PMC6570827 DOI: 10.1186/s12913-019-4147-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Australia's Aboriginal and Torres Strait Islander women have poorer survival and twice the disease burden from breast cancer compared to other Australian women. These disparities are influenced, but not fully explained, by more diagnoses at later stages. Incorporating breast screening, hospital and out of hospital treatment and cancer registry records into a person-linked data system can improve our understanding of breast cancer outcomes. We focussed one such system on a population-based cohort of Aboriginal women in South Australia diagnosed with breast cancer and a matched cohort of non-Aboriginal women with breast cancer. We quantify Aboriginal and non-Aboriginal women's contact with publicly funded screening mammograms; quantify exposure to a selection of cancer treatment modalities; then assess the relationship between screening, treatment and the subsequent risk of breast cancer death. METHODS Breast cancers registered among Aboriginal women in South Australia in 1990-2010 (N = 77) were matched with a random selection of non-Aboriginal women by birth and diagnostic year, then linked to screening records, and treatment 2 months before and 13 months after diagnosis. Competing risk regression summarised associations of Aboriginality, breast screening, cancer stage and treatment with risk of breast cancer death. RESULTS Aboriginal women were less likely to have breast screening (OR = 0.37, 95%CIs 0.19-0.73); systemic therapies (OR = 0.49, 95%CIs 0.24-0.97); and, surgical intervention (OR = 0.35, 95%CIs 0.15-0.83). Where surgery occurred, mastectomy was more common among Aboriginal women (OR = 2.58, 1.22-5.46). Each of these factors influenced the risk of cancer death, reported as sub-hazard ratios (SHR). Regional spread disease (SHR = 34.23 95%CIs 6.76-13.40) and distant spread (SHR = 49.67 95%CIs 6.79-363.51) carried more risk than localised disease (Reference SHR = 1). Breast screening reduced the risk (SHR = 0.07 95%CIs 0.01-0.83). So too did receipt of systemic therapy (SHR = 0.06 95%CIs 0.01-0.41) and surgical treatments (SHR = 0.17 95%CIs 0.04-0.74). In the presence of adjustment for these factors, Aboriginality did not further explain the risk of breast cancer death. CONCLUSION Under-exposure to screening and treatment of Aboriginal women with breast cancers in South Australia contributed to excess cancer deaths. Improved access, utilisation and quality of effective treatments is needed to improve survival after breast cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Dorothy Keefe
- SA Cancer Services, SA Health, Hindmarsh Square, Adelaide, SA 5000 Australia
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Gelareh Farshid
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Marion Eckert
- School of Nursing and Midwifery, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Natasha Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Aboriginal Health Research Group, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - for the CanDAD Aboriginal Community Reference Group and other CanDAD investigators
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- SA Cancer Services, SA Health, Hindmarsh Square, Adelaide, SA 5000 Australia
- Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
- School of Nursing and Midwifery, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
- School of Health Sciences, Aboriginal Health Research Group, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
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Ho-Huynh A, Tran A, Bray G, Abbot S, Elston T, Gunnarsson R, de Costa A. Factors influencing breast cancer outcomes in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13038. [PMID: 30919536 DOI: 10.1111/ecc.13038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION CRD42017072857.
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Affiliation(s)
- Albert Ho-Huynh
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Tran
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Gerard Bray
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Samuel Abbot
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Ronny Gunnarsson
- Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Alan de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Lyle G, Hendrie GA, Hendrie D. Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence. Int J Equity Health 2017; 16:182. [PMID: 29037209 PMCID: PMC5644132 DOI: 10.1186/s12939-017-0676-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum – namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. Methods An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. Results We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. Conclusions In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
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Affiliation(s)
- Greg Lyle
- Centre for Population Health Research, Curtin University, Perth, Australia.
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Australia
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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