Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence—A population-based cohort study in Australia

Utilising the CREATE quality appraisal tool to analyse Aboriginal and Torres Strait Islander peoples' involvement and reporting of cancer research in Australia

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.

Current trends in penile cancer survivorship amongst remote patients and Aboriginal people in Western Australia

BACKGROUND

Penile cancer is a rare urological malignancy, accounting for less than 1% of all cancers in males. Given its rarity, few studies exist reporting survival outcomes. The primary objective of this project was to review the mortality of patients diagnosed with penile cancer in Western Australia between 1992 and 2017 and to determine if Aboriginal and Torres Strait Islander people and patients in rural and remote regions experience discrepancies in survival outcomes.

METHODS

All cases of penile cancer recorded within the Western Australia Cancer Registry between 1992 and 2017 were reviewed. Analysis was performed using chi-squared test of association, binomial logistic regression and survival analysis was conducted using Kaplan Meier and Cox Regression analysis.

RESULTS

One hundred eighty-six cases of penile cancer were identified; 62 patients (33%) were from regional or remote locations and nine patients (4.8%) were Aboriginal. 13 of the regional or remote patients and 5 of the Aboriginal patients died from penile cancer. Patients who were Aboriginal (HR 6.512, CI 2.123-19.968; P = 0.001) or from regional or remote Western Australia (HR 2.382, CI 1.050-5.401; P = 0.038) were at an increased risk of penile cancer-specific mortality.

CONCLUSIONS

Aboriginal people with penile cancer and men from regional and remote Western Australia experience worse penile cancer-specific survival outcomes.

Cancer survival differentials for Aboriginal and Torres Strait Islander peoples in Queensland: the impact of remoteness

PURPOSE

In Australia, Aboriginal and Torres Strait Islander peoples (First Nations population) often have low overall cancer survival, as do all residents of geographically remote areas. This study aimed to quantify the survival disparity between First Nations and other Queenslanders for 12 common cancer types by remoteness areas.

METHODS

For all Queensland residents aged 20-89 years diagnosed with a primary invasive cancer during 1997-2016, we ran flexible parametric survival models incorporating age, First Nations status, sex, diagnosis time period, area-level socioeconomic status, remoteness categories and where appropriate, broad cancer type. Three survival measures were predicted: cause-specific survival, survival differences and the comparative survival ratio, each standardised to First Nations peoples' covariate distributions.

RESULTS

The standardised five-year cause-specific cancer survival was 60% for urban First Nations and 65% for other Queenslanders, while remote residents were 54% (First Nations) and 58% (other). The absolute survival differential between First Nations and other Queenslanders was often similar, regardless of remoteness of residence. The greatest absolute difference in five-year standardised cancer survival was for head and neck cancers, followed by cervical cancer. The five-year comparative survival ratio (First Nations: other Queenslanders) for urban cancer patients was 0.91 (95% CI 0.90-0.93), similar to outer regional, inner regional and remote areas. The greatest comparative survival differential was for oesophageal cancer.

CONCLUSION

First Nations' survival inequalities are largely independent of geographical remoteness. It remains a priority to determine the contribution of other potential factors such as the availability of culturally acceptable diagnostic, management and/or support services.

Factors associated with cancer survival disparities among Aboriginal and Torres Strait Islander peoples compared with other Australians: A systematic review

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.

Quantifying the number of deaths among Aboriginal and Torres Strait Islander cancer patients that could be avoided by removing survival inequalities, Australia 2005–2016

Background

While Aboriginal and Torres Strait Islander peoples have poorer cancer survival than other Australians, absolute measures of survival disparities are lacking. This study quantified crude probabilities of deaths from cancer and other causes and estimated the number of avoidable deaths for Aboriginal and Torres Strait Islanders if these survival disparities were removed.

Methods

Flexible parametric relative survival models were used to estimate reported measures for a population-based cohort of 709,239 Australians (12,830 Aboriginal and Torres Strait Islander peoples), 2005–2016.

Results

Among Aboriginal and Torres Strait Islander peoples, the 5-year crude probability of cancer death was 0.44, while it was 0.07 for other causes of death. These probabilities were 0.07 and 0.03 higher than among other Australians, respectively. Magnitude of these disparities varied by cancer type and ranged for cancer deaths from <0.05 for pancreatic, prostate and uterine cancers to 0.20 for cervical and head and neck cancers. Values for disparity in other causes of death were generally lower. Among an average cohort of Aboriginal and Torres Strait Islander peoples diagnosed per year over the most recent five-year diagnosis period (2012–2016, n = 1,269), approximately 133 deaths within 5 years of diagnosis were potentially avoidable if they had the same overall survival as other Australians, with 94 of these deaths due to cancer. The total number of avoided deaths over the entire study period (2005–2016) was 1,348, with 947 of these deaths due to cancer.

Conclusions

Study findings suggest the need to reduce the prevalence of risk factors prevalence, increase screening participation, and improve early detection, diagnosis and treatment rates to achieve more equitable outcomes for a range of cancer types. Reported measures provide unique insights into the impact of a cancer diagnosis among Aboriginal and Torres Strait Islander peoples from a different perspective to standard relative survival measures.

Quantifying Differences in Remaining Life Expectancy after Cancer Diagnosis, Aboriginal and Torres Strait Islanders, and Other Australians, 2005-2016

BACKGROUND

This study quantified differences in remaining life expectancy (RLE) among Aboriginal and Torres Strait Islander and other Australian patients with cancer. We assessed how much of this disparity was due to differences in cancer and noncancer mortality and calculated the population gain in life years for Aboriginal and Torres Strait Islanders cancer diagnoses if the cancer survival disparities were removed.

METHODS

Flexible parametric relative survival models were used to estimate RLE by Aboriginal and Torres Strait Islander status for a population-based cohort of 709,239 persons (12,830 Aboriginal and Torres Strait Islanders), 2005 to 2016.

RESULTS

For all cancers combined, the average disparity in RLE was 8.0 years between Aboriginal and Torres Strait Islanders (12.0 years) and other Australians (20.0 years). The magnitude of this disparity varied by cancer type, being >10 years for cervical cancer versus <2 years for lung and pancreatic cancers. For all cancers combined, around 26% of this disparity was due to differences in cancer mortality and 74% due to noncancer mortality. Among 1,342 Aboriginal and Torres Strait Islanders diagnosed with cancer in 2015 an estimated 2,818 life years would be gained if cancer survival disparities were removed.

CONCLUSIONS

A cancer diagnosis exacerbates the existing disparities in RLE among Aboriginal and Torres Strait Islanders. Addressing them will require consideration of both cancer-related factors and those contributing to noncancer mortality.

IMPACT

Reported survival-based measures provided additional insights into the overall impact of cancer over a lifetime horizon among Aboriginal and Torres Strait Islander peoples.

Cancer mortality in a population-based cohort of American Indians - The strong heart study

BACKGROUND

Cancer mortality among American Indian (AI) people varies widely, but factors associated with cancer mortality are infrequently assessed.

METHODS

Cancer deaths were identified from death certificate data for 3516 participants of the Strong Heart Study, a population-based cohort study of AI adults ages 45-74 years in Arizona, Oklahoma, and North and South Dakota. Cancer mortality was calculated by age, sex and region. Cox proportional hazards model was used to assess independent associations between baseline factors in 1989 and cancer death by 2010.

RESULTS

After a median follow-up of 15.3 years, the cancer death rate per 1000 person-years was 6.33 (95 % CI 5.67-7.04). Cancer mortality was highest among men in North/South Dakota (8.18; 95 % CI 6.46-10.23) and lowest among women in Arizona (4.57; 95 % CI 2.87-6.92). Factors independently associated with increased cancer mortality included age, current or former smoking, waist circumference, albuminuria, urinary cadmium, and prior cancer history. Factors associated with decreased cancer mortality included Oklahoma compared to Dakota residence, higher body mass index and total cholesterol. Sex was not associated with cancer mortality. Lung cancer was the leading cause of cancer mortality overall (1.56/1000 person-years), but no lung cancer deaths occurred among Arizona participants. Mortality from unspecified cancer was relatively high (0.48/100 person-years; 95 % CI 0.32-0.71).

CONCLUSIONS

Regional variation in AI cancer mortality persisted despite adjustment for individual risk factors. Mortality from unspecified cancer was high. Better understanding of regional differences in cancer mortality, and better classification of cancer deaths, will help healthcare programs address cancer in AI communities.

Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 - 2014: an incidence-based approach in terms of trends, determinants and inequality

OBJECTIVE

Cancer is a leading killer worldwide, including Australia. Cancer diagnosis leads to a substantial burden on the individual, their family and society. The main aim of this study is to understand the trends, determinants and inequalities associated with cancer incidence, hospitalisation, mortality and its burden over the period 1982 to 2014 in Australia.

SETTINGS

The study was conducted in Australia.

STUDY DESIGN

An incidence-based study design was used.

METHODS

Data came from the publicly accessible Australian Institute of Health and Welfare database. This contained 2 784 148 registered cancer cases over the study period for all types of cancer. Erreygers' concentration index was used to examine the magnitude of socioeconomic inequality with regards to cancer outcomes. Furthermore, a generalised linear model was constructed to identify the influential factors on the overall burden of cancer.

RESULTS

The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation (AAPC=1.27%), cancer-related mortality (AAPC=0.76%) and burden of cancer (AAPC=0.84%) all increased significantly over the period. The same-day (AAPC=1.35%) and overnight (AAPC=1.19%) hospitalisation rates also showed an increasing trend. Further, the ratio (least-most advantaged economic resources ratio, LMR of mortality (M) and LMR of incidence (I)) was especially high for cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/I=1.325), non-Hodgkin's lymphoma (M/I=1.325) and breast (M/I=1.318), suggesting that survival inequality was most pronounced for these cancers. Socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality and death.

CONCLUSIONS

Significant differences in the burden of cancer persist across socioeconomic strata in Australia. Policymakers should therefore introduce appropriate cancer policies to provide universal cancer care, which could reduce this burden by ensuring curable and preventive cancer care services are made available to all people.

Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study

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.

An exploration of healthcare providers' experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients

Background

Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients.

Methods

Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data.

Results

Analysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM.

Conclusions

Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.

Geographic variations in stage at diagnosis and survival for colorectal cancer in Australia: A systematic review

INTRODUCTION

Australia has one of the highest incidence rates of colorectal cancer (CRC) in the world. Residents in rural areas of Australia experience disadvantage in health care and outcomes. This review investigates whether patients with CRC in rural areas demonstrate poorer survival and more advanced stages of disease at diagnosis.

METHODS

Systematic review of peer-reviewed articles and grey literature. Studies were included if they provided data on survival or stage of disease at diagnosis across multiple geographical locations; focused on CRC patients; and were conducted in Australia.

RESULTS

Twenty-six articles met inclusion criteria. Twenty-three studies examined survival, while five studies investigated stage at diagnosis. The evidence suggests that non-metropolitan patients are less likely to survive CRC for five years compared to patients living in metropolitan areas, yet there was limited evidence to suggest geographical disparity in stage of diagnosis.

CONCLUSIONS

While five-year survival disparities are apparent, these patterns appear to vary as a function of specific region and health jurisdiction, cancer type and year/s of data collection. Future research should examine current data using consistent and robust methods of reporting survival and classifying geographical location. The impact of population-level screening programmes on survival and stage at diagnosis also needs to be thoroughly explored.

Delay in commencement of palliative care service episodes provided to Indigenous and non-Indigenous patients: cross-sectional analysis of an Australian multi-jurisdictional dataset

Background

Rapid effective responsiveness to patient needs is pivotal to high quality palliative care. Aboriginal and Torres Strait Islander (Indigenous) people are susceptible to life-limiting illnesses at younger ages than other Australians and experience inequity of health service provision. The Palliative Care Outcomes Collaboration collects Australia-wide health service data on patient care, and has established performance benchmarks for specialist palliative care services. We investigated whether the benchmark for timely commencement of palliative care episodes (occurrence of delay >1 day after being designated ‘ready for care’ in <10% instances) is being met for Indigenous Australians in participating services. Additionally, we investigated the association between identification as Indigenous and delay.

Methods

Using multi-jurisdictional Palliative Care Outcomes Collaboration data, this cross-sectional analytical study investigated all episodes of care (n = 84,238) provided to patients ≥18 years (n = 61,073: Indigenous n = 645) in hospital and community settings commenced and completed during the period 01/07/2013–30/06/2015. Proportions of episodes resulting in delay were determined. Crude and adjusted odds of delay among Indigenous compared with non-Indigenous patients were investigated using multiple logistic regression, with missing data handled by multiple imputation.

Results

The benchmark was met for both Indigenous and non-Indigenous patients (delay in 8.3 and 8.4% episodes respectively). However, the likelihood of delay was modestly higher in episodes provided to Indigenous than non-Indigenous patients (adjusted odds ratio [aOR], 1.41; 95% confidence interval [CI] 1.07–1.86). Excess delay among Indigenous patients was accentuated in first episodes (aOR, 1.53; 95% CI 1.14–2.06), in patients aged < 65 years (aOR, 1.66; 95% CI 1.14–2.41), and among those residing in Inner Regional areas (aOR, 1.97; 95% CI 1.19–3.28), and also approached significance among those in outer regional, remote and very remote areas collectively (aOR, 1.72; CI 0.97–3.05).

Conclusions

Although the timeliness benchmark is being met for Indigenous Australians in palliative care, they may experience delayed initiation of care episodes, particularly if younger, and especially at first encounter with a service. Qualitative research is required to explore determinants of delay in initiating palliative care episodes. The timeliness of initial referral for specialist palliative care in this population remains to be determined.

Electronic supplementary material

The online version of this article (10.1186/s12904-018-0380-7) contains supplementary material, which is available to authorized users.

An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia

Travel logistics impede Aboriginal patients' uptake of cancer treatments and is one reason for the poorer outcomes of Aboriginal people with cancer. This research examined benefits of a newly established rurally based radiotherapy unit in southwest Western Australia (WA), and included exploring the experience of Aboriginal patients and possible reasons for Aboriginal people's underrepresentation in treatment. Semi-structured in-depth interviews with 21 service providers involved in the treatment and care of people with cancer, and 3 Aboriginal patients with cancer who undertook radiotherapy at the Service were undertaken. Data were subject to thematic analysis involving immersion in the data for familiarization, inductive coding, investigator discussion and refining of emerging themes and triangulation of patient and provider interviews. Aboriginal cancer patients were positive about the treatment and support they had received, highlighting the often complex challenges faced by rural Aboriginal cancer patients in accessing and maintaining treatment. Service providers offered suggestions for small numbers presenting to the Service, including late presentation, potential perceptions of cultural insensitivity on the part of service providers, out-of-pocket costs and under-ascertainment of Aboriginal status. The Service has put in place practices and initiatives to support patient health and wellbeing, including making the facility more welcoming towards Aboriginal people and ensuring culturally appropriate care.

Comorbidities contribute to the risk of cancer death among Aboriginal and non-Aboriginal South Australians: Analysis of a matched cohort study

BACKGROUND

Aboriginal Australians have poorer cancer survival than other Australians. Diagnoses at later stages and correlates of remote area living influence, but do not fully explain, these disparities. Little is known of the prevalence and influence of comorbid conditions experienced by Aboriginal people, including their effect on cancer survival. This study quantifies hospital recorded comorbidities using the Elixhauser Comorbidity Index (ECI), examines their influence on risk of cancer death, then considers effect variation by Aboriginality.

METHODS

Cancers diagnosed among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Aboriginal cases by birth year, diagnostic year, sex, and primary site, then linked to administrative hospital records to the time of diagnosis. Competing risk regression summarised associations of Aboriginal status, stage, geographic attributes and comorbidities with risk of cancer death.

RESULTS

A threshold of four or more ECI conditions was associated with increased risk of cancer death (sub-hazard ratio SHR 1.66, 95%CI 1.11-2.46). Alternatively, the presence of any one of a subset of ECI conditions was associated with similarly increased risk (SHR = 1.62, 95%CI 1.23-2.14). The observed effects did not differ between Aboriginal and matched non-Aboriginal cases. However, Aboriginal cases experienced three times higher exposure than non-Aboriginal to four or more ECI conditions (14.2% versus 4.5%) and greater exposure to the subset of ECI conditions (20.7% versus 8.0%).

CONCLUSION

Comorbidities at diagnosis increased the risk of cancer death in addition to risks associated with Aboriginality, remoteness of residence and disease stage at diagnosis. The Aboriginal cohort experienced comparatively greater exposure to comorbidities which adds to disparities in cancer outcomes.

Psychological distress among Indigenous Australian cancer survivors

PURPOSE

The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis.

METHODS

The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress.

RESULTS

The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35%; n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/divorced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21-7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08-0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08-0.68, p = 0.008).

CONCLUSIONS

Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.

Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence

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.

Mortality causes and outcomes in Indigenous populations of Canada, the United States, and Australia with rheumatic disease: A systematic review

BACKGROUND

Indigenous populations of Canada, America, Australia, and New Zealand have increased rates and severity of rheumatic disease. Our objective was to summarize mortality outcomes and explore disease and social factors related to mortality.

METHODS

A systematic search was performed in medical (Medline, EMBASE, and CINAHL), Indigenous and conference abstract databases (to June 2015) combining search terms for Indigenous populations and rheumatic diseases. Studies were included if they reported measures of mortality (crude frequency, mortality rate, survival, and potential years of life lost (PYLL)) in Indigenous populations from the four countries.

RESULTS

Of 5269 titles and abstracts identified, 504 underwent full-text review and 12 were included. No studies from New Zealand were found. In five Canadian studies of systemic lupus erythematosus (SLE) patients, First Nations ethnicity was associated with lower survival after adjusting for disease and social factors, and an increased frequency of death from lupus and its complications compared to Caucasians was found. All-cause mortality was higher in Native Americans (n = 2 studies) relative to Whites with SLE after adjusting for disease and social factors, but not in those with lupus nephritis alone. Australian Aborigines with SLE frequently developed infection and lupus complications leading to death (n = 3 studies). Mortality rates were increased in Pima Indians in the United States with rheumatoid arthritis (RA) compared to those without RA. One study in Native Americans with scleroderma found nearly all deaths were related to progressive disease.

CONCLUSIONS

Canadian and American Indigenous populations with SLE have increased mortality rates compared to Caucasian populations. Mortality in Canadian and Australian Indigenous populations with SLE, and in Native American populations with RA and scleroderma, is frequently attributed to disease progression or complications. The proportional attribution of rheumatic disease severity and social factors to mortality and complications leading to death between Indigenous and non-Indigenous populations has not been fully evaluated.

Cancer control-A global perspective

Disparities in cancer control exist in low- and middle-income countries (LMICs). Many countries do not have cancer registries to record incidence, mortality and prevalence and are reliant on Globocan estimates of their cancer burden. Poorer cancer control within and between countries occurs in those living remotely from urban centres, those in a low socioeconomic group and some ethnic groups who have lifestyle and belief systems which impact on cancer control. High-income countries generally have population screening programmes for cervix, breast and bowel cancer. However, simpler forms of screening for cancer of the cervix like visual inspection with acetic acid have been shown to be feasible in developing nations. The widespread use of vaccines to prevent cancer has been achieved with the Hepatitis B vaccine but the human papilloma virus vaccine to prevent cancer of the cervix is largely only available in high-income countries. Access to and training of oncological surgeons in LMICs is limited, while 70% of patients in these countries cannot access radiotherapy. The World Health Organization has developed a list of essential medicines although access remains poor in LMICs. The United Nations has set targets for the control of non-communicable diseases to improve global cancer control.

Disparities in cancer stage at diagnosis and survival of Aboriginal and non-Aboriginal South Australians

BACKGROUND/AIM

This study tested the utility of retrospectively staging cancer registry data for comparing stage and stage-specific survivals of Aboriginal and non-Aboriginal people. Differences by area level factors were also explored.

METHODS

This test dataset comprised 950 Aboriginal cases and all other cases recorded on the South Australian cancer registry with a 1977-2010 diagnosis. A sub-set of 777 Aboriginal cases diagnosed in 1990-2010 were matched with randomly selected non-Aboriginal cases by year of birth, diagnostic year, sex, and primary site of cancer. Competing risk regression summarised associations of Aboriginal status, stage, and geographic attributes with risk of cancer death.

RESULTS

Aboriginal cases were 10 years younger at diagnosis, more likely to present in recent diagnostic years, to be resident of remote areas, and have primary cancer sites of head & neck, lung, liver and cervix. Risk of cancer death was associated in the matched analysis with more advanced stage at diagnosis. More Aboriginal than non-Aboriginal cases had distant metastases at diagnosis (31.3% vs 22.0, p<0.001). After adjusting for stage, remote-living Aboriginal residents had higher risks of cancer death than Aboriginal residents of metropolitan areas. Non-Aboriginal cases had the lowest risk of cancer death.

CONCLUSION

Retrospective staging proved to be feasible using registry data. Results indicated more advanced stages for Aboriginal than matched non-Aboriginal cases. Aboriginal people had higher risks of cancer death, which persisted after adjusting for stage, and applied irrespective of remoteness of residence, with highest risk of death occurring among Aboriginal people from remote areas.

Ethnic density and mortality: aboriginal population health in Taiwan

BACKGROUND

Ethnic density (the proportion of ethnic minority populations in a geographic area) has emerged as an important factor determining population health. By examining the relationship between mortality rates and the proportion of aboriginal population in Taiwan, this ecological approach highlights the pressing need to understand why aboriginal health remains relatively disadvantaged affecting the population as a whole, especially given the provision of universal health coverage.

METHODS

Using combined data from various government departments in Taiwan, we first compare overall mortality rates between aboriginal people and the general population in Taiwan's 21 administrative locations during the years 2010 and 2011. Then we describe the associations between ethnic density and the relative risk of 40 different causes of death.

RESULTS

Aboriginal people in Taiwan on average have higher overall mortality rates than the general population. The proportion of aboriginal population is associated with a higher risk of death for overall mortality, homicide, vehicle crashes, tuberculosis, and several alcohol-related diseases such as peptic ulcer, chronic liver disease, and cirrhosis. These affect the health of the general population in counties where aborigines are abundant.

CONCLUSION

The proportion of aboriginal population may play an essential role in determining Taiwan's population health. When universal health coverage is in place, the root causes (for example, alcoholism, culture, and socioeconomic disadvantages) of health disparities between aboriginal populations and general populations need to be addressed.