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Signal V, Smith M, Costello S, Davies A, Dawkins P, Jackson CGCA, Koea J, Whitehead J, Gurney J. Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence. Cancer Causes Control 2024; 35:1497-1507. [PMID: 39150625 DOI: 10.1007/s10552-024-01904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway. METHODS A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i). RESULTS Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway. CONCLUSION These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.
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Affiliation(s)
- Virginia Signal
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Moira Smith
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | | | - Anna Davies
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Paul Dawkins
- Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | | | | | | | - Jason Gurney
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
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Gurney J, Davies A, Stanley J, Cameron L, Costello S, Dawkins P, Henare K, Jackson CG, Lawrenson R, Whitehead J, Koea J. Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context. JCO Glob Oncol 2024; 10:e2300258. [PMID: 38301179 PMCID: PMC10846779 DOI: 10.1200/go.23.00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis. METHODS We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. RESULTS Māori patients with lung cancer appeared less likely to access surgery than European patients (Māori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Māori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Māori patients compared with European patients, this difference was small and requires further investigation. CONCLUSION Our observation of differences in surgery rates between Māori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Māori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.
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Affiliation(s)
| | - Anna Davies
- University of Otago, Wellington, New Zealand
| | | | - Laird Cameron
- Te Whatu Ora—Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Paul Dawkins
- Te Whatu Ora—Counties Manukau, Auckland, New Zealand
| | | | | | - Ross Lawrenson
- Population and Public Health, Te Whatu Ora—Waikato, Hamilton, New Zealand
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3
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Ronald M, MacCormick AD, Koea J. Inclusion of ethnicity in surgical waitlist prioritization in Aotearoa New Zealand is appropriate and required. ANZ J Surg 2023; 93:2567-2568. [PMID: 37728075 DOI: 10.1111/ans.18699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Maxine Ronald
- Whangārei Hospital, Private Bag 9742, Whangārei, 0148, New Zealand
| | | | - Jonathan Koea
- North Shore Hospital, Takapuna, Auckland, 0620, New Zealand
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Parker K, Colhoun S, Bartholomew K, Sandiford P, Lewis C, Milne D, McKeage M, McKree Jansen R, Fong KM, Marshall H, Tammemägi M, Rankin NM, Hotu S, Young R, Hopkins R, Walker N, Brown R, Crengle S. Invitation methods for Indigenous New Zealand Māori in lung cancer screening: Protocol for a pragmatic cluster randomized controlled trial. PLoS One 2023; 18:e0281420. [PMID: 37527237 PMCID: PMC10393155 DOI: 10.1371/journal.pone.0281420] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/22/2023] [Indexed: 08/03/2023] Open
Abstract
Lung cancer screening can significantly reduce mortality from lung cancer. Further evidence about how to optimize lung cancer screening for specific populations, including Aotearoa New Zealand (NZ)'s Indigenous Māori (who experience disproportionately higher rates of lung cancer), is needed to ensure it is equitable. This community-based, pragmatic cluster randomized trial aims to determine whether a lung cancer screening invitation from a patient's primary care physician, compared to from a centralized screening service, will optimize screening uptake for Māori. Participating primary care practices (clinics) in Auckland, Aotearoa NZ will be randomized to either the primary care-led or centralized service for delivery of the screening invitation. Clinic patients who meet the following criteria will be eligible: Māori; aged 55-74 years; enrolled in participating clinics in the region; ever-smokers; and have at least a 2% risk of developing lung cancer within six years (determined using the PLCOM2012 risk prediction model). Eligible patients who respond positively to the invitation will undertake shared decision-making with a nurse about undergoing a low dose CT scan (LDCT) and an assessment for Chronic Obstructive Pulmonary Disease (COPD). The primary outcomes are: 1) the proportion of eligible population who complete a risk assessment and 2) the proportion of people eligible for a CT scan who complete the CT scan. Secondary outcomes include evaluating the contextual factors needed to inform the screening process, such as including assessment for Chronic Obstructive Pulmonary Disease (COPD). We will also use the RE-AIM framework to evaluate specific implementation factors. This study is a world-first, Indigenous-led lung cancer screening trial for Māori participants. The study will provide policy-relevant information on a key policy parameter, invitation method. In addition, the trial includes a nested analysis of COPD in the screened Indigenous population, and it provides baseline (T0 screen round) data using RE-AIM implementation outcomes.
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Affiliation(s)
- Kate Parker
- Planning Funding and Outcomes, Waitematā District, Te Whatu Ora and Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | - Sarah Colhoun
- Ngāi Tahu Māori Health Research Unit, School of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Karen Bartholomew
- Planning Funding and Outcomes, Waitematā District, Te Whatu Ora and Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | | | - Chris Lewis
- Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | - David Milne
- Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand
| | | | - Rawiri McKree Jansen
- Te Aka Whai Ora, Manukau, New Zealand
- National Hauora Coalition, Auckland, New Zealand
| | - Kwun M Fong
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, Queensland, Australia
- University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | | | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, Australia
| | - Sandra Hotu
- University of Auckland, Auckland, New Zealand
| | | | | | | | - Rachel Brown
- National Hauora Coalition, Auckland, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, School of Health Sciences, University of Otago, Dunedin, New Zealand
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5
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Soszyn N, Cloete E, Sadler L, de Laat MWM, Crengle S, Bloomfield F, Finucane K, Gentles TL. Factors influencing the choice-of-care pathway and survival in the fetus with hypoplastic left heart syndrome in New Zealand: a population-based cohort study. BMJ Open 2023; 13:e069848. [PMID: 37055204 PMCID: PMC10106067 DOI: 10.1136/bmjopen-2022-069848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES To better understand the relative influence of fetal and maternal factors in determining the choice-of-care pathway (CCP) and outcome in the fetus with hypoplastic left heart syndrome (HLHS). DESIGN A retrospective, population-based study of fetuses with HLHS from a national dataset with near-complete case ascertainment from 20 weeks' gestation. Fetal cardiac and non-cardiac factors were recorded from the patient record and maternal factors from the national maternity dataset. The primary endpoint was a prenatal decision for active treatment after birth (intention-to-treat). Factors associated with a delayed diagnosis (≥24 weeks' gestation) were also reviewed. Secondary endpoints included proceeding to surgical treatment, and 30-day postoperative mortality in liveborns with an intention-to-treat. SETTING New Zealand population-wide. PARTICIPANTS Fetuses with a prenatal diagnosis of HLHS between 2006 and 2015. RESULTS Of 105 fetuses, the CCP was intention-to-treat in 43 (41%), and pregnancy termination or comfort care in 62 (59%). Factors associated with intention-to-treat by multivariable analysis included a delay in diagnosis (OR: 7.8, 95% CI: 3.0 to 20.6, p<0.001) and domicile in the maternal fetal medicine (MFM) region with the most widely dispersed population (OR: 5.3, 95% CI: 1.4 to 20.3, p=0.02). Delay in diagnosis was associated with Māori maternal ethnicity compared with European (OR: 12.9, 95% CI: 3.1 to 54, p<0.001) and greater distance from the MFM centre (OR: 3.1, 95% CI: 1.2 to 8.2, p=0.02). In those with a prenatal intention-to-treat, a decision not to proceed to surgery was associated with maternal ethnicity other than European (p=0.005) and the presence of major non-cardiac anomalies (p=0.01). Thirty-day postoperative mortality occurred in 5/32 (16%) and was more frequent when there were major non-cardiac anomalies (p=0.02). CONCLUSIONS Factors associated with the prenatal CCP relate to healthcare access. Anatomic characteristics impact treatment decisions after birth and early postoperative mortality. The association of ethnicity with delayed prenatal diagnosis and postnatal decision-making suggests systemic inequity and requires further investigation.
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Affiliation(s)
- Natalie Soszyn
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Elza Cloete
- The University of Auckland Liggins Institute, Auckland, New Zealand
- Neonatal Unit, Christchurch Women's Hospital, Te Whatu Ora - Health New Zealand, Waitaha Canterbury, Christchurch, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland City Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- The University of Auckland Department of Obstetrics and Gynaecology, Auckland, New Zealand
| | - Monique W M de Laat
- Women's Health, Auckland City Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Sue Crengle
- Otago Medical School Department of Preventive and Social Medicine, Dunedin, New Zealand
| | - Frank Bloomfield
- The University of Auckland Liggins Institute, Auckland, New Zealand
| | - Kirsten Finucane
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Thomas L Gentles
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland Department of Paediatrics Child and Youth Health, Auckland, New Zealand
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Aye PS, Win SS, Tin Tin S, Elwood JM. Comparison of Cancer Mortality and Incidence Between New Zealand and Australia and Reflection on Differences in Cancer Care: An Ecological Cross-Sectional Study of 2014-2018. Cancer Control 2023; 30:10732748231152330. [PMID: 37150819 PMCID: PMC10170599 DOI: 10.1177/10732748231152330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Despite many background similarities, New Zealand showed excess cancer deaths compared to Australia in previous studies. This study extends this comparison using the most recent data of 2014-2018. METHODS This study used publicly available cancer mortality and incidence data of New Zealand Ministry of Health and Australian Institute of Health and Welfare, and resident population data of Statistics New Zealand. Australian cancer mortality and incidence rates were applied to New Zealand population, by site of cancer, year, age and sex, to estimate the expected numbers, which were compared with the New Zealand observed numbers. RESULTS For total cancers in 2014-2018, New Zealand had 780 excess deaths in women (17.1% of the annual total 4549; 95% confidence interval (CI) 15.8-18.4%), and 281 excess deaths in men (5.5% of the annual total 5105; 95% CI 4.3-6.7%) compared to Australia. The excess was contributed by many major cancers including colorectal, melanoma, and stomach cancer in both sexes; lung, uterine, and breast cancer in women, and prostate cancer in men. New Zealand's total cancer incidences were lower than those expected from Australia's in both women and men: average annual difference of 419 cases (-3.6% of the annual total 11 505; 95% CI -4.5 to -2.8%), and 1485 (-11.7% of the annual total 12 669; 95% CI -12.5 to -10.9%), respectively. Comparing time periods, the excesses in total cancer deaths in women were 15.1% in 2000-07, and 17.5% in 1996-1997; and in men 4.7% in 2000-2007 and 5.6% in 1996-1997. The differences by time period were non-significant. CONCLUSION Excess mortality from all cancers combined and several common cancers in New Zealand, compared to Australia, persisted in 2014-2018, being similar to excesses in 2000-2007 and 1996-1997. It cannot be explained by differences in incidence, but may be attributable to various aspects of health systems governance and performance.
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Affiliation(s)
- Phyu Sin Aye
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Shwe Sin Win
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - J Mark Elwood
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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7
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Gurney JK, Stanley J, Adler J, McLeod H, Atkinson J, Sarfati D. National Study of Pain Medicine Access Among Māori and Non-Māori Patients With Lung Cancer in New Zealand. JCO Glob Oncol 2021; 7:1276-1285. [PMID: 34383597 PMCID: PMC8389912 DOI: 10.1200/go.21.00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pain is among the most common and consequential symptoms of cancer, particularly in the context of lung cancer. Māori have extremely high rates of lung cancer, and there is evidence that Māori patients with lung cancer are less likely to receive curative treatment and more likely to receive palliative treatment and to wait longer for their treatment than non-Māori New Zealanders. The extent to which Māori patients with lung cancer are also less likely to have access to pain medicines as part of their supportive care remains unclear. METHODS Using national-level Cancer Registry and linked health records, we describe access to subsidized pain medicines among patients with lung cancer diagnosed over the decade spanning 2007-2016 and compare access between Māori and non-Māori patients. Descriptive and logistic regression methods were used to compare access between ethnic groups. RESULTS We observed that the majority of patients with lung cancer are accessing some form of pain medicine and there do not appear to be strong differences between Māori and non-Māori in terms of overall access or the type of pain medicine dispensed. However, Māori patients appeared more likely than non-Māori to first access pain medicines within 2 weeks before their death and commensurately less likely to access them more than 24 weeks before death. CONCLUSION Given the plausibility that there are differences in first access to pain medicines (particularly opioid medicines) among Māori approaching end of life, further investigation of the factors contributing to this disparity is required.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Adler
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Heather McLeod
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu-Cancer Control Agency, Wellington, New Zealand
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Scott N, Bennett H, Masters-Awatere B, Sarfati D, Atatoa-Carr P, Harris R. Indigenous Cancer Research: Reflections on Roles and Responsibilities. JCO Glob Oncol 2021; 6:143-147. [PMID: 32031451 PMCID: PMC6998022 DOI: 10.1200/jgo.19.00124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Nina Scott
- Waikato District Health Board, Hamilton, New Zealand
| | | | | | - Diana Sarfati
- University of Otago Wellington, Wellington, New Zealand
| | | | - Ricci Harris
- University of Otago Wellington, Wellington, New Zealand
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9
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Chen C, Kolbe J, Christmas T. Surgical treatment of non-small-cell lung cancer in octogenarians: a single-centre retrospective study. Intern Med J 2021; 51:596-599. [PMID: 33890378 DOI: 10.1111/imj.15268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
Lung resection in patients aged ≥80 years is considered high risk and contributes to the low rates of resection in this population. This review of 79 octogenarians who underwent curative surgery for non-small-cell lung cancer demonstrated no intraoperative mortality, 30-day mortality of 1.3% and 12-month mortality of 10%. In this selected cohort of octogenarians, surgery resulted in acceptable short- to medium-term outcomes.
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Affiliation(s)
- Charlotte Chen
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
| | - John Kolbe
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim Christmas
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
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10
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Manners D, Dawkins P, Pascoe D, Crengle S, Bartholomew K, Leong TL. Lung cancer screening in Australia and New Zealand: the evidence and the challenge. Intern Med J 2021; 51:436-441. [PMID: 33738936 DOI: 10.1111/imj.15230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Abstract
Lung cancer remains the commonest cause of cancer death in Australia and New Zealand. Targeted screening of individuals at highest risk of lung cancer aims to detect early stage disease, which may be amenable to potentially curative treatment. While current policy recommendations in Australia and New Zealand have acknowledged the efficacy of lung cancer screening in clinical trials, there has been no implementation of national programmes. With the recent release of findings from large international trials, the evidence and experience in lung cancer screening has broadened. This article discusses the latest evidence and implications for Australia and New Zealand.
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Affiliation(s)
- David Manners
- Department of Respiratory Medicine, St John of God, Perth, Western Australia, Australia
| | - Paul Dawkins
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sue Crengle
- Department of Preventative and Social Medicine, University of Otago, Otago, New Zealand
| | - Karen Bartholomew
- Planning Funding and Outcomes, Waitematã and Auckland District Health Boards, Auckland, New Zealand
| | - Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute of Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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11
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Kidd J, Cassim S, Rolleston A, Chepulis L, Hokowhitu B, Keenan R, Wong J, Firth M, Middleton K, Aitken D, Lawrenson R. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities. BMC Cancer 2021; 21:121. [PMID: 33541294 PMCID: PMC7863263 DOI: 10.1186/s12885-021-07862-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Lung Cancer is the leading cause of cancer deaths in Aotearoa New Zealand. Māori communities in particular have higher incidence and mortality rates from Lung Cancer. Diagnosis of lung cancer at an early stage can allow for curative treatment. This project aimed to document the barriers to early diagnosis and treatment of lung cancer in secondary care for Māori communities. Methods This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Community hui included cancer patients, whānau (families), and other community members. Healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results Barriers and enablers to early diagnosis of lung cancer were categorised into two broad themes: Specialist services and treatment, and whānau journey. The barriers and enablers that participants experienced in specialist services and treatment related to access to care, engagement with specialists, communication with specialist services and cultural values and respect, whereas barriers and enablers relating to the whānau journey focused on agency and the impact on whānau. Conclusions The study highlighted the need to improve communication within and across healthcare services, the importance of understanding the cultural needs of patients and whānau and a health system strategy that meets these needs. Findings also demonstrated the resilience of Māori and the active efforts of whānau as carers to foster health literacy in future generations. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07862-0.
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Affiliation(s)
- Jacquie Kidd
- School of Clinical Sciences, Faculty of Environmental and Health Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Anna Rolleston
- The Centre for Health, PO Box 13068, Tauranga, 3141, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Brendan Hokowhitu
- Te Pua Wananga ki te Ao Faculty of Māori and Indigenous Studies, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Janice Wong
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Karen Middleton
- Waikato District Health Board, Waikato Hospital, Private Bag 3200, Hamilton, 3240, New Zealand
| | - Denise Aitken
- Lakes District Health Board, Rotorua Hospital, Private Bag 3023, Rotorua Mail Centre, Rotorua, 3046, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, Division of Arts, Law, Psychology and Social Sciences, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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12
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Ronald MM, Aramoana JKA, Hill AG. Surgeons and cultural safety and cultural competency: the road to transformation. ANZ J Surg 2020; 90:2563-2566. [PMID: 33090638 DOI: 10.1111/ans.16379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maxine M Ronald
- Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | | | - Andrew G Hill
- Department of Surgery, The University of Auckland Faculty of Medical and Health Sciences, Middlemore Hospital, Auckland, New Zealand
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13
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McLeod M, Sandiford P, Kvizhinadze G, Bartholomew K, Crengle S. Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis. BMJ Open 2020; 10:e037145. [PMID: 32973060 PMCID: PMC7517554 DOI: 10.1136/bmjopen-2020-037145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55-74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years. DESIGN A Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets. SETTING New Zealand. PARTICIPANTS Population aged 55-74 years in 2011. INTERVENTIONS Biennial LDCT screening for lung cancer compared with usual care. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and 'health-adjusted life expectancy' (HALE) were measured. RESULTS LDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival. CONCLUSION A national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.
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Affiliation(s)
- Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Sandiford
- Waitemata District Health Board, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | | | | | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Ethnic Disparities in Access to Publicly Funded Bariatric Surgery in South Auckland, New Zealand. Obes Surg 2020; 30:3459-3465. [DOI: 10.1007/s11695-020-04608-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent? BMC Cancer 2020; 20:109. [PMID: 32041572 PMCID: PMC7011272 DOI: 10.1186/s12885-020-6580-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022] Open
Abstract
Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011–2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8–91.8%) and 5-year survival of 69.6% (95% CI: 63.2–76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37–1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.
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Cloete E, Sadler L, Bloomfield FH, Crengle S, Percival T, Gentles TL. Congenital left heart obstruction: ethnic variation in incidence and infant survival. Arch Dis Child 2019; 104:857-862. [PMID: 30824490 DOI: 10.1136/archdischild-2018-315887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the relationship between ethnicity and health outcomes among fetuses and infants with congenital left heart obstruction (LHO). DESIGN A retrospective population-based review was conducted of fetuses and infants with LHO including all terminations, stillbirths and live births from 20 weeks' gestation in New Zealand over a 9-year period. Disease incidence and mortality were analysed by ethnicity and by disease type: hypoplastic left heart syndrome (HLHS), aortic arch obstruction (AAO), and aortic valve and supravalvular anomalies (AVSA). RESULTS Critical LHO was diagnosed in 243 fetuses and newborns. There were 125 with HLHS, 112 with AAO and 6 with isolated AVSA. The incidence of LHO was significantly higher among Europeans (0.59 per 1000) compared with Māori (0.31 per 1000; p<0.001) and Pacific peoples (0.27 per 1000; p=0.002). Terminations were uncommon among Māori and Pacific peoples. Total case fatality was, however, lower in Europeans compared with other ethnicities (42% vs 63%; p=0.002) due to a higher surgical intervention rate and better infant survival. The perinatal and infant mortality rate was 82% for HLHS, 15% for AAO and 2% for AVSA. CONCLUSION HLHS carries a high perinatal and infant mortality risk. There are ethnic differences in the incidence of and mortality from congenital LHO with differences in mortality rate suggesting inequities may exist in the perinatal management pathway.
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Affiliation(s)
- Elza Cloete
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand
| | | | - Sue Crengle
- Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Thomas L Gentles
- Greenlane Paediatric and Congenital Cardiac Service, Starship Hospital, Auckland, New Zealand
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Muircroft WM, McKimm J, William L, MacLeod RD. A New Zealand Perspective on Palliative Care for MĀOri. J Palliat Care 2018. [DOI: 10.1177/082585971002600111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wendy Margaret Muircroft
- Locum Specialist in Palliative Medicine, North Shore Hospice, 7 Shea Terrace, Takapuna, Auckland, 0622 New Zealand
| | - Judy McKimm
- Centre for Medical and Health Sciences, University of Auckland, Auckland, New Zealand, and University of Bedfordshire, Luton, UK
| | - Leeroy William
- McCulloch House, Supportive and Palliative Care Unit, Melbourne, Australia
| | - Roderick Duncan MacLeod
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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Yap S, Goldsbury D, Yap ML, Yuill S, Rankin N, Weber M, Canfell K, O’Connell DL. Patterns of care and emergency presentations for people with non-small cell lung cancer in New South Wales, Australia: A population-based study. Lung Cancer 2018; 122:171-179. [DOI: 10.1016/j.lungcan.2018.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/15/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
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Rahiri JL, Alexander Z, Harwood M, Koea J, Hill AG. Systematic review of disparities in surgical care for Māori in New Zealand. ANZ J Surg 2017; 88:683-689. [PMID: 29150888 DOI: 10.1111/ans.14310] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL. RESULTS Ten studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post-operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care. CONCLUSION Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties.
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Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Zanazir Alexander
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
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Forrest LF, Sowden S, Rubin G, White M, Adams J. Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis. Thorax 2017; 72:430-436. [PMID: 27682330 PMCID: PMC5390856 DOI: 10.1136/thoraxjnl-2016-209013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
Abstract
Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. MEDLINE, EMBASE and CINAHL databases were searched to locate cohort studies of adults with a primary diagnosis of lung cancer, where the outcome was stage at diagnosis or the length of time spent within an interval on the care pathway, or a suitable proxy measure, analysed according to a measure of socio-economic position. Meta-analysis was undertaken when there were studies available with suitable data. Of the 461 records screened, 39 papers were included in the review (20 from the UK) and seven in a final meta-analysis for stage at diagnosis. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared with the least, deprived group (OR=1.04, 95% CI=0.92 to 1.19). No socio-economic inequalities in the patient interval or in time from diagnosis to treatment were found. Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer. PROSPERO PROTOCOL REGISTRATION NUMBER CRD42014007145.
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Affiliation(s)
- Lynne F Forrest
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Greg Rubin
- Wolfson Research Institute, Durham University, Queen’s Campus, Stockton on Tees, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, CB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, CB2 0QQ, UK
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21
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Whop LJ, Bernardes CM, Kondalsamy-Chennakesavan S, Darshan D, Chetty N, Moore SP, Garvey G, Walpole E, Baade P, Valery PC. Indigenous Australians with non-small cell lung cancer or cervical cancer receive suboptimal treatment. Asia Pac J Clin Oncol 2016; 13:e224-e231. [PMID: 26997361 DOI: 10.1111/ajco.12463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/30/2015] [Accepted: 01/12/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer and cervical cancer are higher in incidence for Indigenous Australians and survival is worse compared with non-Indigenous Australians. Here we aim to determine if being Indigenous and/or other factors are associated with patients receiving "suboptimal treatment" compared to "optimal treatment" according to clinical guidelines for two cancer types. METHODS Data were collected from hospital medical records for Indigenous adults diagnosed with cervical cancer and non-small cell lung cancer (NSCLC) and a frequency-matched comparison group of non-Indigenous patients in the Queensland Cancer Registry between January 1998 and December 2004. The two cancer types were analyzed separately. RESULTS A total of 105 women with cervical cancer were included in the study, 56 of whom were Indigenous. Indigenous women had higher odds of not receiving optimal treatment according to clinical guidelines (unadjusted OR 7.1; 95% CI, 1.5-33.3), even after adjusting for stage (OR 5.7; 95% CI, 1.2-27.3). Of 225 patients with NSCLC, 198 patients (56% Indigenous) had sufficient information available to be analyzed. The odds of receiving suboptimal treatment were significantly higher for Indigenous compared to non-Indigenous NSCLC patients (unadjusted OR 1.9; 95% CI, 1.0-3.6) and remained significant after adjusting for stage, comorbidity and age (adjusted OR 2.1; 95% CI, 1.1-4.1). CONCLUSIONS The monitoring of treatment patterns and appraisal against guidelines can provide valuable evidence of inequity in cancer treatment. We found that Indigenous people with lung cancer or cervical cancer received suboptimal treatment, reinforcing the need for urgent action to reduce the impact of these two cancer types on Indigenous people.
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Affiliation(s)
- Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Christina M Bernardes
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Deepak Darshan
- Toowoomba Hospital and Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.,Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Naven Chetty
- Mater Adult Hospital, Brisbane, Queensland, Australia
| | - Suzanne P Moore
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Euan Walpole
- Princess Alexandra Hospital and Metro South Health and Hospital Service, Brisbane, Queensland, Australia
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Elwood JM, Aye PS, Tin Tin S. Increasing Disadvantages in Cancer Survival in New Zealand Compared to Australia, between 2000-05 and 2006-10. PLoS One 2016; 11:e0150734. [PMID: 26938056 PMCID: PMC4777383 DOI: 10.1371/journal.pone.0150734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
New Zealand has lower cancer survival compared to its neighbour Australia. If this were due to long established differences between the two patient populations, it might be expected to be either constant in time, or decreasing, as improving health services deals with inequities. In this study we compared trends in relative cancer survival ratios in New Zealand and Australia between 2000-05 and 2006-10, using data from the New Zealand Cancer Registry and the Australian Institute for Health and Welfare. Over this period, Australia showed significant improvements (6.0% in men, 3.0% in women) in overall 5-year cancer survival, with substantial increases in survival from major cancer sites such as lung, bowel, prostate, and breast cancers. New Zealand had only a 1.8% increase in cancer survival in men and 1.3% in women, with non-significant changes in survival from lung and bowel cancers, although there were increases in survival from prostate and breast cancers. For all cancers combined, and for lung and bowel cancer, the improvements in survival and the greater improvements in Australia were mainly in 1-year survival, suggesting factors related to diagnosis and presentation. For breast cancer, the improvements were similar in each country and seen in survival after the first year. The findings underscore the need to accelerate the efforts to improve early diagnosis and optimum treatment for New Zealand cancer patients to catch up with the progress in Australia.
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Affiliation(s)
- J. Mark Elwood
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Phyu Sin Aye
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Robson B, Ellison-Loschmann L. Māori and cancer care in Aotearoa/New Zealand - responses to disparities. Eur J Cancer Care (Engl) 2016; 25:214-8. [DOI: 10.1111/ecc.12472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/22/2022]
Affiliation(s)
- B. Robson
- Eru Pōmare Māori Health Research Centre; University of Otago; Wellington
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Schroeder MC, Tien YY, Wright K, Halfdanarson TR, Abu-Hejleh T, Brooks JM. Geographic variation in the use of adjuvant therapy among elderly patients with resected non-small cell lung cancer. Lung Cancer 2016; 95:28-34. [PMID: 27040848 DOI: 10.1016/j.lungcan.2016.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The purpose of this study was to assess to what extent geographic variation in adjuvant treatment for non-small cell lung cancer (NSCLC) patients would remain, after controlling for patient and area-level characteristics. MATERIALS AND METHODS A retrospective cohort of 18,410 Medicare beneficiaries with resected, stage I-IIIA NSCLC was identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Adjuvant therapies were classified as adjuvant chemotherapy (ACT), postoperative radiation therapy (PORT), or no adjuvant therapy. Predicted treatment probabilities were estimated for each patient given their clinical, demographic, and area-level characteristics with multivariate logistic regression. Area Treatment Ratios were used to estimate the propensity of patients in a local area to receive an adjuvant treatment, controlling for characteristics of patients in the area. Areas were categorized as low-, mid- and high-use and mapped for two representative SEER registries. RESULTS Overall, 10%, 12%, and 78% of patients received ACT, PORT and no adjuvant therapy, respectively. Age, sex, stage, type and year of surgery, and comorbidity were associated with adjuvant treatment use. Even after adjusting for patient characteristics, substantial geographic treatment variation remained. High- and low-use areas were tightly juxtaposed within and across SEER registries, often within the same county. In some local areas, patients were up to eight times more likely to receive adjuvant therapy than expected, given their characteristics. On the other hand, almost a quarter of patients lived in local areas in which patients were more than three times less likely to receive ACT than would be predicted. CONCLUSION Controlling for patient and area-level covariates did not remove geographic variation in adjuvant therapies for resected NSCLC patients. A greater proportion of patients were treated less than expected, rather than more than expected. Further research is needed to better understand its causes and potential impact on outcomes.
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Affiliation(s)
- Mary C Schroeder
- Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 South Grand Ave., S525 PHAR, Iowa City, IA 52242, United States.
| | - Yu-Yu Tien
- Graduate Program in Pharmaceutical Socioeconomics, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 South Grand Ave., S532 PHAR, Iowa City, IA 52242, United States.
| | - Kara Wright
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, S441 CPHB, Iowa City, IA 52242, United States.
| | | | - Taher Abu-Hejleh
- Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, C32 GH, Iowa City, IA 52242, United States.
| | - John M Brooks
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 303D, Columbia, SC 29208, United States.
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Ethnic differences in breast cancer survival in New Zealand: contributions of differences in screening, treatment, tumor biology, demographics and comorbidities. Cancer Causes Control 2015; 26:1813-24. [PMID: 26407955 DOI: 10.1007/s10552-015-0674-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated the breast cancer survival disparity between Indigenous Māori and non-Indigenous European women in New Zealand, and quantified the relative contributions of patient, tumor and healthcare system factors toward this disparity. METHODS All women diagnosed with breast cancer in Waikato, New Zealand, during 1999-2012 were identified from the Waikato Breast Cancer Register. Cancer-specific survivals were compared using Kaplan-Meier survival curves, while contributions of different factors toward the survival disparity were quantified with serial Cox proportional hazard modeling. RESULTS Of the 2,679 women included in this study, 2,260 (84.4%) were NZ European and 419 (15.6%) were Māori. Compared with NZ European women, Māori women had a significantly higher age-adjusted cancer-specific mortality (HR 2.02, 95% CI 1.59-2.58) with significantly lower 5-year (86.8 vs. 76.1%, p < 0.001) and 10-year (79.9 vs. 66.9%, p < 0.001%) crude cancer-specific survivals. Stage at diagnosis made the greatest contribution (approximately 25-40%), while screening, treatment and patient factors (i.e., comorbidity, obesity and smoking) contributed by approximately 15% each toward the survival disparity. The final model accounted for almost all of the cancer survival disparity (HR 1.07, 95% CI 0.80-1.44). CONCLUSIONS Māori women experience an age-adjusted risk of death from breast cancer, which is more than twice that for NZ European women. Equity-focussed improvements in health care, including increasing mammographic screening coverage and providing equitable quality and timely cancer care, may improve the survival disparity between Māori and NZ European women.
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Kwon HJ, Morton RP. Ethnic disparities in thyroid surgery outcomes in New Zealand. ANZ J Surg 2015; 87:610-614. [PMID: 25962525 DOI: 10.1111/ans.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although thyroid disease is known to have significant ethnic variability, ethnic disparities in outcomes of thyroid surgery have been poorly studied. METHOD Retrospective review of 716 consecutive thyroid operations at Counties Manukau Health, a public health provider in New Zealand, from January 2002 to August 2013. RESULTS Compared with Europeans, Māori and Pacific Islanders have longer operation times (P < 0.001) and heavier thyroid glands (P < 0.001). Polynesians also had higher risk of post-operative haemorrhage compared with non-Polynesians (P = 0.016). They also have higher body mass index, American Society of Anesthesiologists scores and rates of smoking. There were no differences in length of inpatient stay and readmission rates. CONCLUSIONS There are significant ethnic differences in certain outcomes of thyroid surgery. Part of this may be explained by higher co-morbid characteristics.
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Affiliation(s)
- Hyok Jun Kwon
- Department of Otolaryngology, Head and Neck Surgery, Counties Manukau Health, Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology, Head and Neck Surgery, Counties Manukau Health, Auckland, New Zealand
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Chamberlain J, Sarfati D, Cunningham R, Koea J, Gurney J, Blakely T. Incidence and management of hepatocellular carcinoma among Māori and non-Māori New Zealanders. Aust N Z J Public Health 2015; 37:520-6. [PMID: 24892150 DOI: 10.1111/1753-6405.12108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate time trends in hepatocellular carcinoma (HCC) incidence disparities, and ethnic differences in risk factors, comorbidity and treatment pathways among HCC patients. METHODS Cohorts of the NZ population (1981-2004) were created and probabilistically linked to cancer registry records to investigate trends in incidence by ethnicity over time. Hospital notes of 97 Māori and 92 non-Māori HCC patients diagnosed between 01/01/2006 and 31/12/2008 in NZ's North Island were reviewed. RESULTS Liver cancer incidence was higher among Māori for all time periods. Compared with non-Māori, Māori males had nearly five times the rate of liver cancer (pooled RR=4.79, 95% CI 4.14-5.54), and Māori females three times the rate (pooled RR= 3.02, 95% CI 2.33-3.92). There were no significant differences in tumour characteristics or treatment of Māori and non-Māori patients with HCC. Māori more commonly had hypertension (51% versus 25%) while more non-Māori had cirrhosis recorded (62% versus 41%). The prevalence of hepatitis B among Māori patients (56%; 95% CI 45%-67%) was more than double that of non-Māori (27%; 95% CI 19%-36%). The hazard ratio for cancer-specific death for Māori compared with non-Māori was 1.36 (95% CI 0.96-1.92). CONCLUSIONS AND IMPLICATIONS HCC remains an important health problem particularly for Māori men. Efforts to improve coverage of screening for hepatitis B and surveillance of those with chronic hepatitis should be a priority to address the large inequalities found in liver cancer epidemiology.
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Obertová Z, Scott N, Brown C, Stewart A, Lawrenson R. Survival disparities between Māori and non-Māori men with prostate cancer in New Zealand. BJU Int 2015; 115 Suppl 5:24-30. [DOI: 10.1111/bju.12900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Zuzana Obertová
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Nina Scott
- Te Puna Oranga; Waikato District Health Board; Hamilton New Zealand
| | - Charis Brown
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Alistair Stewart
- School of Population Health; University of Auckland; Hamilton New Zealand
| | - Ross Lawrenson
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
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Seneviratne S, Scott N, Lawrenson R, Campbell I. Ethnic, socio-demographic and socio-economic differences in surgical treatment of breast cancer in New Zealand. ANZ J Surg 2015; 87:E32-E39. [DOI: 10.1111/ans.13011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Nina Scott
- Māori Health Services; Waikato District Health Board; Hamilton Waikato New Zealand
| | - Ross Lawrenson
- Waikato Clinical School; University of Auckland; Hamilton Waikato New Zealand
| | - Ian Campbell
- Waikato Clinical School; University of Auckland; Hamilton Waikato New Zealand
- Department of Surgery; Waikato District Health Board; Hamilton Waikato New Zealand
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Adherence to adjuvant endocrine therapy: Is it a factor for ethnic differences in breast cancer outcomes in New Zealand? Breast 2015; 24:62-7. [DOI: 10.1016/j.breast.2014.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/18/2014] [Accepted: 11/16/2014] [Indexed: 11/19/2022] Open
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Stairmand J, Signal L, Sarfati D, Jackson C, Batten L, Holdaway M, Cunningham C. Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review. Ann Oncol 2015; 26:1325-32. [PMID: 25605751 DOI: 10.1093/annonc/mdv025] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. METHODS A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. RESULTS Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. CONCLUSIONS MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities.
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Affiliation(s)
- J Stairmand
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - L Signal
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - D Sarfati
- Cancer Control and Screening Research Group, University of Otago, Wellington
| | - C Jackson
- Department of Medicine, University of Otago, Dunedin
| | - L Batten
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
| | - M Holdaway
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
| | - C Cunningham
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand
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Obertová Z, Lawrenson R, Scott N, Holmes M, Brown C, Lao C, Tyrie L, Gilling P. Treatment modalities for Māori and New Zealand European men with localised prostate cancer. Int J Clin Oncol 2015; 20:814-20. [PMID: 25557325 DOI: 10.1007/s10147-014-0781-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/20/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine diagnostic and treatment pathways for Māori (the indigenous people of New Zealand [NZ]) and NZ European men with prostate cancer in order to identify causes of higher mortality rates for Māori men. METHODS All Māori men (150) diagnosed with prostate cancer in the Midland Cancer Network region between 2007 and 2010 were identified from the NZ Cancer Registry and frequency age-matched with three randomly sampled NZ European men. Clinical records of these men were searched for information on clinical stage at diagnosis, comorbidities, and type of treatment for localised disease. RESULTS The final cohort included 136 Māori and 400 NZ European men, of whom 97 Māori and 311 NZ European were diagnosed with localised prostate cancer. Māori men were twice as likely to be diagnosed with distant metastases compared with NZ European men (19.1 vs 9.8 %). Māori men with localised disease were less likely to be treated with radical prostatectomy compared with NZ European men [RR 0.66 (95 % CI 0.48, 0.90)]. Multivariate regression analysis adjusted for age, D'Amico risk strata, comorbidities, and socioeconomic deprivation showed that Māori men were more likely to be managed expectantly [RR 1.74 (95 % CI 1.06, 2.57)]. CONCLUSION Differences between Māori and NZ European men observed in the management of localised prostate cancer cannot be readily explained by patient characteristics, such as comorbidities or risk assessment at diagnosis. Poorer outcomes for Māori men may not only be related to later stage at diagnosis but differences in treatment modalities may also be a factor.
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Affiliation(s)
- Zuzana Obertová
- Waikato Clinical School, Peter Rothwell Academic Centre, University of Auckland, Private Bag 3200, Hamilton, 3240, New Zealand,
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Seneviratne S, Campbell I, Scott N, Kuper-Hommel M, Round G, Lawrenson R. Ethnic differences in timely adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand: a cohort study. BMC Cancer 2014; 14:839. [PMID: 25406582 PMCID: PMC4242494 DOI: 10.1186/1471-2407-14-839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 01/07/2023] Open
Abstract
Background Indigenous and/or minority ethnic women are known to experience longer delays for treatment of breast cancer, which has been shown to contribute to ethnic inequities in breast cancer mortality. We examined factors associated with delay in adjuvant chemotherapy and radiotherapy for breast cancer, and its impact on the mortality inequity between Indigenous Māori and European women in New Zealand. Methods All women with newly diagnosed invasive non-metastatic breast cancer diagnosed during 1999–2012, who underwent adjuvant chemotherapy (n = 922) or radiation therapy (n = 996) as first adjuvant therapy after surgery were identified from the Waikato breast cancer register. Factors associated with delay in adjuvant chemotherapy (60-day threshold) and radiation therapy (90-day threshold) were analysed in univariate and multivariate models. Association between delay in adjuvant therapy and breast cancer mortality were explored in Cox regression models. Results Overall, 32.4% and 32.3% women experienced delays longer than thresholds for chemotherapy and radiotherapy, respectively. Higher proportions of Māori compared with NZ European women experienced delays longer than thresholds for adjuvant radiation therapy (39.8% vs. 30.6%, p = 0.045) and chemotherapy (37.3% vs. 30.5%, p = 0.103). Rural compared with urban residency, requiring a surgical re-excision and treatment in public compared with private hospitals were associated with significantly longer delays (p < 0.05) for adjuvant therapy in the multivariate model. Breast cancer mortality was significantly higher for women with a delay in initiating first adjuvant therapy (hazard ratio [HR] =1.45, 95% confidence interval [CI] 1.05-2.01). Mortality risks were higher for women with delays in chemotherapy (HR = 1.34, 95% CI 0.89-2.01) or radiation therapy (HR = 1.28, 95% CI 0.68-2.40), although these were statistically non-significant. Conclusions Indigenous Māori women appeared to experience longer delays for adjuvant breast cancer treatment, which may be contributing towards higher breast cancer mortality in Māori compared with NZ European women. Measures to reduce delay in adjuvant therapy may reduce ethnic inequities and improve breast cancer outcomes for all women with breast cancer in New Zealand.
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Affiliation(s)
- Sanjeewa Seneviratne
- Waikato Clinical School, University of Auckland, Breast Cancer Research Office, Waikato Hospital, PO Box 934, Hamilton 3240, New Zealand.
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Sarfati D, Gurney J, Stanley J, Koea J. A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes. BMC Cancer 2014; 14:821. [PMID: 25380581 PMCID: PMC4233029 DOI: 10.1186/1471-2407-14-821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/27/2014] [Indexed: 11/15/2022] Open
Abstract
Background Comorbidity has an adverse impact on cancer survival partly through its negative impact on receipt of curative treatment. Comorbidity is unevenly distributed within populations, with some ethnic and socioeconomic groups having considerably higher burden. The aim of this study was to investigate the inter-relationships between comorbidity, ethnicity, receipt of treatment, and cancer survival among patients with stomach and liver cancer in New Zealand. Methods Using the New Zealand Cancer Registry, Māori patients diagnosed with stomach and liver cancers were identified (n = 269), and compared with a randomly selected group of non-Māori patients (n = 255). Clinical and outcome data were collected from medical records, and the administrative hospitalisation and mortality databases. Logistic and Cox regression modelling with multivariable adjustment were used to examine the impacts of ethnicity and comorbidity on receipt of treatment, and the impact of these variables on all-cause and cancer specific survival. Results More than 70% of patients had died by two years post-diagnosis. As comorbidity burden increased among those with Stage I-III disease, the likelihood that the patient would receive curative surgery decreased (e.g. C3 Index score 6 vs 0, adjusted OR: 0.32, 95% CI 0.13-0.78) and risk of mortality increased (e.g. C3 Index score 6 vs 0, adjusted all-cause HR: 1.44, 95% CI 0.93-2.23). Receipt of curative surgery reduced this excess mortality, in some cases substantially; but the extent to which this occurred varied by level of comorbidity. Māori patients had somewhat higher levels of comorbidity (34% in highest comorbidity category compared with 23% for non-Māori) and poorer survival that was not explained by age, sex, site, stage, comorbidity or receipt of curative surgery (adjusted cancer-specific HR: 1.36, 95% CI 0.97-1.90; adjusted all-cause HR: 1.33, 95% CI 0.97-1.82). Access to healthcare factors accounted for 25-36% of this survival difference. Conclusions Patients with comorbidity were substantially less likely to receive curative surgery and more likely to die than those without comorbidity. Receipt of curative surgery markedly reduced their excess mortality. Despite no discernible difference in likelihood of curative treatment receipt, Māori remained more likely to die than non-Māori even after adjusting for confounding and mediating variables. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-821) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand.
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Moore SP, Green AC, Bray F, Garvey G, Coory M, Martin J, Valery PC. Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients. BMC Cancer 2014; 14:517. [PMID: 25037075 PMCID: PMC4223410 DOI: 10.1186/1471-2407-14-517] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/04/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Indigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia. METHODS A cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998-2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models. RESULTS Overall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83). CONCLUSION In this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.
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Affiliation(s)
- Suzanne P Moore
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Adèle C Green
- Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane, Australia
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Freddie Bray
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Gail Garvey
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
| | - Michael Coory
- Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052, Australia
| | - Jennifer Martin
- School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne, Australia
- Monash University (Adjunct), Melbourne, Australia
| | - Patricia C Valery
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
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Seneviratne S, Campbell I, Scott N, Coles C, Lawrenson R. Treatment delay for Māori women with breast cancer in New Zealand. ETHNICITY & HEALTH 2014; 20:178-193. [PMID: 24635721 DOI: 10.1080/13557858.2014.895976] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To identify differences in delay for surgical treatment of breast cancer between ethnic groups and to evaluate the role of health system, sociodemographic and tumour factors in ethnic inequities in breast cancer treatment. METHODS A retrospective analysis of prospectively collected data from the Waikato Breast Cancer Register for cancers diagnosed in the Waikato region in New Zealand (NZ) from 1 January 2005 to 31 December 2010. RESULTS Approximately 95% (1449 out of 1514) of women with breast cancer diagnosed in the Waikato over the study period were included. Of women undergoing primary surgery (n = 1264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis, respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among Māori (mean = 37.1 days, p = 0.005) and Pacific women (mean = 42.8 days, p = 0.005). Māori women were more likely to experience delays longer than 31 (p = 0.048) and 90 days (p = 0.286) compared with NZ European women. Factors predicting delays longer than 31 and 90 days in the multivariable model included public sector treatment (OR 5.93, 8.14), DCIS (OR 1.53, 3.17), mastectomy (OR 1.75, 6.60), higher co-morbidity score (OR 2.02, 1.02) and earlier year of diagnosis (OR 1.21, 1.03). Inequities in delay between Māori and NZ European women were greatest for women under 50 years and those older than 70 years. CONCLUSION This study shows that significant inequities in timely access to surgical treatment for breast cancer exist in NZ, with Māori and Pacific women having to wait longer to access treatment than NZ European women. Overall, a high proportion of women did not receive surgical treatment for breast cancer within the guideline limit of 31 days. Urgent steps are needed to reduce ethnic inequities in timely access to breast cancer treatment, and to shorten treatment delays in the public sector for all women.
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The mismeasurement of quality by readmission rate: how blunt is too blunt an instrument?: a quantitative bias analysis. Med Care 2013; 51:418-24. [PMID: 23579352 DOI: 10.1097/mlr.0b013e31828d1275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rate of readmission is widely used as a measure of hospital quality of care, often with funding implications for outlying facilities. OBJECTIVES This study explored the plausibility of readmission as a proxy for health care quality with quantitative bias analysis and the application of a structural Directed Acyclic Graph framework. It applies this paradigm to observed ethnic differences in the odds of readmission in a sample of New Zealand hospital patients. RESEARCH DESIGN Ethnicity was defined as the exposure, readmission rate as the proxy outcome, and quality of care as a missing mediator. Using data from 89,090 surgical patients from New Zealand, and estimates from the literature of the prevalence of "poor quality" and the strength of the quality-of-care readmission association, a series of sensitivity analyses were performed to calculate an odds ratio of the ethnicity-readmission association corrected for the missing mediator "quality." RESULTS Given the assumptions applied, potentially only 29% of the excess odds of readmission for Māori compared with Europeans were due to poor quality of care. CONCLUSIONS This investigation finds substantial error when using readmission as a marker of quality, and suggests that differences in readmission between populations are more likely to be due to factors other than quality of care.
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Rumball-Smith J, Sarfati D, Hider P, Blakely T. Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death. Int J Qual Health Care 2013; 25:248-54. [DOI: 10.1093/intqhc/mzt012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis. PLoS Med 2013; 10:e1001376. [PMID: 23393428 PMCID: PMC3564770 DOI: 10.1371/journal.pmed.1001376] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intervention-generated inequalities are unintended variations in outcome that result from the organisation and delivery of health interventions. Socioeconomic inequalities in treatment may occur for some common cancers. Although the incidence and outcome of lung cancer varies with socioeconomic position (SEP), it is not known whether socioeconomic inequalities in treatment occur and how these might affect mortality. We conducted a systematic review and meta-analysis of existing research on socioeconomic inequalities in receipt of treatment for lung cancer. METHODS AND FINDINGS MEDLINE, EMBASE, and Scopus were searched up to September 2012 for cohort studies of participants with a primary diagnosis of lung cancer (ICD10 C33 or C34), where the outcome was receipt of treatment (rates or odds of receiving treatment) and where the outcome was reported by a measure of SEP. Forty-six papers met the inclusion criteria, and 23 of these papers were included in meta-analysis. Socioeconomic inequalities in receipt of lung cancer treatment were observed. Lower SEP was associated with a reduced likelihood of receiving any treatment (odds ratio [OR] = 0.79 [95% CI 0.73 to 0.86], p<0.001), surgery (OR = 0.68 [CI 0.63 to 0.75], p<0.001) and chemotherapy (OR = 0.82 [95% CI 0.72 to 0.93], p = 0.003), but not radiotherapy (OR = 0.99 [95% CI 0.86 to 1.14], p = 0.89), for lung cancer. The association remained when stage was taken into account for receipt of surgery, and was found in both universal and non-universal health care systems. CONCLUSIONS Patients with lung cancer living in more socioeconomically deprived circumstances are less likely to receive any type of treatment, surgery, and chemotherapy. These inequalities cannot be accounted for by socioeconomic differences in stage at presentation or by differences in health care system. Further investigation is required to determine the patient, tumour, clinician, and system factors that may contribute to socioeconomic inequalities in receipt of lung cancer treatment.
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Hill S, Sarfati D, Robson B, Blakely T. Indigenous inequalities in cancer: what role for health care? ANZ J Surg 2012; 83:36-41. [DOI: 10.1111/ans.12041] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Hill
- Global Public Health Unit; University of Edinburgh; Edinburgh; UK
| | - Diana Sarfati
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
| | - Bridget Robson
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
| | - Tony Blakely
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
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Batten LS, Winter HS, Hardie CL, Holdaway MA. Clinicians' views on introducing epidermal growth factor receptor testing in New Zealand. Asia Pac J Clin Oncol 2012; 9:249-56. [DOI: 10.1111/ajco.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Lesley S Batten
- Research Centre for Māori Health and Development, Massey University, Palmerston North, New Zealand.
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Brewer N, Pearce N, Day P, Borman B. Travel time and distance to health care only partially account for the ethnic inequalities in cervical cancer stage at diagnosis and mortality in New Zealand. Aust N Z J Public Health 2012. [DOI: 10.1111/j.1753-6405.2012.00843.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Hill S, Sarfati D, Blakely T, Robson B, Purdie G, Dennett E, Cormack D, Dew K, Ayanian JZ, Kawachi I. Ethnicity and management of colon cancer in New Zealand. Cancer 2010; 116:3205-14. [DOI: 10.1002/cncr.25127] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Cormack D, Sarfati D, Harris R, Robson B, Shaw C, Blakely T. Re: ‘An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US’ Aust NZ J Public Health. 2009; 33: 109-18. Aust N Z J Public Health 2010; 34:90-1; author reply 91-2. [DOI: 10.1111/j.1753-6405.2010.00481.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ethnic differences in prostate cancer survival in New Zealand: a national study. Cancer Causes Control 2008; 19:993-9. [PMID: 18478341 DOI: 10.1007/s10552-008-9166-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine disease-specific survival from prostate cancer by ethnic group in New Zealand. METHODS Analyses were based on the 7,733 men with histologically confirmed prostate cancer diagnosed from the start of 1996 to the end of 1999 in New Zealand. Five-year adjusted prostate-specific mortality rates and hazard ratios were calculated for Maori, Pacific, and European men. RESULTS In univariate analyses, Maori and Pacific men had higher mortality particularly in the first year after a diagnosis of prostate cancer than did European men. The strongest prognostic factors for prostate cancer were Gleason score and age. When survival analyses by ethnic group were adjusted for age and Gleason score the disparities in survival for Maori men and Pacific men with low-grade prostate cancers remained, with European men having the best survival. CONCLUSIONS Several possible explanations have been proposed to explain the survival disparities by ethnicity in New Zealand. Differentials in Gleason grade of disease by ethnic group explain a lot of these disparities. Further data on stage of disease at diagnosis, co-morbidity, treatment, access to health services, and behavioral and environmental factors are needed to resolve these issues.
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