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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Waddell O, Teo Y, Thompson N, McCombie A, Glyn T, Frizelle F. Do treatment patterns differ in those with early-onset colorectal cancer? Expert Rev Anticancer Ther 2024; 24:313-323. [PMID: 38619285 DOI: 10.1080/14737140.2024.2341731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (EOCRC) is increasing. International guidelines state that treatment should not differ from that of older patients. Several studies have shown that patients under 50 years are receiving more aggressive treatment, without any survival benefit. We aim to determine if treatment for stages 2 and 3 EOCRC differs from those of late-onset colorectal cancer (LOCRC) patients. METHODS This was a retrospective, population-based, cohort study of the treatment patterns of patients diagnosed with colorectal cancer in Canterbury, New Zealand, from 2010 to 2021 age <50 years, compared to those aged 60-74 years. RESULTS A total of 3263 patients were diagnosed with CRC between 2010 and 2021. Following exclusions, we identified 130 EOCRC and 668 LOCRC patients. Stage 2 EOCRC patients are more likely to be offered adjuvant chemotherapy (p = <0.001). Furthermore, EOCRC patients with either stage 2 or 3 disease are more likely to receive multi-agent therapy (p = <0.01), without any associated increase in survival. CONCLUSION EOCRC patients are given more adjuvant chemotherapy, without a corresponding improvement in outcomes, highlighting a potential for increased treatment-related harms, particularly in stage 2 disease. Clinicians should be mindful of these biases when treating young cancer patients and need to carefully consider treatment-related harms.
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Affiliation(s)
- Oliver Waddell
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
- Bowel Cancer Research Aotearoa, University of Otago Christchurch, Christchurch, New Zealand
| | - Yahsze Teo
- Department of Surgery, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Nasya Thompson
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew McCombie
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
- Bowel Cancer Research Aotearoa, University of Otago Christchurch, Christchurch, New Zealand
- Department of Surgery, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Tamara Glyn
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
- Bowel Cancer Research Aotearoa, University of Otago Christchurch, Christchurch, New Zealand
- Department of Surgery, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Frank Frizelle
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
- Bowel Cancer Research Aotearoa, University of Otago Christchurch, Christchurch, New Zealand
- Department of Surgery, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
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Keelan K, Pitama S, Wilkinson T, Lacey C. It's not special treatment… That's part of the Treaty of Waitangi! Organisational barriers to enhancing the Aged Residential Care environment for older Māori and Whānau in New Zealand. Int J Health Plann Manage 2024; 39:447-460. [PMID: 37990140 DOI: 10.1002/hpm.3734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND New Zealand's older Indigenous Māori people experience poorer health and reduced access to healthcare than their older non-Māori counterparts. Organisational factors (such as leadership or workforce) may influence the attitudes and perceptions of older Māori and their family (whānau) to use aged residential care services. Currently, there is a paucity of research surrounding the organisational barriers that impact the experiences of older Māori people who seek care in aged residential care (ARC) services. METHODS This study used a Kaupapa Māori qualitative research approach that legitimises Māori knowledge and critiques structures that subjugate Māori autonomy and control over their wellbeing. Interviews regarding their experiences of care were carried out with older Māori (n = 30) and whānau (family) members (n = 18) who had used, or declined to use an aged residential care facility. Narrative data were analysed inductively for themes that illustrated organisational barriers. RESULTS The key organisational theme was 'Culturally safe care', within which there were three barriers: 'Acceptability and Adequacy of Facility', 'Interface Between Aged Residential Care and Whānau Models of Care', and 'Workforce'. Collectively, these barriers emphasise the importance of an organisational approach to improving the quality of care delivered to older Māori and whānau in ARC. CONCLUSION Fostering a collective culture of equity within ARC provider services and equipping healthcare leaders and staff with the skills and knowledge to deliver culturally safe care is critical to addressing organisational barriers to ARC.
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Affiliation(s)
- Karen Keelan
- Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
| | - Tim Wilkinson
- Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori Indigenous Health Innovation (MIHI), University of Otago, Christchurch, New Zealand
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Nguyen H, Lao C, Keenan R, Laking G, Elwood M, McKeage M, Wong J, Aitken D, Chepulis L, Lawrenson R. Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand. Intern Med J 2024; 54:421-429. [PMID: 37584463 DOI: 10.1111/imj.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics. AIMS To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori. METHODS Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ2 tests and logistic models for categorical variables and Student t tests for continuous variables. RESULTS A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers. CONCLUSIONS The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand.
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Affiliation(s)
- Ha Nguyen
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - George Laking
- Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand
| | - Mark Elwood
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark McKeage
- Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand
| | - Janice Wong
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Denise Aitken
- Te Whatu Ora Health New Zealand, Rotorua, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
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Gurney J, Stanley J, Teng A, Robson B, Scott N, Sika-Paotonu D, Lao C, Lawrenson R, Krebs J, Koea J. Equity of Cancer and Diabetes Co-Occurrence: A National Study With 44 Million Person-Years of Follow-Up. JCO Glob Oncol 2023; 9:e2200357. [PMID: 37141560 DOI: 10.1200/go.22.00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The co-occurrence of diabetes and cancer is becoming increasingly common, and this is likely to compound existing inequities in outcomes from both conditions within populations. METHODS In this study, we investigate the co-occurrence of cancer and diabetes by ethnic groups in New Zealand. National-level diabetes and cancer data on nearly five million individuals over 44 million person-years were used to describe the rate of cancer in a national prevalent cohort of peoples with diabetes versus those without diabetes, by ethnic group (Māori, Pacific, South Asian, Other Asian, and European peoples). RESULTS The rate of cancer was greater for those with diabetes regardless of ethnic group (age-adjusted rate ratios, Māori, 1.37; 95% CI, 1.33 to 1.42; Pacific, 1.35; 95% CI, 1.28 to 1.43; South Asian, 1.23; 95% CI, 1.12 to 1.36; Other Asian, 1.31; 95% CI, 1.21 to 1.43; European, 1.29; 95% CI, 1.27 to 1.31). Māori had the highest rate of diabetes and cancer co-occurrence. Rates of GI, endocrine, and obesity-related cancers comprised a bulk of the excess cancers occurring among Māori and Pacific peoples with diabetes. CONCLUSION Our observations reinforce the need for the primordial prevention of risk factors that are shared between diabetes and cancer. Also, the commonality of diabetes and cancer co-occurrence, particularly for Māori, reinforces the need for a multidisciplinary, joined-up approach to the detection and care of both conditions. Given the disproportionate burden of diabetes and those cancers that share risk factors with diabetes, action in these areas is likely to reduce ethnic inequities in outcomes from both conditions.
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Affiliation(s)
- Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Bridget Robson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nina Scott
- Waikato District Health Board, Hamilton, New Zealand
| | | | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Waitematā District Health Board, Auckland, New Zealand
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Bourke JA, Owen HE, Derrett S, Wyeth EH. Disrupted mana and systemic abdication: Māori qualitative experiences accessing healthcare in the 12 years post-injury. BMC Health Serv Res 2023; 23:130. [PMID: 36755278 PMCID: PMC9906590 DOI: 10.1186/s12913-023-09124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study - 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. METHODS Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. RESULTS Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants' experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) Disrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants' circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. CONCLUSIONS Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed.
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Affiliation(s)
- John A. Bourke
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand ,grid.413145.60000 0004 0508 2586Burwood Academy Trust, Burwood Hospital, 300 Burwood Road, Burwood, Christchurch, 8083 New Zealand
| | - Helen E. Owen
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Sarah Derrett
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Emma H. Wyeth
- grid.29980.3a0000 0004 1936 7830Ngāi Tahu Māori Health Research Unit, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
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Lamprell K, Pulido DF, Arnolda G, Easpaig BNG, Tran Y, Owais SS, Liauw W, Braithwaite J. People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand. BMC PRIMARY CARE 2023; 24:12. [PMID: 36641420 PMCID: PMC9840343 DOI: 10.1186/s12875-023-01967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with early-onset colorectal cancer, under the age of 50, are more likely to experience diagnostic delay and to be diagnosed at later stages of the disease than older people. Advanced stage diagnosis potentially requires invasive therapeutic management at a time of life when these patients are establishing intimate relationships, raising families, building careers and laying foundations for financial stability. Barriers to timely diagnosis at primary care level have been identified but the patient perspective has not been investigated. METHODS Personal accounts of cancer care are increasingly accessed as rich sources of patient experience data. This study uses mixed methods, incorporating quantitative content analysis and qualitative thematic analysis, to investigate patients' accounts of early-onset colorectal cancer diagnosis published on prominent bowel cancer support websites in the United Kingdom, Australia and New Zealand. RESULTS Patients' perceptions (n = 273) of diagnostic barriers at primary care level were thematically similar across the three countries. Patients perceived that GPs' low suspicion of cancer due to age under 50 contributed to delays. Patients reported that their GPs seemed unaware of early-onset colorectal cancer and that they were not offered screening for colorectal cancer even when 'red flag' symptoms were present. Patients described experiences of inadequate information continuity within GP practices and across primary, specialist and tertiary levels of care, which they perceived contributed to diagnostic delay. Patients also reported tensions with GPs over the patient-centredness of care, describing discord related to symptom seriousness and lack of shared decision-making. CONCLUSIONS Wider dissemination of information about early-onset colorectal cancer at primary care level is imperative given the increasing incidence of the disease, the frequency of diagnostic delay, the rates of late-stage diagnosis and the dissatisfaction with patient experience reported by patients whose diagnosis is delayed. Patient education about diagnostic protocols may help to pre-empt or resolve tensions between GPs' enactment of value-based care and patients' concerns about cancer. The challenges of diagnosing early-onset colorectal cancer are significant and will become more pressing for GPs, who will usually be the first point of access to a health system for this growing patient population.
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Affiliation(s)
- Klay Lamprell
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109 Australia
| | - Diana Fajardo Pulido
- grid.41312.350000 0001 1033 6040Pontificia Universidad Javeriana, Bogotá, DC Colombia
| | - Gaston Arnolda
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109 Australia
| | - Bróna Nic Giolla Easpaig
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Darwin, NT Australia
| | - Yvonne Tran
- grid.1004.50000 0001 2158 5405Macquarie University Hearing, Macquarie University, North Ryde, NSW Australia
| | - Syeda Somyyah Owais
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109 Australia
| | - Winston Liauw
- grid.416398.10000 0004 0417 5393St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW Australia ,grid.1005.40000 0004 4902 0432St. George Hospital Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Jeffrey Braithwaite
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109 Australia
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Sanjida S, Garvey G, Ward J, Bainbridge R, Shakeshaft A, Hadikusumo S, Nelson C, Thilakaratne P, Hou XY. Indigenous Australians' Experiences of Cancer Care: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416947. [PMID: 36554828 PMCID: PMC9779788 DOI: 10.3390/ijerph192416947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 05/31/2023]
Abstract
To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples' cancer care experiences in the Australian healthcare system from the patient's point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner.
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Affiliation(s)
- Saira Sanjida
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gail Garvey
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stephanie Hadikusumo
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
- Royal Brisbane and Women’s Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Windsor, Brisbane, QLD 4030, Australia
| | - Prabasha Thilakaratne
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4072, Australia
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Blackmore T, Chepulis L, Rawiri K, Kidd J, Stokes T, Firth M, Elwood M, Weller D, Emery J, Lawrenson R. Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study. Fam Pract 2022; 39:639-647. [PMID: 34871389 PMCID: PMC9295611 DOI: 10.1093/fampra/cmab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES New Zealand (NZ) has high rates of colorectal cancer (CRC) but low rates of early detection. The majority of CRC is diagnosed through general practice, where lengthy diagnostic intervals are common. We investigated factors contributing to diagnostic delay in a cohort of patients newly diagnosed with CRC. METHODS Patients were recruited from the Midland region and interviewed about their diagnostic experience using a questionnaire based on a modified Model of Pathways to Treatment framework and SYMPTOM questionnaire. Descriptive statistics were used to describe the population characteristics. Chi-square analysis and logistic regression were used to analyse factors influencing diagnostic intervals. RESULTS Data from 176 patients were analysed, of which 65 (36.9%) experienced a general practitioner (GP) diagnostic interval of >120 days and 96 (54.5%) experienced a total diagnostic interval (TDI) > 120 days. Patients reporting rectal bleeding were less likely to experience a long TDI (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.14-0.78) and appraisal/help-seeking interval (OR, 0.19, 95% CI: 0.06-0.59). Patients <60 were more likely to report a longer appraisal/help-seeking interval (OR, 3.32, 95% CI: 1.17-9.46). Female (OR, 2.19, 95% CI: 1.08-4.44) and Māori patients (OR, 3.18, 95% CI: 1.04-9.78) were more likely to experience a long GP diagnostic interval. CONCLUSION NZ patients with CRC can experience long diagnostic intervals, attributed to patient and health system factors. Young patients, Māori, females, and patients experiencing change of bowel habit may be at particular risk. We need to increase symptom awareness of CRC for patients and GPs. Concentrated efforts are needed to ensure equity for Māori in access to screening, diagnostics, and treatment.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Keenan Rawiri
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Melissa Firth
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Mark Elwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - David Weller
- Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jon Emery
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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10
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Gurney J, Sarfati D, Stanley J, Kerrison C, Koea J. Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study. BMJ Open 2022; 12:e058749. [PMID: 35487720 PMCID: PMC9058766 DOI: 10.1136/bmjopen-2021-058749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES When combined, liver and stomach cancers are second only to lung cancer as the most common causes of cancer death for the indigenous Māori population of New Zealand-with Māori also experiencing substantial disparities in the likelihood of survival once diagnosed with these cancers. Since a key driver of this disparity in survival could be access to surgical treatment, we have used national-level data to examine surgical procedures performed on Māori patients with liver and stomach cancers and compared the likelihood and timing of access with the majority European population. DESIGN, PARTICIPANTS AND SETTING We examined all cases of liver and stomach cancers diagnosed during 2007-2019 on the New Zealand Cancer Registry (liver cancer: 866 Māori, 2460 European; stomach cancer: 953 Māori, 3192 European) and linked these cases to all inpatient hospitalisations that occurred over this time to identify curative and palliative surgical procedures. As well as descriptive analysis, we compared the likelihood of access to a given procedure between Māori and Europeans, stratified by cancer and adjusted for confounding and mediating factors. Finally, we compared the timing of access to a given procedure between ethnic groups. RESULTS AND CONCLUSIONS We found that (a) access to liver transplant for Māori is lower than for Europeans; (b) Māori with stomach cancer appear more likely to require the type of palliation consistent with gastric outlet obstruction; and (c) differential timing of first stomach cancer surgery between Māori and European patients. However, we may also be cautiously encouraged by the fact that differences in overall access to curative surgical treatment were either marginal (liver) or absent (stomach).
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Affiliation(s)
- Jason Gurney
- Department of Public Health, University of Otago, Dunedin, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu - Cancer Control Agency, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Dunedin, New Zealand
| | - Clarence Kerrison
- Endoscopy Department, Waikato District Health Board, Hamilton, New Zealand
| | - Jonathan Koea
- General Surgery Services, Waitemata District Health Board, Takapuna, New Zealand
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11
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Rashid P, Ronald M, Kong K. Cultural safety and racism. ANZ J Surg 2021; 91:2829-2832. [PMID: 34608738 DOI: 10.1111/ans.17250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Rural Clinical School, Faculty of Medicine, The University of New South Wales, Port Macquarie, NSW, 2444, Australia
| | - Maxine Ronald
- Department of General Surgery, Whangarei Hospital, Aotearoa, New Zealand
| | - Kelvin Kong
- Department of Otolaryngology, Head & Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia.,Department of Linguistics, Faculty of Medicine, Health and Health Sciences, Macquarie University, Sydney, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hearing For Learning Initiative, Menzies School of Health Research, Casuarina, NT, Australia
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12
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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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13
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Oliver J, Robertson O, Zhang J, Marsters BL, Sika-Paotonu D, Jack S, Bennett J, Williamson DA, Wilson N, Pierse N, Baker MG. Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989-2015. Emerg Infect Dis 2021; 27. [PMID: 34153221 PMCID: PMC8237904 DOI: 10.3201/eid2707.203045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated outcomes for patients born after 1983 and hospitalized with initial acute rheumatic fever (ARF) in New Zealand during 1989-2012. We linked ARF progression outcome data (recurrent hospitalization for ARF, hospitalization for rheumatic heart disease [RHD], and death from circulatory causes) for 1989-2015. Retrospective analysis identified initial RHD patients <40 years of age who were hospitalized during 2010-2015 and previously hospitalized for ARF. Most (86.4%) of the 2,182 initial ARF patients did not experience disease progression by the end of 2015. Progression probability after 26.8 years of theoretical follow-up was 24.0%; probability of death, 1.0%. Progression was more rapid and ≈2 times more likely for indigenous Māori or Pacific Islander patients. Of 435 initial RHD patients, 82.2% had not been previously hospitalized for ARF. This young cohort demonstrated low mortality rates but considerable illness, especially among underserved populations. A national patient register could help monitor, prevent, and reduce ARF progression.
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14
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Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. "The support has been brilliant": experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC Health Serv Res 2021; 21:493. [PMID: 34030670 PMCID: PMC8142293 DOI: 10.1186/s12913-021-06535-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Improving health outcomes for Indigenous people by providing person-centred, culturally safe care is a crucial challenge for the health sector, both in Australia and internationally. Many cancer providers and support services are committed to providing high quality care, yet struggle with providing accessible, culturally safe cancer care to Indigenous Australians. Two Australian cancer services, one urban and one regional, were identified as particularly focused on providing culturally safe cancer care for Indigenous cancer patients and their families. The article explores the experiences of Indigenous cancer patients and their families within the cancer services and ascertains how their experiences of care matches with the cancer services’ strategies to improve care. Methods Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience. Results Eight Indigenous people affected by cancer and 23 hospital staff (Indigenous and non-Indigenous) were interviewed. Three experiences were shared by the majority of Indigenous cancer patients and family members interviewed in this study: a positive experience while receiving treatment at the cancer service; a challenging time between receiving diagnosis and reaching the cancer centre; and the importance of family support, while acknowledging the burden on family and carers. Conclusions This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06535-9.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia.
| | - Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Michele Holloway
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Lorraine Parsons
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
| | - Toni Mason
- Aboriginal Health Unit, Mission, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia, 6530, Australia
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15
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Gurney JK, Millar E, Dunn A, Pirie R, Mako M, Manderson J, Hardie C, Jackson CGCA, North R, Ruka M, Scott N, Sarfati D. The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand-a country pursuing COVID-19 elimination. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 10:100127. [PMID: 33778794 PMCID: PMC7983868 DOI: 10.1016/j.lanwpc.2021.100127] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
Background The COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript we use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19. Methods Data were sourced (2018–2020) from national collections, including cancer registrations, inpatient hospitalisations and outpatient events. Cancer registrations, diagnostic testing (gastrointestinal endoscopy), surgery (colorectal, lung and prostate surgeries), medical oncology access (first specialist appointments [FSAs] and intravenous chemotherapy attendances) and radiation oncology access (FSAs and megavoltage attendances) were extracted. Descriptive analyses of count data were performed, stratified by ethnicity (Indigenous Māori, Pacific Island, non-Māori/non-Pacific). Findings Compared to 2018–2019, there was a 40% decline in cancer registrations during New Zealand's national shutdown in March-April 2020, increasing back to pre-shutdown levels over subsequent months. While there was a sharp decline in endoscopies, pre-shutdown volumes were achieved again by August. The impact on cancer surgery and medical oncology has been minimal, but there has been an 8% year-to-date decrease in radiation therapy attendances. With the exception of lung cancer, there is no evidence that existing inequities in service access between ethnic groups have been exacerbated by COVID-19. Interpretation The impact of COVID-19 on cancer care in New Zealand has been largely mitigated. The New Zealand experience may provide other agencies or organisations with a sense of the impact of the COVID-19 pandemic on cancer services within a country that has actively pursued elimination of COVID-19. Funding Data were provided by New Zealand's Ministry of Health, and analyses completed by Te Aho o Te Kahu staff.
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Affiliation(s)
- Jason K Gurney
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand.,Department of Public Health, University of Otago, Mein St, Wellington, New Zealand
| | - Elinor Millar
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Alex Dunn
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Ruth Pirie
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Michelle Mako
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - John Manderson
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Claire Hardie
- Midcentral District Health Board, Ruahine Street, Palmerston North, New Zealand
| | - Chris G C A Jackson
- Department of Medicine, University of Otago, Great King St, Dunedin, New Zealand
| | - Richard North
- Bay of Plenty District Health Board, Cameron Rd, Tauranga, New Zealand
| | - Myra Ruka
- Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Nina Scott
- Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu - Cancer Control Agency, Molesworth St, Wellington, New Zealand
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16
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Valan A, Najid F, Chandran P, Abd Rahim AB, Chuah JA, Roslani AC. Distinctive Clinico-Pathological Characteristics of Colorectal Cancer in Sabahan Indigenous Populations. Asian Pac J Cancer Prev 2021; 22:749-755. [PMID: 33773538 PMCID: PMC8286687 DOI: 10.31557/apjcp.2021.22.3.749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Malaysia is an ethnically diverse nation, comprising Malay, Chinese, Indian and indigenous groups. However, epidemiological studies on colorectal cancer have mainly focused on the three main ethnic groups. There is evidence that the clinico-pathological characteristics of some cancers may differ in indigenous populations, namely that they occur earlier and behave more aggressively. We aimed to determine if there were similar differences in colorectal cancer, focusing on the indigenous populations of Sabah. Methods: Histopathological reports of all patients diagnosed with colorectal carcinoma from January 2012 to December 2016 from public hospitals in Sabah were retrieved from the central computerized database of the Pathology Department of Queen Elizabeth Hospital in Kota Kinabalu, Sabah. Supplementary data was obtained from patients’ case files from each hospital. Clinico-pathological data were analysed using the IBM SPSS Statistical Software Version 23 for Windows for descriptive statistics (mean, median, ASR, AR, relative risk) and inferential statistics (Chi square test). Results: A total of 696 patients met the inclusion criteria. The median age for colorectal cancer in Sabah was 62 years (95% CI 60.3 to 62.3), with an age specific incidence rate of 21.4 per 100 000 population. The age specific incidence rate in the indigenous populations was 26.6 per 100 000, much lower than the Chinese, at 65.0 per 100 000. The risk of colorectal cancer occurring before the age of 50 was three times higher in the indigenous population compared to the Chinese. The tumours were mainly left-sided (56.5%), adenocarcinoma in histology (98.4%) and moderately differentiated (88.7%). Approximately 79.2% of patients received curative treatment. Conclusion: Indigenous populations in Sabah develop colorectal cancer at an earlier age, and present at more advanced stages. This has implications for screening and therapeutic strategic planning.
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Affiliation(s)
- Anuradha Valan
- Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Department of Surgery, Faculty of Medicine, University of Malaya, Malaysia
| | - Fatimah Najid
- Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Pradeep Chandran
- Department of Surgery, Duchess of Kent Hospital, Sandakan, Sabah, Malaysia
| | | | - Jitt Aun Chuah
- Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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17
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Gurney J, Stanley J, Sarfati D. The inequity of morbidity: Disparities in the prevalence of morbidity between ethnic groups in New Zealand. JOURNAL OF COMORBIDITY 2020; 10:2235042X20971168. [PMID: 33224894 PMCID: PMC7658519 DOI: 10.1177/2235042x20971168] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Abstract
Objective: The burden of chronic disease is not evenly shared within our society. In this manuscript, we use comprehensive national-level data to compare morbidity burden between ethnic groups in New Zealand. Methods: We investigated the prevalence of morbidity among all New Zealanders aged 18+ (n = 3,296,837), stratified by ethnic group (Māori, Pacific, Asian, Middle Eastern/Latin American/African, European/Other), using national-level hospitalisation and pharmaceutical data and two measures of morbidity (the M3 and P3 indices). Results and Conclusions: We observed substantial disparities for Māori and Pacific peoples compared to other ethnic groups for the vast majority of commonly-diagnosed morbidities. These disparities appeared strongest for the most-common conditions – meaning that Māori and Pacific peoples disproportionately shoulder an increased burden of these key conditions. We also observed that prevalence of these conditions emerged at earlier ages, meaning that Māori and Pacific peoples also experience a disproportionate impact of individual conditions on the quality and quantity of life. Finally, we observed strong disparities in the prevalence of conditions that may exacerbate the impact of COVID-19, such as chronic pulmonary, liver or renal disease. The substantial inequities we have presented here have been created and perpetuated by the social determinants of health, including institutionalised racism: thus solutions will require addressing these systemic issues as well as addressing inequities in individual-level care.
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Affiliation(s)
- Jason Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand.,Cancer Control Agency, Wellington, New Zealand
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18
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Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. AUST HEALTH REV 2020; 43:611-618. [PMID: 30458120 DOI: 10.1071/ah18062] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/06/2018] [Indexed: 01/22/2023]
Abstract
Objectives The aims of this study were to: (1) examine institutional racism's role in creating health outcome discrepancies for Aboriginal and Torres Strait Islander peoples; and (2) assess the management of institutional racism in an Australian hospital and health service (HHS). Methods A literature review informed consideration of institutional racism and the health outcome disparities it produces. Publicly available information, provided by an Australian HHS, was used to assess change in an Australian HHS in five key areas of institutional racism: inclusion in governance, policy implementation, service delivery, employment and financial accountability. These findings were compared with a 2014 case study. Results The literature concurs that outcome disparity is a defining characteristic of institutional racism, but there is contention about processes. Transformative change was detected in the areas of governance, service delivery and employment at an Australian HHS, but there was no change in financial accountability or policy implementation. Conclusions The health outcomes of some racial groups can be damaged by institutional racism. An external assessment tool can help hospitals and health services to change. What is known about the topic? Institutional racism theory is still developing. An external assessment tool to measure, monitor and report on institutional racism has been developed in Australia. What does this paper add? This study on institutional racism has useful propositions for healthcare organisations experiencing disparities in outcomes between racial groups. What are the implications for practitioners? The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation.
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Affiliation(s)
- Christopher John Bourke
- Australian Healthcare and Hospitals Association, Unit 8, 2 Phipps Close, Deakin, ACT 2600, Australia
| | - Henrietta Marrie
- CQ University, Office of Indigenous Engagement, corner of Abbott and Shields Streets, Cairns, Qld 4870, Australia. Email
| | - Adrian Marrie
- CQ University, Centre for Indigenous Health Equity and Research, corner of Abbott and Shields Streets, Cairns, Qld 4870, Australia. Email
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19
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Gurney JK, McLeod M, Stanley J, Campbell D, Boyle L, Dennett E, Jackson S, Koea J, Ongley D, Sarfati D. Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends. BMJ Open 2020; 10:e036451. [PMID: 32973053 PMCID: PMC7517556 DOI: 10.1136/bmjopen-2019-036451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES In this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017. DESIGN, PARTICIPANTS AND SETTING We use high-quality national-level hospitalisation data to compare the risk of postoperative mortality between demographic subgroups after adjusting for key patient-level confounders and mediators. We also present temporal trends and consider how rates in postoperative death following acute and elective/waiting list procedures have changed over this time period. RESULTS AND CONCLUSION A total of 1 836 683 unique patients accounted for 3 117 374 admissions in which a procedure was performed under general anaesthetic over the study period. We observed an overall 30-day mortality rate of 0.5 per 100 procedures and a 90-day mortality rate of 0.9 per 100. For acute procedures, we observed a 30-day mortality rate of 1.6 per 100, compared with 0.2 per 100 for elective/waiting list procedures. In terms of procedure specialty, respiratory and cardiovascular procedures had the highest rate of 30-day mortality (age-standardised rate, acute procedures: 3-6 per 100; elective/waiting list: 0.7-1 per 100). As in other contexts, we observed that the likelihood of postoperative death was not proportionally distributed within our population: older patients, Māori patients, those living in areas with higher deprivation and those with comorbidity were at increased risk of postoperative death, even after adjusting for all available factors that might explain differences between these groups. Increasing procedure risk (measured using the Johns Hopkins Surgical Risk Classification System) was also associated with an increased risk of postoperative death. Encouragingly, it appears that risk of postoperative mortality has declined over the past decade, possibly reflecting improvements in perioperative quality of care; however, this decline did not occur equally across procedure specialties.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Doug Campbell
- Department of Anaesthesia and Perioperative Medicine, Auckland DHB Anaesthesia, Auckland District Health Board, Auckland, New Zealand
| | - Luke Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Dennett
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
- Department of General Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sarah Jackson
- Department of Anaesthesia, Capital and Coast District Health Board, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Dick Ongley
- Department of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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20
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Shaw CV, D'Souza AJ, Cunningham R, Sarfati D. Revolutionized Public Health Teaching to Equip Medical Students for 21st Century Practice. Am J Prev Med 2020; 59:296-304. [PMID: 32376145 DOI: 10.1016/j.amepre.2020.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/28/2022]
Abstract
Medical graduates increasingly need public health skills to equip them to face the challenges of healthcare practice in the 21st century; however, incorporating public health learning within medical degrees remains a challenge. This paper describes the process and preliminary outcomes of the transformation, between 2016 and 2019, of a 5-week public health module taught within an undergraduate medical degree in New Zealand. The previous course consisted of a research project and standalone lectures on public health topics. The new course takes an active case-based learning approach to engage student interest and stimulate a broadening of perspective from the individual to the population while retaining relevance to students. A combination of individual- and population-level case scenarios aim to help students understand the context of health, think critically about determinants of health and health inequities, and develop skills in disease prevention, health promotion, and system change that are relevant to their future clinical careers. The new module is based on contemporary medical education theory, emphasizes reflective practice, and is integrated with other learning in the degree. It challenges students to understand the relevance of public health to every aspect of medicine and equips them with the skills needed to act to improve population health and reduce inequities as health professionals and leaders of the future.
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Affiliation(s)
- Caroline V Shaw
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Amanda J D'Souza
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
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21
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Context of cancer control in New Zealand. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Gurney JK, Campbell S, Turner S, Scott N. Addressing cancer inequities for indigenous populations: The New Zealand story. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Came H, Kidd J, Goza T. A critical Tiriti analysis of the New Zealand Cancer Control Strategy. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Gurney JK, Sarfati D, Lawrence B, Jackson C, Findlay M, McPherson K. Cancer research in the New Zealand context: Challenges and advantages. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Kim DH, Chepulis L, Keenan R, Lao C, Hodgson F, Bullen C, Lawrenson R. Prevalence of invasive cancer in a large general practice patient population in New Zealand. J Prim Health Care 2020; 12:215-224. [DOI: 10.1071/hc19113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONThe prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment.
AIMTo determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients.
METHODSData were sourced from the patient management system of a large general practice (n=11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018.
RESULTSThere were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%).
DISCUSSIONResults suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.
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Pitama S, Beckert L, Huria T, Palmer S, Melbourne-Wilcox M, Patu M, Lacey C, Wilkinson TJ. The role of social accountable medical education in addressing health inequity in Aotearoa New Zealand. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1659379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Pitama
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tania Huria
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Maira Patu
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Tim J. Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Chepulis L, Ryan B, Blackmore T, Burrett V, McCleery J, Lawrenson R. Characteristics of lung cancer patients receiving psychosocial support in urban New Zealand. Psychooncology 2019; 28:1588-1590. [PMID: 31141622 DOI: 10.1002/pon.5137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Brittany Ryan
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Tania Blackmore
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Vanessa Burrett
- Cancer Psychological and Social Support Service, Waikato District Health Board, Hamilton, New Zealand
| | - Jenny McCleery
- Cancer Psychological and Social Support Service, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
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Borges MFDSO, Koifman S, Koifman RJ, Silva IFD. [Cancer mortality among indigenous population in Acre State, Brazil]. CAD SAUDE PUBLICA 2019; 35:e00143818. [PMID: 31141029 DOI: 10.1590/0102-311x00143818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/24/2019] [Indexed: 12/22/2022] Open
Abstract
The study aimed to estimate cancer mortality among indigenous peoples in Acre State, Brazil. This was a descriptive observational study based on the nominal bank of the Brazilian Mortality Information System for the period from January 1st, 2000, to December 31st, 2012. The study analyzed the distribution death frequencies by sex and age. Standardized mortality ratio (SMR) was calculated taking Goiânia (Goiás State), Acre State, and the North Region of Brazil as the references. A total of 81 deaths were identified, the majority in men (59.3%) and in individuals over 70 years of age. The five main sites in men were stomach, liver, colon and rectum, leukemia, and prostate. The five main sites in women were uterine cervix, stomach, liver, leukemia, and uterus. In indigenous men there was an excess of deaths from stomach cancer compared to the populations of Goiânia (SMR = 2.72; 2.58-2.87), Acre State (SMR = 2.05; 1.94-2.16) and North region (SMR = 3.10; 2.93-3.27). The same was observed for deaths from hepatic cell carcinomas referenced against Goiânia (SMR = 3.89; 3.66-4.14), Acre State (SMR = 1.79; 1.68-1.91), and the North of Brazil (SMR = 4.04; 3.77-4.30). Among indigenous women, there was an excess of cervical cancer in comparison to Goiânia (SMR = 4.67; 4.41-4.93), Acre State (SMR = 2.12; 2.00-2.24), and the North (SMR = 2.60; 2.45-2.75). The estimates show that preventable neoplasms such as cervical cancer and those linked to underdevelopment, such as stomach and liver cancer, account for 49.4% of deaths among indigenous peoples. Compared to the reference population, mortality from liver, stomach, and colorectal cancer and leukemias was more than twice as high in indigenous men; among indigenous women, cervical, stomach, and liver cancer and leukemias were 30% higher.
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Affiliation(s)
| | | | - Rosalina Jorge Koifman
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ilce Ferreira da Silva
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Do household living arrangements explain gender and ethnicity differences in receipt of support services? Findings from LiLACS NZ Māori and non-Māori advanced age cohorts. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18001514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractServices providing practical support are a key component in the spectrum of social care assisting older people to age in place. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu/Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), a longitudinal study of Māori and non-Māori in advanced age, aims to determine predictors of successful ageing and to understand trajectories of health and wellbeing. This paper investigates whether household living arrangements (living alone or with others) might explain previously reported gender and ethnic differences in support service utilisation. We had shown that women and non-Māori received more services than men and Māori despite better health. The results of analyses in this paper show that, as expected, poorer physical function led to increased service use. After controlling for functional status, household living arrangements (living alone) were the next strongest driver of service use. In a fully adjusted model, previously observed differences around gender and ethnicity were no longer significant predictors of support service use. However, gender and ethnicity do shape living arrangements in advanced age. Women in advanced age are more likely to live alone, consequently needing more outside support, whereas men are more likely to have a spouse/partner able to provide care. Māori are more likely to live in multigenerational households, the care available at home meaning they are less likely to qualify for formal support. This study points to a need for understanding how gender and ethnicity interact with living arrangements and suggests that inequities may not be absent when the presence of others in a household renders an older person ineligible for formal care.
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Matheson A, Bourke C, Verhoeven A, Khan MI, Nkunda D, Dahar Z, Ellison-Loschmann L. Lowering hospital walls to achieve health equity. BMJ 2018; 362:k3597. [PMID: 30237307 PMCID: PMC6146487 DOI: 10.1136/bmj.k3597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues
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Affiliation(s)
- Anna Matheson
- Te Pūnaha Matatini, School of Health Sciences, Massey University, Wellington, New Zealand
| | - Chris Bourke
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia
| | - Alison Verhoeven
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia
| | - M Imran Khan
- Maternal Newborn and Child Health, Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | - Zaib Dahar
- People's Primary Healthcare Initiative, Karachi, Pakistan
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Isaac HM. Towards a bicultural psychotherapy: Decolonising psychotherapy in hospice care. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2018. [DOI: 10.1002/ppi.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whiting C, Cavers S, Bassendowski S, Petrucka P. Using Two-Eyed Seeing to Explore Interagency Collaboration. Can J Nurs Res 2018; 50:133-144. [PMID: 29648461 DOI: 10.1177/0844562118766176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Health-care environments influence service delivery; approaches need to be more wholistic and culturally competent requiring effective interagency collaboration to bridge traditional Indigenous and mainstream health services. Despite considerable research on collaboration, the concept remains misunderstood, at worst, and formative, at best. Within the nexus of these two diverse health services, there is limited information on how collaborations could be created and sustained effectively. Purpose To explore the perspectives/experiences of collaboration of select Saskatchewan health professionals practicing across these diverse services to understand the concept from their perspectives. Methods This qualitative study explored collaboration through observation and interviews to elicit perspectives (two-eyed seeing) of health professionals working within the context of a traditional-mainstream health services partnership. Results Individual- and system-level factors and accountabilities are needed for successful cross-cultural collaboration and can be enabled by embedding the virtues of Indigenous and values of mainstream health services along with building and maintaining relationships, valuing difference, creating supportive environments and wholistic approaches, having the right people at the table, and making a change for impactful outcomes. Conclusion Findings support the need for implementing contextually relevant collaborative practice models for productive, wholistic health services. Two-eyed seeing provides the ability to capture and catalyze the tremendous value and strengths of both worlds, potentiating complementary aspects to meet the needs of clients and communities.
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Affiliation(s)
- Cheryl Whiting
- 1 Population Health, Quality and Research Division, Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Stephanie Cavers
- 2 Eagle Moon Health Office, former Regina Qu'Appelle Health Region (now Saskatchewan Health Authority), Regina, Saskatchewan, Canada
| | - Sandra Bassendowski
- 3 College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Pammla Petrucka
- 3 College of Nursing, University of Saskatchewan, Regina, Saskatchewan, Canada
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Taylor EV, Haigh MM, Shahid S, Garvey G, Cunningham J, Thompson SC. Cancer Services and Their Initiatives to Improve the Care of Indigenous Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040717. [PMID: 29641441 PMCID: PMC5923759 DOI: 10.3390/ijerph15040717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 02/02/2023]
Abstract
Indigenous Australians continue to experience significantly poorer outcomes from cancer than non-Indigenous Australians. Despite the importance of culturally appropriate cancer services in improving outcomes, there is a lack of awareness of current programs and initiatives that are aimed at meeting the needs of Indigenous patients. Telephone interviews were used to identify and describe the Indigenous-specific programs and initiatives that are implemented in a subset of the services that participated in a larger national online survey of cancer treatment services. Fourteen services located across Australia participated in the interviews. Participants identified a number of factors that were seen as critical to delivering culturally appropriate treatment and support, including having a trained workforce with effective cross-cultural communication skills, providing best practice care, and improving the knowledge, attitudes, and understanding of cancer by Indigenous people. However, over a third of participants were not sure how their service compared with others, indicating that they were not aware of how other services are doing in this field. There are currently many Indigenous-specific programs and initiatives that are aimed at providing culturally appropriate treatment and supporting Indigenous people affected by cancer across Australia. However, details of these initiatives are not widely known and barriers to information sharing exist. Further research in this area is needed to evaluate programs and initiatives and showcase the effective approaches to Indigenous cancer care.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
- Centre for Aboriginal Studies, Curtin University, Kent Street, Perth, WA 6102, Australia.
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
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Champion C, Alvarez GG, Affleck E, Kuziemsky C. A systems perspective on rural and remote colorectal cancer screening access. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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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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Disney G, Teng A, Atkinson J, Wilson N, Blakely T. Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up. Popul Health Metr 2017; 15:15. [PMID: 28446238 PMCID: PMC5406924 DOI: 10.1186/s12963-017-0132-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 04/12/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. METHODS Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. RESULTS All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. CONCLUSIONS We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.
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Affiliation(s)
- George Disney
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Andrea Teng
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - June Atkinson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Nick Wilson
- University of Otago, 23a Mein Street, Wellington, New Zealand
| | - Tony Blakely
- University of Otago, 23a Mein Street, Wellington, New Zealand
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Withrow DR, Pole JD, Nishri ED, Tjepkema M, Marrett LD. Cancer Survival Disparities Between First Nation and Non-Aboriginal Adults in Canada: Follow-up of the 1991 Census Mortality Cohort. Cancer Epidemiol Biomarkers Prev 2016; 26:145-151. [DOI: 10.1158/1055-9965.epi-16-0706] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/04/2016] [Indexed: 11/16/2022] Open
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Muircroft W. An Australasian perspective on the curative treatment of patients with pancreatic cancer, supportive care, and future directions for management. Ecancermedicalscience 2016; 10:700. [PMID: 28105071 PMCID: PMC5221644 DOI: 10.3332/ecancer.2016.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Indexed: 11/06/2022] Open
Abstract
The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops.
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Affiliation(s)
- Wendy Muircroft
- Southern Adelaide Palliative Service, Adelaide 5041, Australia
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Ethnic inequalities in cancer incidence and mortality: census-linked cohort studies with 87 million years of person-time follow-up. BMC Cancer 2016; 16:755. [PMID: 27669745 PMCID: PMC5037611 DOI: 10.1186/s12885-016-2781-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer makes up a large and increasing proportion of excess mortality for indigenous, marginalised and socioeconomically deprived populations, and much of this inequality is preventable. This study aimed to determine which cancers give rise to changing ethnic inequalities over time. METHODS New Zealand census data from 1981, 1986, 1991, 1996, 2001, and 2006, were all probabilistically linked to three to five subsequent years of mortality (68 million person-years) and cancer registrations (87 million person years) and weighted for linkage bias. Age-standardised rate differences (SRDs) for Māori (indigenous) and Pacific peoples, each compared to European/Other, were decomposed by cancer type. RESULTS The absolute size and percentage of the cancer contribution to excess mortality increased from 1981-86 to 2006-11 in Māori males (SRD 72.5 to 102.0 per 100,000) and females (SRD 72.2 to 109.4), and Pacific females (SRD -9.8 to 42.2) each compared to European/Other. Specifically, excess mortality (SRDs) increased for breast cancer in Māori females (linear trend p < 0.01) and prostate (p < 0.01) and colorectal cancers (p < 0.01) in Māori males. The incidence gap (SRDs) increased for breast (Māori and Pacific females p < 0.01), endometrial (Pacific females p < 0.01) and liver cancers (Māori males p = 0.04), and for cervical cancer it decreased (Māori females p = 0.03). The colorectal cancer incidence gap which formerly favoured Māori, decreased for Māori males and females (p < 0.01). The greatest contributors to absolute inequalities (SRDs) in mortality in 2006-11 were lung cancer (Māori males 50 %, Māori females 44 %, Pacific males 81 %), breast cancer (Māori females 18 %, Pacific females 23 %) and stomach cancers (Māori males 9 %, Pacific males 16 %, Pacific females 20 %). The top contributors to the ethnic gap in cancer incidence were lung, breast, stomach, endometrial and liver cancer. CONCLUSIONS A transition is occurring in what diseases contribute to inequalities. The increasing excess incidence and mortality rates in several obesity- and health care access-related cancers provide a sentinel warning of the emerging drivers of ethnic inequalities. Action to further address inequalities in cancer burden needs to be multi-pronged with attention to enhanced control of tobacco, obesity, and carcinogenic infectious agents, and focus on addressing access to effective screening and quality health care.
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Ethnic Inequalities in Rectal Cancer Care in a Universal Access Healthcare System: A Nationwide Register-Based Study. Dis Colon Rectum 2016; 59:513-9. [PMID: 27145308 DOI: 10.1097/dcr.0000000000000585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ethnic inequalities in colorectal cancer care were reported previously in the United States. Studies specifically reporting on ethnic inequalities in rectal cancer care are limited. OBJECTIVE This study aimed to explore potential ethnic inequalities in rectal cancer care in the Netherlands. DESIGN This was a nationwide, population-based observational study. SETTINGS The study linked data of the Netherlands Cancer Registry with the Dutch population registry and the Social Statistics Database of Statistics Netherlands. Data were analyzed using stepwise multivariable logistic regression models. PATIENTS All of the patients diagnosed with rectal carcinoma in 2003-2011 in the Netherlands (N = 27,159) were included. MAIN OUTCOME MEASURES We analyzed 2 rectal cancer treatment indicators (preoperative radiotherapy and sphincter-sparing surgery) and 2 indicators of short-term outcome of rectal cancer surgery (anastomotic leakage and 30-day postoperative mortality). RESULTS Patients of Western non-Dutch and non-Western origin with rectal cancer were significantly younger and had a higher tumor stage than ethnic Dutch patients. Considering preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality, no ethnic inequalities were detected. After adjustment for age, sex, disease characteristics, and socioeconomic status, Western non-Dutch and non-Western patients were significantly more likely to receive sphincter-sparing surgery than ethnic Dutch patients (OR = 1.27 (95% CI, 1.04-1.55) and OR = 1.57 (95% CI, 1.02-2.42)). LIMITATIONS This study was limited by the relatively low numbers of non-Dutch patients with rectal cancer. CONCLUSIONS Non-Dutch ethnic origin was associated with a higher rate of sphincter-sparing surgery. The absence of ethnic inequalities in preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality suggests that ethnic minority patients have similar chances of optimal rectal cancer care outcomes as Dutch patients.
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Tervonen HE, Aranda S, Roder D, Walton R, Baker D, You H, Currow D. Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence—A population-based cohort study in Australia. Cancer Epidemiol 2016; 41:132-8. [DOI: 10.1016/j.canep.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
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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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Weir K, Supramaniam R, Gibberd A, Dillon A, Armstrong BK, O'Connell DL. Comparing colorectal cancer treatment and survival for Aboriginal and non-Aboriginal people in New South Wales. Med J Aust 2016; 204:156. [PMID: 26937671 DOI: 10.5694/mja15.01153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Our aim was to compare surgical treatment rates and survival rates for Aboriginal and non-Aboriginal people in New South Wales with colorectal cancer, and to describe the medical treatment received by a sample of Aboriginal people with colorectal cancer. DESIGN, SETTING AND PARTICIPANTS All people diagnosed with colorectal cancer in NSW during 2001-2007 were identified and their cancer registry records linked to hospital admissions data and death records. A medical records audit of a sample of Aboriginal people diagnosed with colorectal cancer during 2000-2011 was also conducted. MAIN OUTCOME MEASURES Cause-specific survival, odds of surgical treatment, and the proportions of people receiving adjuvant treatments. RESULTS Of 29 777 eligible colorectal cancer cases, 278 (0.9%) involved Aboriginal people. Similar proportions of Aboriginal (76%) and non-Aboriginal (79%) people had undergone surgical treatment. Colorectal cancer-specific survival was similar for Aboriginal and non-Aboriginal people up to 18 months after diagnosis, but 5 years post-diagnosis the risk of death for Aboriginal people who had had surgical treatment was 68% higher than for non-Aboriginal people (adjusted hazards ratio, 1.68; 95% CI, 1.32-2.09). Of 145 Aboriginal people with colorectal cancer identified by the medical records audit, 117 (81%) had undergone surgery, and 56 (48%) had also received adjuvant chemotherapy and/or radiotherapy. CONCLUSIONS Aboriginal people with colorectal cancer had poorer survival rates than non-Aboriginal people, although rates of surgical treatment, complications and follow-up colonoscopy were similar. More work is needed to identify and understand why outcomes for Aboriginal people with colorectal cancer are different from those of other New South Wales residents.
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Affiliation(s)
| | | | | | - Anthony Dillon
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW
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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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Slater T, Matheson A, Ellison-Loschmann L, Davies C, Earp R, Gellatly K, Holdaway M. Exploring Māori cancer patients', their families', community and hospice views of hospice care. Int J Palliat Nurs 2016; 21:439-45. [PMID: 26412274 DOI: 10.12968/ijpn.2015.21.9.439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite poor cancer survival statistics, Māori do not readily access hospice services. This study aims to explore how hospice services respond to Māori by investigating the different influences and interactions between three perspectives of hospice care. METHOD The authors conducted a Māori-centred, cross-sectional qualitative study by undertaking semi-structured interviews with hospice patients and whānau (families) (n=8), hospice representatives (n=4), and representatives from three Māori health provider organisations (n=5). CONCLUSIONS The study found that negative perceptions of hospice are being changed by hospices' relationships with other organisations and positive stories from whānau. Involvement from whānau, continuity of care and after-hours care with a greater Māori workforce and a further emphasis on culturally safe care are critical for this work to gain momentum. Findings can be of use to further develop quality of care indicators that reflect the perspectives of patients and whānau, and those who provide their care.
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Affiliation(s)
| | | | - Lis Ellison-Loschmann
- Senior Research Fellow, Public Health Research, all above at the Centre for Public Health Research, Massey University, Wellington, New Zealand
| | | | - Ria Earp
- Chief Executive, Mary Potter Hospice, Wellington
| | - Kate Gellatly
- Clinical Nurse Specialist Educator, Te Omanga Hospice, Lower Hutt
| | - Maureen Holdaway
- Associate Director, Research Centre for Māori Health and Development, Massey University, Palmerston North
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Ellison-Loschmann L, Firestone R, Aquilina L, McKenzie F, Gray M, Jeffreys M. Barriers to and delays in accessing breast cancer care among New Zealand women: disparities by ethnicity. BMC Health Serv Res 2015; 15:394. [PMID: 26385793 PMCID: PMC4575458 DOI: 10.1186/s12913-015-1050-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/07/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Unequal access to health care contributes to disparities in cancer outcomes. We examined the ethnic disparity in barriers to accessing primary and specialist health care experienced by New Zealand women with breast cancer. METHODS Women diagnosed with a primary invasive breast cancer between 2005 and 2007 were eligible. There were 1,799 respondents, n = 302 Māori (the indigenous population of NZ), n = 70 Pacific and n = 1,427 non-Māori/non-Pacific women. Participants completed a questionnaire listing 12 barriers grouped into three domains for analysis: personal; practical; and health care process factors, and reported the number of days between seeing a primary and a specialist care provider. Chi-squared, Fisher exact tests and logistic regression were used to assess uni- and multivariable differences in prevalence between ethnic groupings. RESULTS The prevalence of reporting three or more barriers was 18% among Pacific, 10% among Māori and 3% among non-Māori/non-Pacific women (P <0.001). The most commonly reported barriers were fear (Māori women) and cost (Pacific and non-Māori/non-Pacific women). Ethnic differences in reported barriers were not explained by deprivation or diabetes prevalence. Women with diabetes reported a two-fold higher risk of experiencing barriers to care compared to those without diabetes (odds ratio [OR]: 2.06, 95%CI 1.20 to 3.57). Māori and Pacific women were more likely to face delays (median 14 days) in seeing a specialist than non-Māori/non-Pacific women (median 7 days); these differences were not explained by the reported barriers. CONCLUSIONS Patterns of reported barriers to care differed according to ethnicity and were not explained by deprivation, or presence of co-morbidity. Māori and Pacific women are more likely to experience barriers to breast cancer care compared to non- Māori/non-Pacific women. We identified two key barriers affecting care for Māori and Pacific women; (a) delays in follow-up, and (b) the impact of co-morbid conditions. Future New Zealand work needs to focus attention on health care process factors and improving the interface between primary and secondary care to ensure quality health care is realised for all women with breast cancer.
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Affiliation(s)
- Lis Ellison-Loschmann
- Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand.
| | - Ridvan Firestone
- Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand.
| | - Lucy Aquilina
- University of Bristol, Tyndall Ave, Bristol, BS8 1TH, UK.
| | - Fiona McKenzie
- Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand.
- The International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon, France.
| | - Michelle Gray
- Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand.
| | - Mona Jeffreys
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS6 7TQ, UK.
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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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Gurney JK, Sarfati D, Stanley J. Obscure etiology, unusual disparity: the epidemiology of testicular cancer in New Zealand. Cancer Causes Control 2015; 26:561-9. [PMID: 25687480 DOI: 10.1007/s10552-015-0533-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/07/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Testicular cancer (TC) remains perplexing, both in terms of what causes the disease and why certain populations are at greater risk of developing it. In New Zealand, an unusual ethnic disparity exists, whereby the indigenous Māori population suffer the highest rates of disease. In this study, we further describe the epidemiology of TC in the New Zealand context. METHODS Eligible patients diagnosed with TC between 2000 and 2011 (n = 1,800) were determined from the NZ Cancer Registry and linked to mortality data. Census data were used to estimate population incidence of TC and tumor sub-type by ethnic group. Kaplan-Meier and Cox regression analyses were used to compare survival between ethnic groups. RESULTS Māori males aged 15-44 were 80% more likely to be diagnosed with TC compared to European/Other males [age-standardized relative risk (RR) 1.80, 95% CI 1.58-2.05]. By contrast, disease burden was comparatively low among Pacific and Asian populations. Māori had a greater incidence of both seminoma (RR 1.88, 95% CI 1.52-2.22) and non-seminoma (RR 1.67, 95% CI 1.35-2.07) germ cell tumors than the European/Other population, reducing the likelihood that our observed disparity is driven by differential propensity to one given sub-type among Māori. Māori had poorer survival outcomes [cancer-specific adjusted hazard ratio (HR) 2.29, 95% CI 1.14-4.59] than the European/Other population. CONCLUSIONS Understanding the drivers of New Zealand's unusual incidence disparities--particularly between Māori and Pacific--could further our understanding of the key exposures involved in TC etiology.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand,
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Lawton B, Filoche SK, Rose SB, Stanley J, Garrett S, Robson B, Brown S, Sykes P. Uterine cancer: exploring access to services in the public health system. Aust N Z J Obstet Gynaecol 2014; 54:457-61. [PMID: 25287562 DOI: 10.1111/ajo.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/11/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding (PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact (FMC) to first specialist appointment (FSA). AIMS To compare access to services for the investigation of PMB between Māori and non-Māori women. MATERIALS AND METHODS The time interval between FMC to FSA was obtained from medical records for women presenting to gynaecology clinics for PMB. Dates of first bleeding symptoms, knowledge and access issues were collected in a nurse-administered questionnaire. RESULTS A total of 154 women (n = 27 Māori and 127 non-Māori) participated in the study. 23% of women had their FSA from FMC within 28 days and 67% waited more than six weeks. The 75th percentile was approximately two weeks longer for Māori women. 25% (n = 37) of women were not aware that they needed to see a doctor about PMB, and this was significantly more common for Māori women (44%; 95% CI 25-65) than non-Māori women (20%; 95% CI 13-28; P = 0.011). CONCLUSIONS The majority of women were not seen for FSA within 28 days of their FMC. Māori women were more likely to experience lengthy delays and to report that they did not know they should see a doctor about PMB. Further investigation into reasons for delays and initiatives to improve access to services and health information appears warranted.
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Affiliation(s)
- Beverley Lawton
- Women's Health Research Centre, Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
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