Effect of ethnicity and rurality on treatment delays in patients with colorectal cancer in Northland, New Zealand

Improved stage and survival for patients in the Aotearoa New Zealand colorectal cancer screening program 2012-2019

BACKGROUND

Colorectal cancer (CRC) screening was introduced in Aotearoa New Zealand at Waitematā District Health Board (WDHB) in late 2011. This study reviewed patterns of disease, treatment received, and survival of patients with national bowel screening program (NBSP)-detected CRC versus non-NBSP patients at WDHB 2012-2019.

METHODS

Data collected retrospectively for all patients with adenocarcinoma of the colon or rectum at WDHB 2012-2019. Patient records were manually reviewed. Chi-square, Fisher's exact test and the Mann Whitney U-test used as appropriate. Kaplan-Meier and Cox proportional hazards regression modelling for survival analysis.

RESULTS

1667 patients included (360 NBSP and 1307 non-NBSP). 863 (51.8%) were male. Median age at diagnosis 73 years (range 21-100); NBSP patients were younger (median 68 vs. 76 years, P < 0.001). NBSP patients had significantly lower T, N, M and overall TNM stage than non-BSP patients. Median survival estimate on Kaplan-Meier analysis was 94 months for all patients. Statistically significant (P < 0.05) predictors of mortality on multi-variate regression analysis included increasing overall TNM stage compared with stage I (stage II HR 1.63 (95% CI 1.14-2.34), stage III HR 2.86 (95% CI 2.03-4.03), stage IV HR 7.73 (95% CI 5.59-10.68)), diagnosis within NBSP (HR 0.51 (95% CI 0.37-0.71)), increasing age in years (HR 1.03 (95% CI 1.02-1.03)), urgent/emergency surgery (HR 1.66 (95% CI 1.36-2.01)) and formal resection of primary tumour (HR 0.31 (95% CI 0.25-0.38)).

CONCLUSION

Patients diagnosed within the Aotearoa New Zealand NBSP were found to be younger and have earlier stage CRC. Diagnosis within the NBSP is an independent predictor of survival for patients with CRC.

Impact of rurality and ethnicity on complexity of acute diverticulitis in Northland, New Zealand

BACKGROUND

Acute diverticulitis is a common general surgical condition associated with significant costs and healthcare burden. It is unknown if rurality represents a barrier to healthcare and whether ethnic disparities exist in Northland, New Zealand. This study, therefore, aims to assess the impact of rurality and ethnicity on complexity, management, and outcomes in patients with acute diverticulitis.

METHODS

A retrospective observational study of all adults aged >18 years admitted with acute diverticulitis to any Northland District Health Board hospital between 1 January 2015 and 31 December 2019 was performed. Diverticulitis complexity was assessed using the modified Hinchey classification. The primary outcome was the effect of rurality and ethnicity on complexity of diverticulitis. Multivariable logistic regression was performed.

RESULTS

A total of 397 patients (mean age 60.3 years (standard deviation (SD) 13.8); 48.7% female) were included. Overall, 134 patients had complicated diverticulitis. Rurality nor distance from the hospital were not associated with complexity of diverticulitis or clinical outcomes (p > 0.05). Maori patients presented younger than non-Maori (mean 51 vs. 63 years, p < 0.001) but there was no difference in complications, management, or clinical outcomes (p > 0.05). On multivariable analysis, rurality status and Maori ethnicity were not associated with more complicated diverticulitis.

CONCLUSION

This study found that rurality and ethnicity were not significant predictors of the complexity of diverticulitis.

Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples

PURPOSE OF REVIEW

Persistent and significant inequalities for Indigenous people with cancer around the globe exist, arising from colonial settlement of Indigenous land with profound social, economic and cultural impacts. We summarize recent publications concerning cancer disparities affecting Australian Aboriginal and Torres Strait Islander Peoples and Aotearoa New Zealand Māori Peoples.

RECENT FINDINGS

Cancer-free survival and overall survival statistics testify to the urgent need to 'close the gap'. For Indigenous peoples in Australia and New Zealand, disparity persists along the cancer care pathway, from increased risk factors to lower screening access, health resource utilization and survivorship care. Recent publications highlight multimorbidity as contributing to poor cancer outcomes in Indigenous populations. The implementation of tailored Optimal Care Pathways is described, as is the validation of tailored tools capturing the perspectives of Indigenous persons. Finally, the importance of Indigenous-led research is emphasized.

SUMMARY

Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.