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Clark Adnyamathanha JR, Buck Kamilaroi J, Richards-Satour Adnyamathanha And Barngarla A, Lyons Jaadwa L, Brown Yuin A. Towards precision cancer medicine for Aboriginal and Torres Strait Islander cancer health equity. Med J Aust 2024; 221:68-73. [PMID: 38946636 DOI: 10.5694/mja2.52346] [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: 01/15/2024] [Accepted: 05/09/2024] [Indexed: 07/02/2024]
Abstract
Delivering cancer control at scale for Aboriginal and Torres Strait Islander communities is a national priority that requires Aboriginal and Torres Strait Islander leadership and codesign, as well as significant involvement of the Aboriginal community-controlled health sector. The unique genomic variation observed among Aboriginal and Torres Strait Islander peoples may have implications for standard and precision medicine. Yet, Aboriginal and Torres Strait Islander peoples are absent from, or under-represented within, human reference genome resources, genomic studies, cancer studies, cancer cell lines, patient-derived xenografts and cancer clinical trials. Genomics-guided precision cancer medicine offers an opportunity to reduce cancer health disparities experienced by Aboriginal and Torres Strait Islander peoples through personalising prevention, diagnosis, treatment and long term management. Here, we describe what is required to ensure that Aboriginal and Torres Strait Islander peoples can receive the benefits of precision cancer medicine. Equity of access to care, an Aboriginal and Torres Strait Islander cancer workforce, and appropriate genome reference resources are important for safe and effective cancer medicine. Building Indigenous data sovereignty principles and Aboriginal and Torres Strait Islander governance into research is required to protect Aboriginal and Torres Strait Islander rights and collective interests. Aboriginal and Torres Strait Islander community engagement should be undertaken to develop an understanding of the unique cultural and ethical considerations for precision cancer research. Local and national genomic health research guidelines are needed to define a consensus best practice in genomics research with Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
| | - Jessica Buck Kamilaroi
- Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA
- Centre for Child Health Research, University of Western Australia, Perth, WA
| | | | | | - Alex Brown Yuin
- Telethon Kids Institute, Adelaide, SA
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT
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2
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Henningham M, Gilroy J, McGlone J, Meehan D, Nila F, McAtamney A, Buchanan T. Utilising the CREATE quality appraisal tool to analyse Aboriginal and Torres Strait Islander peoples' involvement and reporting of cancer research in Australia. Aust N Z J Public Health 2024; 48:100142. [PMID: 38574430 DOI: 10.1016/j.anzjph.2024.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE We aimed to evaluate Aboriginal and Torres Strait Islander involvement in research focusing on cancer experiences using an Aboriginal and Torres Strait Islander quality appraisal tool (the QAT). METHODS We conducted a systematic review of the peer-reviewed literature on Aboriginal and Torres Strait Islander peoples' experiences associated with cancer, recently published elsewhere. We then appraised articles for the inclusion of Aboriginal and Torres Strait Islander-led research, community consultation, and involvement. RESULTS 91 articles were appraised. A lack of Aboriginal and Torres Strait Islander-led research and consultation was reported in the majority of articles, only 10 (11%) demonstrated success across seven (50%) or more questions of the QAT. CONCLUSIONS This review underscores the need for anti-racist research and publication practices that actively engage Aboriginal and Torres Strait Islander peoples and researchers. This approach is vital to enhance cancer outcomes within these communities. IMPLICATIONS FOR PUBLIC HEALTH To advance and prioritise appropriate involvement of Aboriginal and Torres Strait Islander peoples in cancer research, the onus must be on 'systems owners,' including academic journals and institutions, to require and report genuine engagement as standard practice. Researchers will produce higher-calibre research with a strengths-based focus, advancing the cause of equitable research.
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Affiliation(s)
- Mandy Henningham
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - John Gilroy
- Charles Perkins Centre and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Drew Meehan
- Cancer Council Australia, Sydney, NSW, 2000, Australia
| | - Farhana Nila
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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3
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Dasgupta P, Harris VM, Garvey G, Aitken JF, Baade PD. Factors associated with cancer survival disparities among Aboriginal and Torres Strait Islander peoples compared with other Australians: A systematic review. Front Oncol 2022; 12:968400. [PMID: 36185181 PMCID: PMC9521397 DOI: 10.3389/fonc.2022.968400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background While cancer survival among Aboriginal and Torres Strait Islander peoples has improved over time, they continue to experience poorer cancer survival than other Australians. Key drivers of these disparities are not well understood. This systematic review aimed to summarise existing evidence on Aboriginal and Torres Strait Islander cancer survival disparities and identify influential factors and potential solutions. Methods In accordance with PRISMA guidelines, multiple databases were systematically searched for English language peer-reviewed articles on cancer survival by Aboriginal and Torres Strait Islander status published from 1/1/2008 to 4/05/2022. Observational studies presenting adjusted survival measures in relation to potential causal factors for disparities were included. Articles were screened independently by two authors. Included studies were critically assessed using Joanna Briggs Institute tools. Results Thirty population-based and predominantly state-level studies were included. A consistent pattern of poorer unadjusted cancer survival for Aboriginal and Torres Strait Islander peoples was evident. Studies varied widely in the covariates adjusted for including a combination of socio-demographics, cancer stage, comorbidities, and treatment. Potential contributions of these factors varied by cancer type. For lung and female breast cancer, adjusting for treatment and comorbidities reduced the survival disparity, which, while still elevated was no longer statistically significant. This pattern was also evident for cervical cancer after adjustment for stage and treatment. However, most studies for all cancers combined, or colorectal cancer, reported that unexplained survival disparities remained after adjusting for various combinations of covariates. Conclusions While some of the poorer survival faced by Aboriginal and Torres Strait Islander cancer patients can be explained, substantial disparities likely to be related to Aboriginal determinants, remain. It is imperative that future research consider innovative study designs and strength-based approaches to better understand cancer survival for Aboriginal and Torres Strait Islander peoples and to inform evidence-based action.
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Affiliation(s)
- Paramita Dasgupta
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Veronica Martinez Harris
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joanne F. Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Peter D. Baade
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
- Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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4
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Mejía-Hernández JO, Keam SP, Saleh R, Muntz F, Fox SB, Byrne D, Kogan A, Pang L, Huynh J, Litchfield C, Caramia F, Lozano G, He H, You JM, Sandhu S, Williams SG, Haupt Y, Haupt S. Modelling aggressive prostate cancers of young men in immune-competent mice, driven by isogenic Trp53 alterations and Pten loss. Cell Death Dis 2022; 13:777. [PMID: 36075907 PMCID: PMC9465983 DOI: 10.1038/s41419-022-05211-y] [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: 05/26/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
Understanding prostate cancer onset and progression in order to rationally treat this disease has been critically limited by a dire lack of relevant pre-clinical animal models. We have generated a set of genetically engineered mice that mimic human prostate cancer, initiated from the gland epithelia. We chose driver gene mutations that are specifically relevant to cancers of young men, where aggressive disease poses accentuated survival risks. An outstanding advantage of our models are their intact repertoires of immune cells. These mice provide invaluable insight into the importance of immune responses in prostate cancer and offer scope for studying treatments, including immunotherapies. Our prostate cancer models strongly support the role of tumour suppressor p53 in functioning to critically restrain the emergence of cancer pathways that drive cell cycle progression; alter metabolism and vasculature to fuel tumour growth; and mediate epithelial to mesenchymal-transition, as vital to invasion. Importantly, we also discovered that the type of p53 alteration dictates the specific immune cell profiles most significantly disrupted, in a temporal manner, with ramifications for disease progression. These new orthotopic mouse models demonstrate that each of the isogenic hotspot p53 amino acid mutations studied (R172H and R245W, the mouse equivalents of human R175H and R248W respectively), drive unique cellular changes affecting pathways of proliferation and immunity. Our findings support the hypothesis that individual p53 mutations confer their own particular oncogenic gain of function in prostate cancer.
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Affiliation(s)
- Javier Octavio Mejía-Hernández
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,Present Address: Telix Pharmaceuticals Ltd, Melbourne, VIC 3051 Australia
| | - Simon P. Keam
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1135.60000 0001 1512 2287Present Address: CSL Innovation, CSL Ltd, Melbourne, VIC 3052 Australia
| | - Reem Saleh
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Fenella Muntz
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Stephen B. Fox
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - David Byrne
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1055.10000000403978434Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Arielle Kogan
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Lokman Pang
- grid.1018.80000 0001 2342 0938Olivia Newton-John Cancer Research Institute, School of Cancer Medicine, La Trobe University, Heidelberg, VIC 3084 Australia
| | - Jennifer Huynh
- grid.1018.80000 0001 2342 0938Olivia Newton-John Cancer Research Institute, School of Cancer Medicine, La Trobe University, Heidelberg, VIC 3084 Australia
| | - Cassandra Litchfield
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Franco Caramia
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Guillermina Lozano
- grid.240145.60000 0001 2291 4776Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX USA ,grid.267308.80000 0000 9206 2401University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX USA
| | - Hua He
- grid.240145.60000 0001 2291 4776Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX USA
| | - James M. You
- grid.267308.80000 0000 9206 2401University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, University of Texas, Houston, TX USA ,grid.240145.60000 0001 2291 4776Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX USA
| | - Shahneen Sandhu
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC 3000 Australia
| | - Scott G. Williams
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
| | - Ygal Haupt
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,Present Address: Vittail Ltd, Melbourne, VIC 3146 Australia
| | - Sue Haupt
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia
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Novel germline mutations for active surveillance and imaging strategies in prostate cancer. Curr Opin Urol 2022; 32:456-461. [PMID: 35855555 DOI: 10.1097/mou.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review highlights the emerging role of genetics-lead medicine (GLM) in prostate cancer. We describe the benefits of GLM integration into prostate cancer screening, diagnosis and management. Imaging techniques enhancing prostate cancer detection are advancing concurrently, facilitating strategic active surveillance protocols for appropriately selected patients. We aim to improve clinician awareness of the role of GLM in current and future practice. RECENT FINDINGS We explore recent literature advancing the role of GLM in prostate cancer detection and management, particularly as this coexists with the development of imaging technology. Our current understanding of germline mutations implicated in familial prostate cancer development is summarized. We describe how these developments are being utilized to inform screening, surveillance and the development of novel therapies. We summarize current guidelines and explore factors inhibiting optimal implementation of recommendations in clinical practice. SUMMARY Integration and further development of genetics-lead medicine in the detection, surveillance and management of prostate cancer will improve clinical outcomes for men at risk of aggressive disease as a result of familial predispositions to prostate cancer. This review summarizes the pertinent developments in the field including improving clinician awareness to facilitate implantation of these strategies into current clinical practice.
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Fitzadam S, Lin E, Creighton N, Currow DC. Lung, breast and bowel cancer treatment for Aboriginal people in New South Wales: a population-based cohort study. Intern Med J 2021; 51:879-890. [PMID: 32638476 PMCID: PMC8362177 DOI: 10.1111/imj.14967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/23/2020] [Accepted: 06/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aboriginal Australians have higher cancer mortality than non-Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this. AIMS To investigate demographic, clinical and access factors associated with lung, breast and bowel cancer treatment for Aboriginal people compared with non-Aboriginal people in New South Wales, Australia. METHODS Population-based cohort study using linked routinely collected datasets, including all diagnoses of primary lung, breast or bowel cancer from January 2009 to June 2012. Treatment (surgery, radiotherapy or chemotherapy) within 6 months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer-specific multidisciplinary team, visit to a specialist and possession of private health insurance. Logistic regression modelling was employed. RESULTS There were 587 Aboriginal and 34 015 non-Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non-Aboriginal people received surgery (odds ratio 0.46, 95% confidence interval 0.29-0.73, P < 0.001) or any treatment (surgery, chemotherapy or radiotherapy; odds ratio 0.64, 95% confidence interval 0.47-0.88, P = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 vs 33.3%, 2865/8597, P = 0.04) compared with non-Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non-Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities. CONCLUSION Aboriginal people were significantly less likely to receive surgery for lung cancer than non-Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways.
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Affiliation(s)
- Suzanne Fitzadam
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Enmoore Lin
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Nicola Creighton
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - David C Currow
- Chief Cancer Officer, Cancer Institute NSW, Sydney, New South Wales, Australia
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7
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Prostate cancer outcomes disparities: Population survival analysis in an ethnically diverse nation. Urol Oncol 2021; 39:367.e19-367.e26. [PMID: 33858746 DOI: 10.1016/j.urolonc.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer represents a significant health burden on New Zealand men. There are increasing concerns regarding inequities in prostate cancer morbidity and mortality among the different ethnic groups in New Zealand. This study aims to assess ethnic differences in survival outcomes among men newly diagnosed with prostate cancer. MATERIALS AND METHODS The analyzed cohort included 42,563 men, 40 years or older, diagnosed with prostate cancer from January 1st, 2000 to January 1st, 2016. Overall and cancer-specific survivals were estimated for the main ethnic groups in New Zealand namely: Māori (indigenous), Pacific, Asian, and European. Hazard ratio (HR) of death from prostate cancer was calculated with Fine-Gray competing risk regression, while adjusting for age, socioeconomic deprivation, year of cancer diagnosis, residential status, presence of urology service, and cancer grade at diagnosis. RESULTS Among all ethnic groups, Māori participants consistently had worst survival outcomes. At 15-year follow-up, the overall cumulative survival probabilities were 39.8%, 43.6%, 63.3%, and 46.5%, for Māori, Pacific, Asian and European men, respectively. In the same order, cancer-specific survivals were 62.7%, 64.3%, 79.8% and 72.0%. Māori men had 43% higher risk of dying from prostate cancer when compared to Europeans. This persisted following adjustments in the multivariable model (adjusted HR = 1.44, [95% CI: 1.29-1.61], P< 0.001). Conversely, differences in sociodemographic and cancer characteristics between Pacific and European men could explain the higher mortality risk in the former group (adjusted HR = 1.00, [95% CI: 0.84-1.19], P= 0.990). CONCLUSIONS Significant ethnic disparities in prostate cancer survival outcomes are currently present in New Zealand. Several explanations have been proposed to account for this observation including differences in comorbidities, healthcare access and cancer grade at diagnosis.
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8
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Yap ML, O'Connell DL, Goldsbury DE, Weber MF, Smith DP, Barton MB. Patterns of care for men with prostate cancer: the 45 and Up Study. Med J Aust 2021; 214:271-278. [PMID: 33665811 DOI: 10.5694/mja2.50966] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe patterns of care in New South Wales for men with prostate cancer, and to ascertain factors associated with receiving different types of treatment. DESIGN Individual patient data record linkage study. SETTING, PARTICIPANTS 4003 New South Wales men aged 45 years or more enrolled in the population-based 45 and Up Study in whom prostate cancer was first diagnosed during 2006-2013. MAIN OUTCOME MEASURES Prostate cancer treatment type received; factors statistically associated with treatment received; proportions of patients who consulted radiation oncologists prior to treatment. RESULTS In total, 1619 of 4003 patients underwent radical prostatectomy (40%), 893 external beam radiotherapy (EBRT) (22%), 183 brachytherapy (5%), 87 chemotherapy (2%), 373 androgen deprivation therapy alone (9%), and 848 no active treatment (21%). 205 of 1628 patients who had radical prostatectomies (13%) had radiation oncology consultations prior to surgery. Radical prostatectomy was more likely for patients aged 45-59 years, with regional stage disease, living 100 km or more from the nearest radiotherapy centre, having partners, or having private health insurance, while lower physical functioning, obesity, and living in areas of greater socio-economic disadvantage reduced the likelihood. EBRT was more likely for patients aged 70-79 years, with non-localised or unknown stage disease, living less than 100 km from the nearest radiotherapy centre, or not having private health insurance, while the likelihood was lower for patients aged 45-59 years or more than 80 years and for those who had several comorbid conditions. CONCLUSIONS Men with prostate cancer were twice as likely to have radical prostatectomy as to receive EBRT, and fewer than one in seven had consulted radiation oncologists prior to prostatectomy. The treatment received was influenced by several socio-demographic factors. Given the treatment-specific side effects and costs, policies that affect access to different treatments for prostate cancer should be reviewed.
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Affiliation(s)
- Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Sydney, NSW.,Cancer Council NSW, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | | | - Marianne F Weber
- Cancer Council NSW, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - David P Smith
- Cancer Council NSW, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Sydney, NSW
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9
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Dunn J, Green A, Ralph N, Newton RU, Kneebone A, Frydenberg M, Chambers SK. Prostate cancer survivorship essentials framework: guidelines for practitioners. BJU Int 2020; 128 Suppl 3:18-29. [PMID: 32627306 PMCID: PMC9291032 DOI: 10.1111/bju.15159] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To develop contemporary and inclusive prostate cancer survivorship guidelines for the Australian setting. Participants and Methods A four‐round iterative policy Delphi was used, with a 47‐member expert panel that included leaders from key Australian and New Zealand clinical and community groups and consumers from diverse backgrounds, including LGBTQIA people and those from regional, rural and urban settings. The first three rounds were undertaken using an online survey (94–96% response) followed by a fourth final face‐to‐face panel meeting. Descriptors for men’s current prostate cancer survivorship experience were generated, along with survivorship elements that were assessed for importance and feasibility. From these, survivorship domains were generated for consideration. Results Six key descriptors for men’s current prostate cancer survivorship experience that emerged were: dealing with side effects; challenging; medically focused; uncoordinated; unmet needs; and anxious. In all, 26 survivorship elements were identified within six domains: health promotion and advocacy; shared management; vigilance; personal agency; care coordination; and evidence‐based survivorship interventions. Consensus was high for all domains as being essential. All elements were rated high on importance but consensus was mixed for feasibility. Seven priorities were derived for immediate action. Conclusion The policy Delphi allowed a uniquely inclusive expert clinical and community group to develop prostate cancer survivorship domains that extend beyond traditional healthcare parameters. These domains provide guidance for policymakers, clinicians, community and consumers on what is essential for step change in prostate cancer survivorship outcomes.
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Affiliation(s)
- Jeff Dunn
- Prostate Cancer Foundation of Australia; Sydney NSW Australia
- Division of Research and Innovation; University of Southern Queensland; Springfield Qld Australia
- Cancer Council Queensland; Brisbane Qld Australia
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
| | - Anna Green
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
| | - Nicholas Ralph
- Division of Research and Innovation; University of Southern Queensland; Springfield Qld Australia
- Cancer Council Queensland; Brisbane Qld Australia
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
- School of Nursing and Midwifery; University of Southern Queensland; Toowoomba Qld Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute; Edith Cowan University; Perth WA Australia
- School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Qld Australia
| | - Andrew Kneebone
- Royal North Shore Hospital; Sydney NSW Australia
- School of Medicine; University of Sydney; Sydney NSW Australia
| | | | - Suzanne K. Chambers
- Division of Research and Innovation; University of Southern Queensland; Springfield Qld Australia
- Faculty of Health; University of Technology Sydney; Ultimo NSW Australia
- Exercise Medicine Research Institute; Edith Cowan University; Perth WA Australia
- Menzies Health Institute Queensland; Gold Coast Qld Australia
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10
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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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11
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Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4:CD012663. [PMID: 31022301 PMCID: PMC6483565 DOI: 10.1002/14651858.cd012663.pub2] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision-making. OBJECTIVES To determine the diagnostic accuracy of the index tests MRI only, MRI-targeted biopsy, the MRI pathway (MRI with or without MRI-targeted biopsy) and systematic biopsy as compared to template-guided biopsy as the reference standard in detecting clinically significant prostate cancer as the target condition, defined as International Society of Urological Pathology (ISUP) grade 2 or higher. Secondary target conditions were the detection of grade 1 and grade 3 or higher-grade prostate cancer, and a potential change in the number of biopsy procedures. SEARCH METHODS We performed a comprehensive systematic literature search up to 31 July 2018. We searched CENTRAL, MEDLINE, Embase, eight other databases and one trials register. SELECTION CRITERIA We considered for inclusion any cross-sectional study if it investigated one or more index tests verified by the reference standard, or if it investigated the agreement between the MRI pathway and systematic biopsy, both performed in the same men. We included only studies on men who were biopsy naïve or who previously had a negative biopsy (or a mix of both). Studies involving MRI had to report on both MRI-positive and MRI-negative men. All studies had to report on the primary target condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the risk of bias using the QUADAS-2 tool. To estimate test accuracy, we calculated sensitivity and specificity using the bivariate model. To estimate agreement between the MRI pathway and systematic biopsy, we synthesised detection ratios by performing random-effects meta-analyses. To estimate the proportions of participants with prostate cancer detected by only one of the index tests, we used random-effects multinomial or binary logistic regression models. For the main comparisions, we assessed the certainty of evidence using GRADE. MAIN RESULTS The test accuracy analyses included 18 studies overall.MRI compared to template-guided biopsy: Based on a pooled sensitivity of 0.91 (95% confidence interval (CI): 0.83 to 0.95; 12 studies; low certainty of evidence) and a pooled specificity of 0.37 (95% CI: 0.29 to 0.46; 12 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI may result in 273 (95% CI: 249 to 285) true positives, 441 false positives (95% CI: 378 to 497), 259 true negatives (95% CI: 203 to 322) and 27 (95% CI: 15 to 51) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.MRI-targeted biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.80 (95% CI: 0.69 to 0.87; 8 studies; low certainty of evidence) and a pooled specificity of 0.94 (95% CI: 0.90 to 0.97; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI-targeted biopsy may result in 240 (95% CI: 207 to 261) true positives, 42 (95% CI: 21 to 70) false positives, 658 (95% CI: 630 to 679) true negatives and 60 (95% CI: 39 to 93) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.The MRI pathway compared to template-guided biopsy: Based on a pooled sensitivity of 0.72 (95% CI: 0.60 to 0.82; 8 studies; low certainty of evidence) and a pooled specificity of 0.96 (95% CI: 0.94 to 0.98; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, the MRI pathway may result in 216 (95% CI: 180 to 246) true positives, 28 (95% CI: 14 to 42) false positives, 672 (95% CI: 658 to 686) true negatives and 84 (95% CI: 54 to 120) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations, inconsistency and imprecision.Systemic biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.63 (95% CI: 0.19 to 0.93; 4 studies; low certainty of evidence) and a pooled specificity of 1.00 (95% CI: 0.91 to 1.00; 4 studies; low certainty of evidence) using a baseline prevalence of 30%, systematic biopsy may result in 189 (95% CI: 57 to 279) true positives, 0 (95% CI: 0 to 63) false positives, 700 (95% CI: 637 to 700) true negatives and 111 (95% CI: 21 to 243) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.Agreement analyses: In a mixed population of both biopsy-naïve and prior-negative biopsy men comparing the MRI pathway to systematic biopsy, we found a pooled detection ratio of 1.12 (95% CI: 1.02 to 1.23; 25 studies). We found pooled detection ratios of 1.44 (95% CI 1.19 to 1.75; 10 studies) in prior-negative biopsy men and 1.05 (95% CI: 0.95 to 1.16; 20 studies) in biopsy-naïve men. AUTHORS' CONCLUSIONS Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed. The certainty in our findings was reduced by study limitations, specifically issues surrounding selection bias, as well as inconsistency. Based on these findings, further improvement of prostate cancer diagnostic pathways should be pursued.
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Affiliation(s)
- Frank‐Jan H Drost
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daniël F Osses
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daan Nieboer
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ewout W Steyerberg
- Erasmus University Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Chris H Bangma
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Monique J Roobol
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ivo G Schoots
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
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12
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Nesbitt AL, Kapoor J, Piesse C, Evans G, Antoniou S, Smith P, Pridgeon SW. Prediction of pathological stage at radical prostatectomy: do commonly used prostate cancer nomograms apply to men from Far North Queensland? ANZ J Surg 2018; 89:111-114. [PMID: 30560567 DOI: 10.1111/ans.14960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical nomograms are routinely used by urologists to predict pathological and clinical outcomes. Commonly used prostate cancer nomograms include Partin's tables and Memorial Sloan Kettering Cancer Centre (MSKCC) nomograms which were developed in high-volume centres in the United States. We aimed to assess whether these tools are valid for prostate cancer patients in Far North Queensland. METHODS All patients undergoing radical prostatectomy in Cairns between August 2014 and September 2017 were identified. Preoperative data were entered into the online nomogram tools. The predicted probability of organ-confined (OC) disease, extra-prostatic extension (EPE) and seminal vesical invasion was compared to the observed outcomes. RESULTS Preoperative clinical information was available for 290 patients. Partin's tables accurately estimated OC disease, EPE and seminal vesical invasion with the observed outcome plot overlying the ideal correlation curve. More patients in our cohort had OC disease than was predicted by the MSKCC nomogram; fewer patients had EPE that was predicted by the MSKCC nomogram. On logistic regression modelling, the area under the curve for MSKCC and Partin's were 0.751 and 0.706, respectively, suggesting both tests have good performance in predicting final pathological outcome for our population of patients with no statistical difference between the two nomograms (P = 0.29). CONCLUSION The MSKCC preoperative nomogram and Partin's tables were both able to accurately predict pathological outcomes from preoperative clinical information in men from Far North Queensland, despite likely differences in population genetics and environmental exposures.
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Affiliation(s)
| | - Jada Kapoor
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Charlotte Piesse
- Department of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Garrath Evans
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia.,Northern Urology, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Stefan Antoniou
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia.,Northern Urology, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Philip Smith
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia.,Northern Urology, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Simon W Pridgeon
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia.,Northern Urology, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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13
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Tervonen HE, Walton R, You H, Baker D, Roder D, Currow D, Aranda S. After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales. BMC Cancer 2017; 17:398. [PMID: 28577351 PMCID: PMC5457659 DOI: 10.1186/s12885-017-3374-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/18/2017] [Indexed: 01/07/2023] Open
Abstract
Background Aboriginal and Torres Strait Islander peoples in Australia have been found to have poorer cancer survival than non-Aboriginal people. However, use of conventional relative survival analyses is limited due to a lack of life tables. This cohort study examined whether poorer survival persist after accounting for competing risks of death from other causes and disparities in cancer stage at diagnosis, for all cancers collectively and by cancer site. Methods People diagnosed in 2000–2008 were extracted from the population-based New South Wales Cancer Registry. Aboriginal status was multiply imputed for people with missing information (12.9%). Logistic regression models were used to compute odds ratios (ORs) with 95% confidence intervals (CIs) for ‘advanced stage’ at diagnosis (separately for distant and distant/regional stage). Survival was examined using competing risk regression to compute subhazard ratios (SHRs) with 95%CIs. Results Of the 301,356 cases, 2517 (0.84%) identified as Aboriginal (0.94% after imputation). After adjusting for age, sex, year of diagnosis, socio-economic status, remoteness, and cancer site Aboriginal peoples were more likely to be diagnosed with distant (OR 1.30, 95%CI 1.17–1.44) or distant/regional stage (OR 1.29, 95%CI 1.18–1.40) for all cancers collectively. This applied to cancers of the female breast, uterus, prostate, kidney, others (those not included in other categories) and cervix (when analyses were restricted to cases with known stages/known Aboriginal status). Aboriginal peoples had a higher hazard of death than non-Aboriginal people after accounting for competing risks from other causes of death, socio-demographic factors, stage and cancer site (SHR 1.40, 95%CI 1.31–1.50 for all cancers collectively). Consistent results applied to colorectal, lung, breast, prostate and other cancers. Conclusions Aboriginal peoples with cancer have an elevated hazard of cancer death compared with non-Aboriginal people, after accounting for more advanced stage and competing causes of death. Further research is needed to determine reasons, including any contribution of co-morbidity, lifestyle factors and differentials in service access to help explain disparities.
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Affiliation(s)
- Hanna E Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Richard Walton
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Hui You
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Deborah Baker
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.,Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Currow
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Sanchia Aranda
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
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14
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Yerrell PH, Roder D, Cargo M, Reilly R, Banham D, Micklem JM, Morey K, Stewart HB, Stajic J, Norris M, Brown A. Cancer Data and Aboriginal Disparities (CanDAD)-developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol. BMJ Open 2016; 6:e012505. [PMID: 28011808 PMCID: PMC5223717 DOI: 10.1136/bmjopen-2016-012505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancer-related mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. METHODS AND ANALYSIS The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non-Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. ETHICS AND DISSEMINATION The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of the recommendations in these documents.
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Affiliation(s)
- Paul Henry Yerrell
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Epidemiology Group, Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Margaret Cargo
- Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Rachel Reilly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jasmine May Micklem
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Harold Bundamurra Stewart
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Janet Stajic
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Michael Norris
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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15
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Baade PD, Dasgupta P, Dickman PW, Cramb S, Williamson JD, Condon JR, Garvey G. Quantifying the changes in survival inequality for Indigenous people diagnosed with cancer in Queensland, Australia. Cancer Epidemiol 2016; 43:1-8. [DOI: 10.1016/j.canep.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/30/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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Gibberd A, Supramaniam R, Dillon A, Armstrong BK, O'Connell DL. Lung cancer treatment and mortality for Aboriginal people in New South Wales, Australia: results from a population-based record linkage study and medical record audit. BMC Cancer 2016; 16:289. [PMID: 27112140 PMCID: PMC4845365 DOI: 10.1186/s12885-016-2322-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to compare surgical treatment received by Aboriginal and non-Aboriginal people with non-small cell lung cancer (NSCLC) in New South Wales (NSW), Australia and to examine whether patient and disease characteristics are associated with any disparities found. An additional objective was to describe the adjuvant treatments received by Aboriginal people diagnosed with NSCLC in NSW. Finally, we compared the risk of death from NSCLC for Aboriginal and non-Aboriginal people. Methods We used logistic regression and competing risks regression to analyse population-based cancer registry records for people diagnosed with NSCLC in NSW, 2001–2007, linked to hospital inpatient episodes and deaths. We also analysed treatment patterns from a medical record audit for 170 Aboriginal people diagnosed with NSCLC in NSW, 2000–2010. Results Of 20,154 people diagnosed with primary lung cancer, 341 (1.7 %) were Aboriginal. Larger proportions of Aboriginal people were younger, female, living outside major cities or in areas of greater socioeconomic disadvantage, smoking at the time of diagnosis and had comorbidities. Although Aboriginal people were, on average, younger at diagnosis with non-metastatic NSCLC than non-Aboriginal people, only 30.8 % of Aboriginal people received surgery, compared with 39.5 % of non-Aboriginal people. Further, Aboriginal people who were not receiving surgery, at the time of diagnosis, were more likely to be younger, live in major cities and have no comorbidities. The observed risk of death from NSCLC 5 years after diagnosis was higher for 266 Aboriginal people (83.3 % 95 % CI 77.5–87.7) than for 15,491 non-Aboriginal people (77.6 % 95 % CI 76.9–78.3) and the adjusted subhazard ratio was 1.32 (95 % CI 1.14–1.52). From the medical record audit, 29 % of Aboriginal people with NSCLC had potentially curative treatment, 45 % had palliative radiotherapy/chemotherapy and 26 % had no active treatment. Conclusions There are disparities in NSCLC surgical treatment and mortality for Aboriginal people compared with non-Aboriginal people in NSW. It is imperative that Aboriginal people are offered active lung cancer treatment, particularly those who are younger and without comorbidities and are therefore most likely to benefit, and are provided with assistance to access it if required.
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Affiliation(s)
- Alison Gibberd
- School of Public Health, University of Sydney, Sydney, Australia
| | | | - Anthony Dillon
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | | | - Dianne L O'Connell
- School of Public Health, University of Sydney, Sydney, Australia. .,Cancer Research Division, Cancer Council NSW, Sydney, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
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18
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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: 11] [Impact Index Per Article: 1.4] [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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Evans SM, Nag N, Roder D, Brooks A, L Millar J, Moretti KL, Pryor D, Skala M, J. McNeil J. Development of an International Prostate Cancer Outcomes Registry. BJU Int 2016; 117 Suppl 4:60-7. [DOI: 10.1111/bju.13258] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sue M. Evans
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - Nupur Nag
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - David Roder
- Centre for Population Health Research; University of South Australia; Adelaide SA Australia
| | - Andrew Brooks
- Department of Urology Westmead Hospital; Westmead NSW Australia
| | | | - Kim L Moretti
- Centre for Population Health Research; University of South Australia; Adelaide SA Australia
| | - David Pryor
- Department of Radiation Oncology; Princess Alexandra Hospital; Wooloongabba Qld Australia
| | | | - John J. McNeil
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
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20
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Carson PJ. Survival after the diagnosis of prostate cancer for Australian Aboriginal and Māori men. BJU Int 2015; 115 Suppl 5:14-5. [DOI: 10.1111/bju.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Phillip J. Carson
- Royal Darwin Hospital and Flinders NT Medical School; Tiwi NT Australia
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21
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Basto M, Goggins A, Loeb S. Updates in the care and management of prostate cancer: highlights from the 2013 prostate cancer world congress, august 6-10, 2013, melbourne, australia. Rev Urol 2013; 15:185-7. [PMID: 24659915 PMCID: PMC3922323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Marnique Basto
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Aine Goggins
- Department of Medicine, Queen's University, Belfast, UK
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and the Manhattan Veterans Affairs Hospital, New York, NY
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