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Clough S, Wheeler M, Stanley J, Signal V, Ruka M, Koea J, Gurney J. Blood cancer incidence, mortality and survival for Māori in New Zealand. Cancer Epidemiol 2024; 93:102656. [PMID: 39217827 DOI: 10.1016/j.canep.2024.102656] [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: 06/05/2024] [Revised: 08/05/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Haematological ('blood') cancers are a diverse group of non-solid cancers with varying incidence, mortality and survival. While there is some evidence that Māori experience disparities in blood cancer outcomes relative to New Zealand's majority European population, there is a need for a comprehensive overview of the current state of evidence in this context. METHODS Blood cancer registrations were derived from the NZ Cancer Registry for the 2007-2019 period (combined blood cancers: 2653 Māori, 20,458 Europeans), and linked to Mortality records. We calculated age-sex-standardised incidence and mortality rates, and conducted cancer-specific survival analysis, for four main categories of blood cancers (leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma) as well as for sub-types of leukaemia non-Hodgkin lymphoma. RESULTS We found that Māori are more likely to be diagnosed with (incidence) and to die from (mortality) both leukaemia and myeloma, and similarly likely to be diagnosed or die from Hodgkin and non-Hodgkin lymphoma, compared to Europeans. Māori had demonstrably poorer cancer-specific survival outcomes across most blood cancer types (age-sex-adjusted hazard ratios [HRs], Māori vs European: leukaemia 1.77, 95 % CI 1.57-2.00; Hodgkin lymphoma 1.18, 95 % CI 0.65-2.16; non-Hodgkin lymphoma 1.71, 95 % CI 1.50-1.95; myeloma 1.40, 95 % CI 1.19-1.64). CONCLUSION Blood cancers are a common cancer type for Māori, and we found evidence of disparities in incidence, mortality and survival compared to Europeans. Further research is required to further pinpoint exactly where interventions should be aimed to reduce blood cancer incidence and address survival disparities for Māori.
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Affiliation(s)
| | | | | | | | - Myra Ruka
- Te Whatu Ora - Waikato, Hamilton, New Zealand.
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Signal V, Smith M, Costello S, Davies A, Dawkins P, Jackson CGCA, Koea J, Whitehead J, Gurney J. Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence. Cancer Causes Control 2024:10.1007/s10552-024-01904-1. [PMID: 39150625 DOI: 10.1007/s10552-024-01904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway. METHODS A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i). RESULTS Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway. CONCLUSION These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.
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Affiliation(s)
- Virginia Signal
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Moira Smith
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | | | - Anna Davies
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Paul Dawkins
- Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | | | | | | | - Jason Gurney
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
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Kelly RJ, Anderson GD, Joshi BS, Donald JJ. Utility of FDG PET-CT in CT Stage IA non-small cell lung cancer: The New Zealand Te Whatu Ora Northern region experience. J Med Imaging Radiat Oncol 2024. [PMID: 38941179 DOI: 10.1111/1754-9485.13720] [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: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Our objective was to investigate the utility of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in assessing CT Stage 1A non-small cell lung cancer (NSCLC) in patients under consideration for curative treatment. Performing FDG PET-CT in these patients may lead to unnecessary delays in treatment if it can be shown to provide no added value. METHODS We retrospectively reviewed 735 lesions in 653 patients from the New Zealand Te Whatu Ora Northern region lung cancer database with suspected or pathologically proven Stage 1A NSCLC on CT scan who also underwent FDG PET-CT imaging. We determined how often FDG PET-CT findings upstaged patients and then compared to pathological staging where available. RESULTS FDG PET-CT provided an overall upstaging rate of 9.7%. Category-specific rates were 0% in Tis, 0.9% in T1mi, 7.4% in T1a, 10% in T1b and 12% in T1c groups. The percentage of lesions upstaged on FDG PET-CT that remained Stage 1A was 100% in T1mi, 100% in T1a, 47.1% in T1b and 40.7% in T1c groups. The P value was statistically significant at 0.004, indicating upstaging beyond Stage 1A was dependent on T category. CONCLUSION Our data suggests that FDG PET-CT is indicated for T1b and T1c lesions but is of limited utility in Tis, T1mi and T1a lesions. Adopting a more targeted approach and omitting FDG PET-CT in patients with Tis, T1mi, and T1a lesions may benefit all patients with lung cancer by improving accessibility and treatment timelines.
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Affiliation(s)
- Richard J Kelly
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Graeme D Anderson
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Budresh S Joshi
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Jennifer J Donald
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
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Koea J, Chao P, Srinivasa S, Gurney J. Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume-outcome relationship with accessibility in a surgically low volume country. World J Surg 2024; 48:1481-1491. [PMID: 38610103 DOI: 10.1002/wjs.12174] [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: 12/22/2023] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION New Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a "low-volume center." However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand. METHODS Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset. RESULTS New Zealand is a low-volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid-Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non-Māori. CONCLUSIONS The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.
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Affiliation(s)
- Jonathan Koea
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Phillip Chao
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Sanket Srinivasa
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jason Gurney
- The Department of Public Health, The University of Otago, Wellington, New Zealand
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Cunningham R, Stanley J, Imlach F, Haitana T, Lockett H, Every-Palmer S, Clark MTR, Lacey C, Telfer K, Peterson D. Cancer diagnosis after emergency presentations in people with mental health and substance use conditions: a national cohort study. BMC Cancer 2024; 24:546. [PMID: 38689242 PMCID: PMC11062004 DOI: 10.1186/s12885-024-12292-9] [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: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Cancer survival and mortality outcomes for people with mental health and substance use conditions (MHSUC) are worse than for people without MHSUC, which may be partly explained by poorer access to timely and appropriate healthcare, from screening and diagnosis through to treatment and follow-up. Access and quality of healthcare can be evaluated by comparing the proportion of people who receive a cancer diagnosis following an acute or emergency hospital admission (emergency presentation) across different population groups: those diagnosed with cancer following an emergency presentation have lower survival. METHODS National mental health service use datasets (2002-2018) were linked to national cancer registry and hospitalisation data (2006-2018), to create a study population of people aged 15 years and older with one of four cancer diagnoses: lung, prostate, breast and colorectal. The exposure group included people with a history of mental health/addiction service contact within the five years before cancer diagnosis, with a subgroup of people with a diagnosis of bipolar disorder, schizophrenia or psychotic disorders. Marginal standardised rates were used to compare emergency presentations (hospital admission within 30 days of cancer diagnosis) in the exposure and comparison groups, adjusted for age, gender (for lung and colorectal cancers), ethnicity, area deprivation and stage at diagnosis. RESULTS For all four cancers, the rates of emergency presentation in the fully adjusted models were significantly higher in people with a history of mental health/addiction service use than people without (lung cancer, RR 1.19, 95% CI 1.13, 1.24; prostate cancer RR 1.69, 95% CI 1.44, 1.93; breast cancer RR 1.42, 95% CI 1.14, 1.69; colorectal cancer 1.31, 95% CI 1.22, 1.39). Rates were substantially higher in those with a diagnosis of schizophrenia, bipolar disorder or psychotic disorders. CONCLUSIONS Implementing pathways for earlier detection and diagnosis of cancers in people with MHSUC could reduce the rates of emergency presentation, with improved cancer survival outcomes. All health services, including cancer screening programmes, primary and secondary care, have a responsibility to ensure equitable access to healthcare for people with MHSUC.
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Veenstra N, Kewene F, Morgaine K, Crengle S. What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Māori public health competencies. Aust N Z J Public Health 2024; 48:100132. [PMID: 38422582 DOI: 10.1016/j.anzjph.2024.100132] [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: 06/26/2023] [Revised: 11/14/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This research sought to expand on a set of core Māori hauora ā-iwi/public health competencies initially designed for teaching and to enable their use in workplaces. METHODS The research used a kaupapa Māori methodology in four stages including the development of draft levels of competence for all core competencies, consultation hui (meetings), analysis of feedback and redrafting, and respondent validation. RESULTS Key themes elicited in relation to the content of the competencies included increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism. Reflective practice was identified as a fundamental cross-cutting competency. Participants suggested planetary health and political ideologies be included as additional socio-political determinants of health with equity impacts. Key concerns related to the application of the competency document included the need for cultural safety and ensuring that all public health practitioners are 'seen'. CONCLUSIONS The Māori hauora ā-iwi/public health competencies have been published under a Creative Commons licence. IMPLICATIONS FOR PUBLIC HEALTH The process of drafting a set of Māori public health competencies elicited key themes potentially relevant for public health practice in other countries and resulted in a competency document for use by universities and workplaces.
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Affiliation(s)
- Nina Veenstra
- Ngāi Tahu Māori Health Research Unit/ Te Roopū Rakahau Hauora Māori o Kāi Tahu, University of Otago/Te Whare Wānanga o Ōtago, Dunedin, New Zealand
| | - Fran Kewene
- School of Health/Te Kura Tātai Hauora, Victoria University Wellington/Te Herenga Waka, Wellington, New Zealand
| | - Kate Morgaine
- Department of Preventive and Social Medicine/Te Tari Hauora Tūmatanui, University of Otago/ Te Whare Wānanga o Ōtago, Dunedin, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit/ Te Roopū Rakahau Hauora Māori o Kāi Tahu, University of Otago/Te Whare Wānanga o Ōtago, Dunedin, New Zealand.
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Gurney J, Davies A, Stanley J, Whitehead J, Costello S, Dawkins P, Henare K, Jackson CGCA, Lawrenson R, Scott N, Koea J. Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand. Support Care Cancer 2024; 32:171. [PMID: 38378932 PMCID: PMC10879218 DOI: 10.1007/s00520-024-08375-9] [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: 10/03/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Centralisation of lung cancer treatment can improve outcomes, but may result in differential access to care for those who do not reside within treatment centres. METHODS We used national-level cancer registration and health care access data and used Geographic Information Systems (GIS) methods to determine the distance and time to access first relevant surgery and first radiation therapy among all New Zealanders diagnosed with lung cancer (2007-2019; N = 27,869), and compared these outcomes between ethnic groups. We also explored the likelihood of being treated at a high-, medium-, or low-volume hospital. Analysis involved both descriptive and adjusted logistic regression modelling. RESULTS We found that Māori tend to need to travel further (with longer travel times) to access both surgery (median travel distance: Māori 57 km, European 34 km) and radiation therapy (Māori 75 km, European 35 km) than Europeans. Māori have greater odds of living more than 200 km away from both surgery (adjusted odds ratio [aOR] 1.83, 95% CI 1.49-2.25) and radiation therapy (aOR 1.41, 95% CI 1.25-1.60). CONCLUSIONS Centralisation of care may often improve treatment outcomes, but it also makes accessing treatment even more difficult for populations who are more likely to live rurally and in deprivation, such as Māori.
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Affiliation(s)
- Jason Gurney
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
| | - Anna Davies
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - James Stanley
- University of Otago Wellington, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | | | | | - Paul Dawkins
- Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | | | | | - Ross Lawrenson
- Population and Public Health, Te Whatu Ora - Waikato, Hamilton, New Zealand
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Fyfe R, Anstis O, Kapadia K, Jordan M, Sword DO, Weinkove R. Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design. BMJ Open 2024; 14:e071112. [PMID: 38262637 PMCID: PMC10824048 DOI: 10.1136/bmjopen-2022-071112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES RE-TELL is a qualitative study, which aims to understand patient, support person, clinician and coordinator experiences and perspectives of chimeric antigen receptor (CAR) T-cell therapy, to inform design of a clinical CAR T-cell service in Aotearoa New Zealand. DESIGN Semistructured qualitative interviews focused on domains of: experience through treatment, elements that work well and those that could be improved on. Interviews used thematic analysis to identify key themes. A workshop was held to obtain participants' reflections on interim analysis and proposed improvements. PARTICIPANTS New Zealanders with experience of CAR T-cell therapy, including recipients, support persons, clinicians and coordinators. RESULTS We interviewed 19 participants comprising 5 CAR T-cell recipients, 3 support persons, 6 clinicians and 5 coordinators. Four participants identified as Māori. Thematic analysis identified three global themes. The first, 'sociocultural factors impact CAR T access', identified potential sources of inequity including geographic, financial and informed consent barriers. The second, 'varying emotions, roles and enablers', identified an easier treatment experience compared with alternatives; an underwhelming cell administration process; frustration with inpatient monitoring; burden on support persons and importance of 'bridge' organisations such as charities and patient support groups. Lastly, 'golden opportunities: reimagining CAR T service delivery', suggested: improved geographical access to CAR T-cell therapy, while retaining consolidated clinician experience; a 'dashboard' with information on CAR T-cell treatment, time frames and manufacture; a health navigator to co-ordinate non-medical aspects of treatment and signpost care; embedding of indigenous data sovereignty and ownership of cells; a cell infusion ceremony, incorporating family involvement and Māori cultural elements and outpatient administration and monitoring where possible. CONCLUSION This study documented the current experience of New Zealanders receiving CAR T-cell therapy and identified opportunities for future service development. These insights are relevant to service design within Aotearoa New Zealand, and other countries developing equitable CAR T-cell services.
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Affiliation(s)
- Robert Fyfe
- Malaghan Institute of Medical Research, Wellington, New Zealand
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Olivia Anstis
- Health Advisory, Deloitte Limited, Auckland, New Zealand
| | | | - Mallory Jordan
- Health Advisory, Deloitte Limited, Auckland, New Zealand
| | | | - Robert Weinkove
- Malaghan Institute of Medical Research, Wellington, New Zealand
- Te Rerenga Ora Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley, Wellington, New Zealand
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de Vries M, Stewart T, Ireton T, Keelan K, Jordan J, Robinson BA, Dachs GU. Patients' and carers' priorities for cancer research in Aotearoa/New Zealand. PLoS One 2023; 18:e0290321. [PMID: 37607163 PMCID: PMC10443847 DOI: 10.1371/journal.pone.0290321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Discrepancies have been reported between what is being researched, and what patients/families deem important to be investigated. Our aim was to understand research priorities for those who live with cancer in Aotearoa/New Zealand, with emphasis on Māori. METHODS Adult outpatients with cancer and their whānau/family completed a survey (demographics, selecting keywords, free-text comments) at Christchurch hospital. Quantitative and qualitative data were evaluated using standard statistical and thematic analyses, respectively. RESULTS We recruited 205 participants, including both tūroro/patients (n = 129) and their whānau/family/carer (n = 76). Partnership with Māori health workers enabled greater recruitment of Māori participants (19%), compared to the proportion of Māori in Canterbury (9%). Cancer research was seen as a priority by 96% of participants. Priorities were similar between Māori and non-Māori participants, with the keywords 'Cancer screening', 'Quality of Life' and 'Development of new drugs' chosen most often. Free-text analysis identified three themes; 'Genetics and Prevention', 'Early Detection and Treatment', and 'Service Delivery', with some differences by ethnicity. CONCLUSIONS Cancer research is a high priority for those living with cancer. In addition, participants want researchers to listen to their immediate and practical needs. These findings may inform future cancer research in Aotearoa. MāORI TERMS AND TRANSLATION Aotearoa (New Zealand) he aha ō whakaaro (what are your thoughts) hui (gathering) mate pukupuku (cancer) mokopuna (descendent) Ōtautahi (Christchurch) rongoā (traditional healing) tāne (male) te reo (Māori language) Te Whatu Ora (weaving of wellness, Health New Zealand) tikanga (methods, customary practices) tūroro (patients) (alternative terms used: whānau affected by cancer or tangata whaiora (person seeking health)) wahine (female) Waitaha (Canterbury) whakapapa (genealogy) whānau ((extended) family, based on whakapapa, here also carer).
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Affiliation(s)
- Millie de Vries
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
| | - Tiria Stewart
- Te Pūtahi Mātai Toto o Te Waipounamu, Christchurch Hospital, Christchurch, NZ (Nga Puhi, Ngāti Porou)
| | - Theona Ireton
- Māori Health Services, Christchurch Hospital, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ (Ngā Wairiki, Ngāti Porou)
| | - Karen Keelan
- Te Aho o Te Kahu–Cancer Control Agency, Ministry of Health, NZ (Ngāti Porou)
| | - Jennifer Jordan
- Psychological Medicine, University of Otago, Christchurch, NZ
- Specialist Mental Health Service Clinical Research Unit, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ
| | - Bridget A. Robinson
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
- Canterbury Regional Cancer and Haematology Service, Te Whatu Ora, Waitaha/Canterbury, Christchurch, NZ
| | - Gabi U. Dachs
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand (NZ)
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Dahl V, Lee Y, Wagner JD, Moore M, Pretell-Mazzini J. Epidemiology and survival factors for sarcoma patients in minority populations: a SEER-retrospective study. Rep Pract Oncol Radiother 2023; 28:370-378. [PMID: 37795400 PMCID: PMC10547403 DOI: 10.5603/rpor.a2023.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Epidemiologic studies have demonstrated race as a predictor of worse oncological outcomes. To better understand the effect of race on oncological outcomes, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to determine what treatment courses are provided to minority patients and how this impacts survival. Materials and methods A retrospective review of bone and soft tissue sarcoma cases was performed using the SEER database for a minimum 5-year survival rate (SR) using Kaplan-Meier curves. Categorical variables were compared using Pearson's χ2 test and Cramer V. Kaplan-Meier curves were used to determine survival rates (SR) and Cox regression analysis was used to determine hazard ratios (HRs). Results Races that had an increased risk of death included Native American/Alaska Native (NA/AN) [hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.049-1.761, p = 0.020) and Black (HR = 1.17, 95% CI: 1.091-1.256, p < 0.001). NA/AN individuals had the lowest SR (5-year SR = 70.9%, 95% CI: 63.8-78.0%, p < 0.001). The rate of metastasis at diagnosis for each race was 13.07% - Hispanic, 10.62% - NA/AN, 12.77% - Black, 10.61% - Asian/Pacific Islander (A/PI), and 9.02% - White individuals (p < 0.001). There were increases in the rate of metastasis at diagnosis and decreases in rates of surgical excision for Hispanic and Black patients (p < 0.001). Conclusion Race is determined to be an independent risk factor for death in NA/AN and Black patients with sarcomas of the extremities. Access to healthcare and delay in seeking treatment may contribute to higher rates of metastasis upon diagnosis for minority patients, and decreased rates of surgical excision could be associated with poor follow up and lack of resources.
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Affiliation(s)
- Victoria Dahl
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Yonghoon Lee
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Jaxon D. Wagner
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Maya Moore
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Juan Pretell-Mazzini
- Musculoskeletal Oncology Surgeon, Chief of Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health System, Miami, Florida, United States
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Fitzgerald S, Blenkiron C, Stephens R, Mathy JA, Somers-Edgar T, Rolfe G, Martin R, Jackson C, Eccles M, Robb T, Rodger E, Lawrence B, Guilford P, Lasham A, Print CG. Dynamic ctDNA Mutational Complexity in Patients with Melanoma Receiving Immunotherapy. Mol Diagn Ther 2023; 27:537-550. [PMID: 37099071 PMCID: PMC10131510 DOI: 10.1007/s40291-023-00651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Circulating tumour DNA (ctDNA) analysis promises to improve the clinical care of people with cancer, address health inequities and guide translational research. This observational cohort study used ctDNA to follow 29 patients with advanced-stage cutaneous melanoma through multiple cycles of immunotherapy. METHOD A melanoma-specific ctDNA next-generation sequencing (NGS) panel, droplet digital polymerase chain reaction (ddPCR) and mass spectrometry analysis were used to identify ctDNA mutations in longitudinal blood plasma samples from Aotearoa New Zealand (NZ) patients receiving immunotherapy for melanoma. These technologies were used in conjunction to identify the breadth and complexity of tumour genomic information that ctDNA analysis can reliably report. RESULTS During the course of immunotherapy treatment, a high level of dynamic mutational complexity was identified in blood plasma, including multiple BRAF mutations in the same patient, clinically relevant BRAF mutations emerging through therapy and co-occurring sub-clonal BRAF and NRAS mutations. The technical validity of this ctDNA analysis was supported by high sample analysis-reanalysis concordance, as well as concordance between different ctDNA measurement technologies. In addition, we observed > 90% concordance in the detection of ctDNA when using cell-stabilising collection tubes followed by 7-day delayed processing, compared with standard EDTA blood collection protocols with rapid processing. We also found that the undetectability of ctDNA at a proportion of treatment cycles was associated with durable clinical benefit (DCB). CONCLUSION We found that multiple ctDNA processing and analysis methods consistently identified complex longitudinal patterns of clinically relevant mutations, adding support for expanded clinical trials of this technology in a variety of oncology settings.
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Affiliation(s)
- Sandra Fitzgerald
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
| | - Cherie Blenkiron
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
| | - Rosalie Stephens
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai (previously Auckland City Hospital), Auckland, New Zealand
| | - Jon A Mathy
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau Health, Auckland, New Zealand
| | - Tiffany Somers-Edgar
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau Health, Auckland, New Zealand
| | | | - Richard Martin
- Te Whatu Ora Wāitemata (previously Waitemata District Health Board, New Zealand), Auckland, New Zealand
| | - Christopher Jackson
- Te Whatu Ora Southern (previously Southern District Health Board, New Zealand), Dunedin, New Zealand
| | - Michael Eccles
- Maurice Wilkins Centre, Auckland, New Zealand
- University of Otago, Dunedin, New Zealand
| | - Tamsin Robb
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
| | - Euan Rodger
- Maurice Wilkins Centre, Auckland, New Zealand
- University of Otago, Dunedin, New Zealand
| | - Ben Lawrence
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai (previously Auckland City Hospital), Auckland, New Zealand
| | | | - Annette Lasham
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, Auckland, New Zealand
| | - Cristin G Print
- Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand.
- Maurice Wilkins Centre, Auckland, New Zealand.
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12
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Panthi VK, Dua K, Singh SK, Gupta G, Hansbro PM, Paudel KR. Nanoformulations-Based Metronomic Chemotherapy: Mechanism, Challenges, Recent Advances, and Future Perspectives. Pharmaceutics 2023; 15:pharmaceutics15041192. [PMID: 37111677 PMCID: PMC10146318 DOI: 10.3390/pharmaceutics15041192] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Cancer-related death is a significant health and economic burden worldwide, and some conventional chemotherapy is associated with limited effectiveness in completely curing various cancers, severe adverse effects, and destruction of healthy cells. To overcome the complications associated with conventional treatment, metronomic chemotherapy (MCT) is extensively suggested. In this review, we aim to highlight the importance of MCT over conventional chemotherapeutic approach with emphasis on nanoformulations-based MCT, their mechanism, challenges, recent advances, and future perspectives. Nanoformulations-based MCT revealed remarkable antitumor activity in both preclinical and clinical settings. For example, the metronomic scheduling of oxaliplatin-loaded nanoemulsion and polyethylene glycol-coated stealth nanoparticles incorporating paclitaxel were proven very effective in tumor-bearing mice and rats, respectively. Additionally, several clinical studies have demonstrated the benefit of MCT with acceptable tolerance. Moreover, metronomic might be a promising treatment strategy for improving cancer care in low- and middle-income nations. However, an appropriate alternative to a metronomic regimen for an individual ailment, suitable combinational delivery and scheduling, and predictive biomarkers are certain parts that remain unanswered. Further clinical-based comparative research studies are mandatory to be performed before entailing this treatment modality in clinical practice as alternative maintenance therapy or in place of transferring to therapeutic management.
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Affiliation(s)
- Vijay Kumar Panthi
- Department of Pharmacy, College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Jeonnam 58554, Republic of Korea
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
- Faculty of Health, Australian Research Centre in Complementary & Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Sachin Kumar Singh
- Faculty of Health, Australian Research Centre in Complementary & Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur 302017, India
| | - Philip M Hansbro
- Centre for Inflammation, Faculty of Science, School of Life Sciences, Centenary Institute and University of Technology Sydney, Sydney, NSW 2050, Australia
| | - Keshav Raj Paudel
- Centre for Inflammation, Faculty of Science, School of Life Sciences, Centenary Institute and University of Technology Sydney, Sydney, NSW 2050, Australia
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13
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Gurney J, Davies A, Stanley J, Signal V, Costello S, Dawkins P, Henare K, Jackson C, Lawrenson R, Whitehead J, Koea J. Emergency presentation prior to lung cancer diagnosis: A national-level examination of disparities and survival outcomes. Lung Cancer 2023; 179:107174. [PMID: 36958240 DOI: 10.1016/j.lungcan.2023.03.010] [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: 02/27/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES A recent multinational investigation of emergency presentation within 30 days of cancer diagnosis, conducted within the International Cancer Benchmarking Programme (ICBP), observed that New Zealand had the highest rate of emergency presentation prior to lung cancer diagnosis compared to other similar countries. Here we use national-level health data to further investigate these trends, focussing on ethnic disparities in emergency presentation prior to lung cancer diagnosis. We have also compared survival outcomes between those who had an emergency presentation in the preceding 30 days to those who did not. MATERIALS AND METHODS Our study included all lung cancer registrations between 2007 and 2019 on the New Zealand Cancer Registry (N = 27,869), linked to national hospitalisation and primary healthcare data. We used descriptive (crude and age-standardised proportions) and logistic regression (crude and adjusted odds ratios) analyses to examine primary care access prior to cancer diagnosis, emergency hospitalisation up to and including 30 days prior to diagnosis, and one-year mortality post-diagnosis, both for the total population and between ethnicities. Regression models adjusted for age, sex, deprivation, rurality, comorbidity, tumour type and stage. RESULTS We found stark disparities by ethnic group, with 62% of Pacific peoples and 54% of Māori having an emergency presentation within 30 days prior to diagnosis, compared to 47% of Europeans. These disparities remained after adjusting for multiple covariates including comorbidity and deprivation (adj. OR: Māori 1.21, 95% CI 1.13-1.30; Pacific 1.50, 95% CI 1.31-1.71). Emergency presentation was associated with substantially poorer survival outcomes across ethnic groups (e.g. 1-year mortality for Māori: no emergency presentation 50%, emergency presentation 79%; adj. OR 2.40, 95% CI 2.10-2.74). CONCLUSIONS These observations reinforce the need for improvements in the early detection of lung cancer, particularly for Māori and Pacific populations, with a view to preventing diagnosis of these cancers in an emergency setting.
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Affiliation(s)
- Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Anna Davies
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Virginia Signal
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shaun Costello
- Southern Blood and Cancer Unit, Te Whatu Ora - Southern, Dunedin, New Zealand
| | - Paul Dawkins
- Respiratory Services, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | - Kimiora Henare
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Chris Jackson
- Southern Blood and Cancer Unit, Te Whatu Ora - Southern, Dunedin, New Zealand; Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand; Population and Public Health, Te Whatu Ora - Waikato, Hamilton, New Zealand
| | - Jesse Whitehead
- Te Ngira Institute for Population Research, University of Waikato, New Zealand
| | - Jonathan Koea
- General Surgery Services, Te Whatu Ora, Waitematā, Auckland, New Zealand
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14
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Dunn J. It Is Time to Close the Gap in Cancer Care. JCO Glob Oncol 2023; 9:e2200429. [PMID: 36706348 PMCID: PMC10166341 DOI: 10.1200/go.22.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jeff Dunn
- Union for International Cancer Control, Geneva, Switzerland.,University of Southern Queensland, Division of Research and Innovation, Queensland, Australia
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15
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Nightingale C, Bavor C, Stone E, Rankin NM. Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region. JCO Glob Oncol 2023; 9:e2200329. [PMID: 36749907 PMCID: PMC10166439 DOI: 10.1200/go.22.00329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Claire Nightingale
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Bavor
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emily Stone
- Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Nicole M. Rankin
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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16
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Mako M, Gurney J, Goza M, Ruka M, Scott N, Thompson G, Sarfati D. Te Aho o Te Kahu: weaving equity into national-level cancer control. Lancet Oncol 2022; 23:e427-e434. [PMID: 36055311 DOI: 10.1016/s1470-2045(22)00279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
The purpose of this manuscript was to consider how mainstream health organisations can develop structures, processes, and functions to address inequity, using the New Zealand Cancer Control Agency (Te Aho o Te Kahu) as an example. In New Zealand (Aotearoa), as in other countries, inequities in cancer incidence and outcomes exist between population groups, including for indigenous populations. Despite much discussion regarding the need to address racial inequities, often the proposed solutions are at operational or programmatic levels, and disadvantaged communities are unable to have much of a say in the system design and service delivery of these solutions. The establishment of a dedicated cancer control agency has created a unique opportunity to centralise principles and approaches to achieving equity within the core functions of the agency, and enabled a new method of approaching cancer control with the aim of achieving equity for the most disadvantaged populations. Using a framework based on the founding agreement between New Zealand's Indigenous Māori people and the British Government (Te Tiriti o Waitangi), we consider how health system organisations can develop structures, processes, and functions to achieve equity, and summarise how this new agency has been shaped to achieve these objectives for Māori people in particular, including the innovative and equity-first approach to organisational structure and focus. Within this framework, we highlight the key equity-focused work programmes, initiatives, and other actions taken since the inception of the agency. Finally, we discuss the ongoing equity-related challenges the agency faces, as well as the current and future opportunities for achieving equity in health outcomes.
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Affiliation(s)
- Michelle Mako
- Te Aho o Te Kahu Cancer Control Agency, Wellington, New Zealand
| | - Jason Gurney
- Te Aho o Te Kahu Cancer Control Agency, Wellington, New Zealand; Department of Public Health, University of Otago, Wellington, New Zealand; National Māori Cancer Leadership Network (Hei Āhuru Mōwa), Hamilton, New Zealand.
| | - Moahia Goza
- National Māori Cancer Leadership Network (Hei Āhuru Mōwa), Hamilton, New Zealand
| | - Myra Ruka
- National Māori Cancer Leadership Network (Hei Āhuru Mōwa), Hamilton, New Zealand; Waikato District Health Board, Hamilton, New Zealand
| | - Nina Scott
- National Māori Cancer Leadership Network (Hei Āhuru Mōwa), Hamilton, New Zealand; Waikato District Health Board, Hamilton, New Zealand
| | - Gary Thompson
- National Māori Cancer Leadership Network (Hei Āhuru Mōwa), Hamilton, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu Cancer Control Agency, Wellington, New Zealand
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17
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Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand. PLoS One 2022; 17:e0269593. [PMID: 35951652 PMCID: PMC9371338 DOI: 10.1371/journal.pone.0269593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007–2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09–2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.
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18
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Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
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19
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Pitama SG. Context is everything. ANZ J Surg 2022; 92:944-945. [PMID: 35535006 DOI: 10.1111/ans.17731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suzanne G Pitama
- The Office of the Dean, University of Otago, Christchurch, New Zealand
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20
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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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21
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Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach. Curr Oncol 2021; 29:132-143. [PMID: 35049686 PMCID: PMC8775083 DOI: 10.3390/curroncol29010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.
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22
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Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Curr Opin Support Palliat Care 2021; 15:162-168. [PMID: 34232133 DOI: 10.1097/spc.0000000000000558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Amy Davies
- Department of Oncology, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Jason Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
- School of Public Health, University of Queensland, Brisbane
| | - Abbey Diaz
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
| | - Eva Segelov
- Department of Medical Oncology, Monash Health, Melbourne, Victoria
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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23
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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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24
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Social Determinants of Health Influencing the New Zealand COVID-19 Response and Recovery: A Scoping Review and Causal Loop Diagram. SYSTEMS 2021. [DOI: 10.3390/systems9030052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Coronavirus pandemic of 2019–20 (COVID-19) affected multiple social determinants of health (SDH) across the globe, including in New Zealand, exacerbating health inequities. Understanding these system dynamics can support decision making for the pandemic response and recovery measures. This study combined a scoping review with a causal loop diagram to further understanding of the connections between SDH, pandemic measures, and both short- and long-term outcomes in New Zealand. The causal loop diagram showed the reinforcing nature of structural SDH, such as colonization and socio-economic influences, on health inequities. While balancing actions taken by government eliminated COVID-19, the diagram showed that existing structural SDH inequities could increase health inequities in the longer term, unless the opportunity is taken for socio-economic policies to be reset. Such policy resets would be difficult to implement, as they are at odds with the current socio-economic system. The causal loop diagram highlighted that SDH significantly influenced the dynamics of the COVID-19 impact and response, pointing to a need for purposeful systemic action to disrupt the reinforcing loops which increase health inequities over time. This will require strong systems leadership, and coordination between policy makers and implementation at local level.
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25
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Millar E, Gurney J, Beuker S, Goza M, Hamilton MA, Hardie C, Jackson CG, Mako M, Middlemiss T, Ruka M, Willis N, Sarfati D. Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 11:100172. [PMID: 34327369 PMCID: PMC8315642 DOI: 10.1016/j.lanwpc.2021.100172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
COVID-19 caused significant disruption to cancer services around the world. The health system in Aotearoa New Zealand has fared better than many other regions, with the country being successful, so far, in avoiding sustained community transmission. However, there was a significant initial disruption to services across the cancer continuum, resulting in a decrease in the number of new diagnoses of cancer in March and April 2020. Te Aho o Te Kahu, Aotearoa New Zealand's national Cancer Control Agency, coordinated a nationwide response to minimise the impact of COVID-19 on people with cancer. The response, outlined in this paper, included rapid clinical governance, a strong equity focus, development of national clinical guidance, utilising new ways of delivering care, identifying and addressing systems issues and close monitoring and reporting of the impact on cancer services. Diagnostic procedures and new cancer registrations increased in the months following the national lockdown, and the cumulative number of cancer registrations in 2020 surpassed the number of registrations in 2019 by the end of September. Cancer treatment services – surgery, medical oncology, radiation oncology and haematology – continued during the national COVID-19 lockdown in March and April 2020 and continued to be delivered at pre-COVID-19 volumes in the months since. We are cautiously optimistic that, in general, the COVID-19 pandemic does not appear to have increased inequities in cancer diagnosis and treatment for Māori in Aotearoa New Zealand.
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Affiliation(s)
- Elinor Millar
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Jason 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
| | - Suzanne Beuker
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Moahuia Goza
- Hei Āhuru Mōwai Māori Cancer Leadership, Victoria St, Hamilton, New Zealand
| | - Mary-Ann Hamilton
- Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Claire Hardie
- Midcentral District Health Board, Ruahine Street, Palmerston North, New Zealand
| | | | - Michelle Mako
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Tom Middlemiss
- Hutt Valley District Health Board, Boulcott St, Lower Hutt, New Zealand.,Te Omanga Hospice, Woburn Road, Lower Hutt, New Zealand
| | - Myra Ruka
- Hei Āhuru Mōwai Māori Cancer Leadership, Victoria St, Hamilton, New Zealand.,Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Nicole Willis
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
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Blackmore T, Chepulis L, Keenan R, Kidd J, Stokes T, Weller D, Emery J, Lawrenson R. How do colorectal cancer patients rate their GP: a mixed methods study. BMC FAMILY PRACTICE 2021; 22:67. [PMID: 33832431 PMCID: PMC8034162 DOI: 10.1186/s12875-021-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. METHODS This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. RESULTS Most participants rated their GP as 'Very good/Good' at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as 'Not at all'. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). CONCLUSIONS Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.
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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
| | - Rawiri Keenan
- 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, Dunedin, University of Otago, Dunedin, 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, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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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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28
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Alcindor T, Dumitra S, Albritton K, Thomas DM. Disparities in Cancer Care: The Example of Sarcoma-In Search of Solutions for a Global Issue. Am Soc Clin Oncol Educ Book 2021; 41:1-7. [PMID: 33770458 DOI: 10.1200/edbk_320463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Disparities in health care have an adverse effect on the outcome of disadvantaged patients with cancer. Patients may be at a disadvantage because of geographic isolation; insurance status; or racial, ethnic, or other factors. In this article, we examine how disparities affect the care of patients with sarcoma in the United States, Canada, and the Asia-Pacific region. Because of the rarity of sarcomas and their challenging diagnosis and complex treatment patterns, some professional or national guidelines stipulate that patients with sarcoma should be treated at centers of expertise by multidisciplinary teams. This recommendation, based on published evidence, is not always applicable because of various sociopolitical or patient-related factors. We are proposing solutions to overcome these obstacles in a practical and patient-centered way while acknowledging that disparities exist among countries as well as within any country.
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Affiliation(s)
| | | | | | - David M Thomas
- Garvan Institute of Medical Research, Darlinghurst, Australia
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29
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Ronald MM, Aramoana JKA, Hill AG. Surgeons and cultural safety and cultural competency: the road to transformation. ANZ J Surg 2020; 90:2563-2566. [PMID: 33090638 DOI: 10.1111/ans.16379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maxine M Ronald
- Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | | | - Andrew G Hill
- Department of Surgery, The University of Auckland Faculty of Medical and Health Sciences, Middlemore Hospital, Auckland, New Zealand
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