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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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Whop LJ, Smith MA, Butler TL, Adcock A, Bartholomew K, Goodman MT, Winer RL, Milosevic E, Lawton B. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144:106314. [PMID: 33678228 DOI: 10.1016/j.ypmed.2020.106314] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 11/02/2020] [Indexed: 01/16/2023]
Abstract
Achieving the World Health Organisation (WHO) cervical cancer elimination target of fewer than four new cases per 100,000 woman-years requires scaling up HPV vaccination of girls, cervical screening, and pre-cancer and cancer treatment. We reviewed data from four high-income colonised countries (Australia, Canada, Aotearoa New Zealand (NZ), and the United States (US)) to identify how each is currently performing compared to the cervical cancer incidence elimination and triple-intervention targets, nationally and in Indigenous women. We also summarise barriers and enablers to meeting targets for Indigenous women. To achieve elimination, cervical cancer incidence must be reduced by 74% in Indigenous women in Australia, and 63% in Maori women in NZ; data were not published in sufficient detail to compare incidence in Indigenous women in Canada or the US to the WHO target. Only Australia meets the vaccination coverage target, but uptake appears comparatively equitable within Australia, NZ and the US, whereas there appears to be a substantial gap in Canada. Screening coverage is lower for Indigenous women in all four countries though the differential varies by country. Currently, only Australia universally offers HPV-based screening. Data on pre-cancer and cancer treatment were limited in all countries. Large inequities in cervical cancer currently exist for Indigenous peoples in Australia, Canada, New Zealand and the US, and elimination is not on track for all women in these countries. Current data gaps hinder improvements. These countries must urgently address their systemic failure to care and provide health care for Indigenous women.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Tamara L Butler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Auckland, New Zealand
| | - Marc T Goodman
- Cedars-Sinai Cancer and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Milosevic
- Canadian Partnership Against Cancer, Toronto, Canada; Global Health Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Victoria University of Wellington, New Zealand
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Segelov E, Garvey G. Cancer and Indigenous Populations: Time to End the Disparity. JCO Glob Oncol 2020; 6:80-82. [PMID: 32031442 PMCID: PMC6998017 DOI: 10.1200/jgo.19.00379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Eva Segelov
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Northern Territory, Australia
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