No abstract

This cohort was characterized by high comorbidity and advanced disease. Although similar to the United Kingdom, initial treatment rates were low in comparison with Australia and the United States, despite similar stage distributions. Overall, 50% of patients, including 30% with early-stage disease, did not receive initial anticancer treatment. Low anticancer treatment rates may contribute to poorer survival outcomes in New Zealand.

Multiple factors are potentially responsible for the higher case-fatality ratio in Mäori. Such factors include presentation with more advanced disease, lower rates of curative treatment for nonmetastatic disease, and longer transit times from diagnosis to treatment. In this retrospective study, socioeconomic deprivation, comorbidity levels, and failure to accept treatment did not fully explain ethnic differences in management. Further assessment of the underlying issues by prospective evaluation is warranted.

Relatively fewer patients received potentially curative treatment in this NZ study than in countries with better survival outcomes and many were not managed within recommended time frames. Management differences increased with increasing age and comorbidity, possibly suggesting more nihilistic attitudes in NZ.