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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsOf 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.ConclusionsThere 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.

Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study

“…For example, receiving any cancer treatment reduced the risk of cancer death among head and neck cancer cases in Queensland by 20% [31] after adjusting for socio-demographic influences, stage, and comorbidities. In NSW, lung cancer surgery reduced risk of cancer death by around three-quarters, but Aboriginal and Torres Strait Island people faced 30% higher residual risk (SHR = 1.3) [28]. Also, the NT reported hazard ratios in the order of 1.5 [29] among Aboriginal and Torres Strait Islander cases with the most commonly diagnosed cancers after allowing for the effects of treatment and this is equivalent to the sub-hazard risk of 1.6 observed in our study.…”

“…Australia’s first review of cancer treatments among Aboriginal and Torres Strait Islander people reported that poor survival outcomes were accompanied by lower rates of cancer hospitalisation [4]. Subsequent analyses within Australian states and territories, focussing on lung cancer and using person-linked cancer registry and hospital records, found surgery was clearly less frequent among Aboriginal and Torres Strait Islander people in Western Australia (WA) [26, 27], New South Wales (NSW) [28], the Northern Territory (NT) [29] and Queensland [30]. In Queensland, Aboriginal and Torres Strait Islander people with head and neck cancers were less like to receive surgery [31], and those with cervical cancer were less likely to receive optimal treatment [30] than other Australians.…”

“…Two matched cohort studies in Queensland considered cancer treatment more generally [8, 9] and found Aboriginal and Torres Strait Islander patients were less likely to receive surgery, chemotherapy and radiotherapy compared to cases among other Australians for the same primary sites, similar ages, and diagnostic periods of time. The observed lesser treatment of cancer was considered to pose a significant risk to cancer survival in each study [8, 9, 28, 29, 33].…”

Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)

“…For NSW non-small cell lung cancer patients, Indigenous patients without comorbidity were half as likely to receive surgery as non-Indigenous patients, while there was no difference in surgery rates for Indigenous and non-Indigenous patients with comorbidity. [ 40 ] Although it is not clear whether these patterns are generalizable to cervical cancer treatment, the combination of lower participation in cervical screening,[ 21 ] more advanced disease at diagnosis,[ 22 , 41 , 42 ] and less optimal cancer treatment[ 23 ] is likely to at least partially explain the survival differential for Indigenous women compared to non-Indigenous women. That this relationship is restricted to women without comorbidity suggests factors other than those measured in this study are responsible for most of the survival differential and this warrants further investigation.…”

ERS statement on harmonised standards for lung cancer registration and lung cancer services in Europe

“…There is evidence of significant variations in the prevalence of somatic mutations in adenocarcinoma of the lung based on ethnicity [29,30]. There is also evidence of variation in the route to accessing healthcare services based on patient ethnicity [31][32][33]. However, it is difficult to find one coding system for ethnicity that would capture the needs of every country in Europe.…”