Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for indigenous Australians

Abstract

Indigenous Australians with cancer are diagnosed with more advanced disease and have lower survival than other Australians. To investigate reasons for these differences. Retrospective cohort study of 1197 indigenous and nonindigenous people in the Northern Territory diagnosed with cancers of the colon and rectum, lung, breast, cervix and non-Hodgkin lymphoma between 1991 and 2000. Outcome measures were stage at diagnosis and relative risk of cancer death. Indigenous people compared with nonindigenous people had higher relative odds of advanced stage of cancer at diagnosis (relative odds 1.9, 95% CI 1.3-2.7) for four cancers but lower relative odds for lung cancer (relative odds 0.3, 95% CI 0.2-0.5). None of the potentially contributing factors examined could explain this difference. Risk of cancer death (adjusted for cancer type and age and stage at diagnosis) was higher in indigenous than in nonindigenous people (relative risk 1.7, 95% CI 1.4-2.1). This difference, however, was confined to indigenous people with an indigenous first language (relative risk 2.9, 95% CI 2.2-3.8). Adjustment for cancer treatment variables further reduced but did not eliminate this higher risk of death. Although more advanced stage at diagnosis appeared to be a sufficient explanation for poorer cancer outcome in indigenous people whose first language was English, poorer treatment also contributed to, but was still not sufficient to explain, poorer outcome in those who had an indigenous first language. Other factors, possibly including communication difficulties, knowledge of and attitudes to cancer symptoms and treatment and social and cultural 'distance' from mainstream health services, may also be involved.

Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils

“…3 For almost all cancers, they experience later diagnosis, lower 5-year survival and a higher mortality rate than non-Indigenous Australians. 10 Indigenous women have lower participation in mammography and Pap sm ear s creenin g t han n on -I nd ig eno us women. 11,12 It has also been reported that the overall response rate was significantly lower for Indigenous people than the general population in the Bowel Cancer Screening Pilot Program that ran between November 2002 and June 2004 at three sites in Australia.…”

History of the LIME Network and the development of Indigenous health in medical education

“…Indigenous people living in remote areas were more likely than those in non-remote areas to report experiencing difficulty (19% compared with 8%) (ABS & AIHW 2005). Condon et al (2006) examined the effect of speaking a language other than English on health outcomes in a study about cancer diagnosis and treatment in the Northern Territory. Among Indigenous people diagnosed with cancer, those with an Indigenous first language had a much higher risk of cancer death than English language speakers.…”

Stage at Diagnosis and Comorbidity Influence Breast Cancer Survival in First Nations Women in Ontario, Canada

“…Outside of Canada, literature on breast cancer prognosis comparing indigenous to nonindigenous populations within the same geographic area is emerging. These studies have found poorer all-cause (8)(9)(10)(11), cancer-specific (8,12,13), and/or breast cancer-specific survival (10,(14)(15)(16)(17)(18) among their indigenous populations with breast cancer. Where further investigations have been conducted for breast cancer, poorer stage- (10-12, 16, 18) and treatment- (10,11,18) adjusted survival have been observed.…”