Cancer survival in Indigenous and non-Indigenous Australian children: what is the difference?

Abstract

Differences in place of residence, socio-economic disadvantage, and cancer diagnostic group only partially explain the survival disadvantage of Indigenous children. Other reasons underlying the disparities in childhood cancer outcomes by Indigenous status are yet to be determined, but may involve factors such as differences in treatment.

Rural/urban residence and childhood and adolescent cancer survival in the United States

“…Although it has been the subject of many international studies, to the best of our knowledge, US data regarding the potential impact of rural residence on childhood and adolescent cancer outcomes are sparse. One US study reported no evidence for the impact of distance to treatment on stage of disease at the time of diagnosis for children and another US study reported no association between population density and diagnosis delays in adolescents and young adults .…”

“…7 However, when stratified by age group, cancer death rates among those aged <20 years living in metro counties of ≥1 million individuals (2.4 per 100,000 population) were significantly greater than those living in nonmetro rural counties (2.2 per 100,000 population). 7 Although it has been the subject of many international studies, [8][9][10][11][12][13] to the best of our knowledge, US data regarding the potential impact of rural residence on childhood and adolescent cancer outcomes are sparse. One US study reported Cancer January 15, 2019 no evidence for the impact of distance to treatment on stage of disease at the time of diagnosis for children 14 and another US study reported no association between population density and diagnosis delays in adolescents and young adults.…”

Cancer outcomes for Aboriginal and Torres Strait Islander Australians in rural and remote areas

“…In a national study of invasive childhood cancers, Indigenous children in metropolitan and inner regional areas had approximately 9% higher 5‐year cancer‐specific survival compared to those in outer regional and remote areas, although this difference was not statistically significant . The difference in 5‐year survival between Indigenous and non‐Indigenous children from the same remoteness area was greater, although not statistically significant, in outer regional/remote/very remote areas (Indigenous : non‐Indigenous HR 1.7, 95% CI 1.1–2.6) than in major city/inner regional areas (HR 1.2, 95% CI 0.8–1.8) …”

“…Five studies were identified that directly compared survival by level of remoteness for Indigenous cancer patients for either all cancers combined or for selected cancers . Two of these studies, and one additional study, compared Indigenous : non‐Indigenous survival differentials by level of remoteness.…”

Oncology service initiatives and research in regional Australia

“…Yet data have shown that even if the non‐Indigenous populations had similar distributions of lethal cancers as those in Aboriginal populations, their 5‐year survival from cancer would still be higher. After adjustment for stage at presentation and access to treatment, there is still a significant survival deficit for Aboriginal patients . The lower survival rate might be partly explained by factors such as lower likelihood of receiving treatment or later diagnosis and co‐morbidities; however, little is known about the biological or pathological characteristics of tumours in this population.…”