Ethnic Differences in the Management of Lung Cancer in New Zealand

Stevens, Wendy; Stevens, Graham; Kolbe, John; Cox, Brian

doi:10.1097/jto.0b013e3181653d08

Cited by 55 publications

(55 citation statements)

References 17 publications

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“…Exclusion of these 91 patients yielded an eligible sample of 685. We excluded another 56 patients (equal numbers of Maori and non-Maori individuals) who had missing information on key variables, including date of diagnosis, 26 tumor histology, 17 tumor site and/or grade, 9 and key demographic data. 4 The final study cohort (n ¼ 629) represented 92% of all eligible individuals and comprised 301 Maori patients and 328 non-Maori patients.…”

Section: Resultsmentioning

confidence: 99%

“…Survey data indicate that Maori New Zealanders are more likely to report having experienced discrimination from health professionals on the basis of their ethnicity. 43 Evidence from the United States suggests that interpersonal discrimination contributes to ethnic disparities in care, 7,9 but treatment inequities there are driven more by differences between healthcare providers than by differential care within the same facility. 35,37,42 The balance of these factors may be somewhat different in New Zealand, where ethnic segregation is less marked than in the United States.…”

Section: Discussionmentioning

confidence: 99%

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Ethnicity and management of colon cancer in New Zealand

Hill

Sarfati

Blakely

et al. 2010

Cancer

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BACKGROUND: Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer. METHODS: On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status. RESULTS: Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity. CONCLUSIONS: Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ethnicity and management of colon cancer in New Zealand

Hill

Sarfati

Blakely

et al. 2010

Cancer

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“…30,31 Yet both recent studies of cancer treatment found Māori patients received lower rates of curative intervention even after adjustment for co-morbidity. 25,26 Co-morbidity is not necessarily a contraindication to treatment such as chemotherapy, which confers significant survival advantage even in the presence of pre-existing medical conditions. 32,33 Withholding potentially curative treatment in the presence of co-morbidity will disproportionately disadvantage groups with higher levels of coexisting disease.…”

Section: Patient Factorsmentioning

confidence: 99%

“…18 Two recent studies show Māori are less likely than European patients to receive curative treatment for cancer of the lung and colon. 25,26 Stevens et al reviewed management of lung cancer in a cohort of patients diagnosed and treated in Auckland and Northland in 2004. 25 They found Māori patients were significantly less likely than Europeans to receive potentially curative treatment (received by 12% of Māori compared with 22% of European patients).…”

Section: Inequalities In Cancer Treatmentmentioning

confidence: 99%

“…25,26 Stevens et al reviewed management of lung cancer in a cohort of patients diagnosed and treated in Auckland and Northland in 2004. 25 They found Māori patients were significantly less likely than Europeans to receive potentially curative treatment (received by 12% of Māori compared with 22% of European patients). This disparity was not accounted for by differences in disease factors or patient co-morbidity: after adjustment for age, sex, tumour type and stage, co-morbidity and small area deprivation, Māori patients remained only a third as likely to receive curative treatment (Māori/European odds ratio = 0.30, 95% confidence interval (CI) 0.10-0.80).…”

Section: Inequalities In Cancer Treatmentmentioning

confidence: 99%

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Indigenous inequalities in cancer: what role for health care?

Hill

Sarfati

Robson

et al. 2012

ANZ Journal of Surgery

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Introduction: Poorer cancer survival in Indigenous populations contributes to health inequalities in both New Zealand and Australia. Methods: We reviewed recent evidence of cancer treatment and outcomes among Māori and non-Māori New Zealanders and examined the range of factors that may contribute to poorer survival in Māori. Results: There is clear evidence that Māori have poorer cancer survival compared with other ethnic groups, particularly European New Zealanders. Two recent studies show that Māori patients receive poorer quality treatment for cancers of the lung and colon, even after adjusting for patient factors. These findings suggest the need to consider how the health-care system as a whole may disadvantage Indigenous patients. Discussion: We present a framework for considering how inequalities may arise in the delivery of cancer care, taking account of the health system as a whole -including the structure and organization of cancer services -as well as treatment processes and patient factors. A key feature of this framework is that it directs attention towards system-level factors affecting cancer care, including the location, resourcing and cultural focus of services. Our analysis suggests a need to look beyond individual patient factors in order to improve the quality and equity of cancer services and to optimize cancer survival in Indigenous populations.

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What Is Comorbidity?

Sarfati

Gurney

2016

Cancer and Chronic Conditions

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Ethnic Differences in the Management of Lung Cancer in New Zealand

Cited by 55 publications

References 17 publications

Ethnicity and management of colon cancer in New Zealand

Ethnicity and management of colon cancer in New Zealand

Indigenous inequalities in cancer: what role for health care?

What Is Comorbidity?

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