Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory

Abstract

Objective: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. Design: Retrospective cohort study. Setting and participants: Indigenous and non‐Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non‐Hodgkin lymphoma in the Northern Territory of Australia in 1991–2000. Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause‐specific cancer survival rates and relative risk of cancer death. Results: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%–78%) than for non‐Indigenous people (51%; 95% CI, 53%–59%) with cancers of the colon and rectum, breast, cervix and non‐Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%–65%] v non‐Indigenous, 69% [95% CI, 64%–75%]). Stage‐adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site. Conclusions: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia.

A study of head and neck cancer treatment and survival among indigenous and non-indigenous people in Queensland, Australia, 1998 to 2004

“…Although the numbers in our cohort were small and so the results lacked statistical precision, we identified disparities in cancer treatment delivery which should be further investigated and addressed by health service personnel. Although survival from head and neck cancer in Indigenous populations has not been reported elsewhere, the results of this study are consistent with the poor cancer survival and worse mortality that has been extensively reported for Indigenous people in Australian with other cancers [24,25]. We were unable to adjust for the presence of HPV which has been found to be a predictor of survival in whites in America [26] as HPV testing was not routinely undertaken at the time of the study.…”

Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients

“…Compared with non-Indigenous patients resident in Queensland, Australia, Indigenous people were diagnosed with more advanced cancer, had greater comorbidity, received less cancer treatment and were 30% more likely to die of their cancer; findings similar to those reported previously [5,6,15]. Concomitant disease is reported to influence cancer treatment choices (dose, duration, modality), cause complications, and impede survival [9,16-18].…”

Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study

“…A recent study in the Northern Territory (Australia)44 also found that of women diagnosed as having breast cancer, indigenous women were significantly more likely to be diagnosed as having advanced disease compared with non-indigenous women, suggesting this was due to later diagnosis.…”

“…Reasons for more advanced disease among indigenous women are varied and could include a reduced awareness of early symptoms of breast cancer, delay in seeking medical advice, poorer access and quality of screening and diagnostic services, and nihilistic beliefs about cancer and the chance of its cure causing reluctance to seek medical attention44 (personal communication, BreastScreen Queensland).…”