Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors

Hill, Sarah; Sarfati, Diana; Blakely, Tony; Robson, Bridget; Purdie, Gordon; Chen, Jarvis T.; Dennett, Elizabeth; Cormack, Donna; Cunningham, Ruth; Dew, Kevin; McCreanor, Tim; Kawachi, Ichiro

doi:10.1136/jech.2008.083816

Cited by 117 publications

(93 citation statements)

References 36 publications

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“…50 Private care may offer advantages in terms of shorter waiting times and possibly better outcomes compared with secondary public services. 17 Māori/non-Māori differences in private cancer care are greater than the ethnic gap in insurance coverage (26% among Māori and 43% among Pākehā in the 2002-2003 New Zealand health survey 51 ), suggesting that in the absence of insurance, non-Māori may be more likely to pay for private care. This suggests non-Māori may be better able to 'buy out' of geographical disadvantage in cancer care -for example, by paying for private investigation and diagnosis rather than depending on non-specialist public services.…”

Section: Health System Factorsmentioning

confidence: 95%

“…Research from both New Zealand and Australia suggests not, with poorer survival in Indigenous patients persisting even after adjustment for both stage and co-morbidity. 6,17 Moreover, it is important to consider why Māori patients are more likely than non-Māori to have co-morbid conditions and less likely to be diagnosed at an early stage of cancer progression as both factors are potentially responsive to health care.…”

Section: Inequalities In Cancer Outcomesmentioning

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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Section: Health System Factorsmentioning

confidence: 95%

Section: Inequalities In Cancer Outcomesmentioning

confidence: 99%

Indigenous inequalities in cancer: what role for health care?

Hill

Sarfati

Robson

et al. 2012

ANZ Journal of Surgery

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“…Also, given that the worse cancer survival among Māori was partly due to later stage at diagnosis, 19,26 another relevant task is to incorporate stage at diagnosis in the survival analysis and the cancer disease models. The Burden of Disease Epidemiology, Equity and CostEffectiveness (BODE3) Programme is currently working on these improvements.…”

Section: Health Economics the Burden Of Cancer In New Zealandmentioning

confidence: 99%

The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities

Costilla

Tobias

Blakely

2013

Australian and New Zealand Journal of Public Health

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As cardiovascular disease incidence and mortality have steadily declined over the past 30-40 years, the relative burden of disease due to cancer has increased. In 2009, cancer was the leading cause of mortality in New Zealand (NZ) at ICD chapter level, accounting for about 30% of the total number of deaths.1 The age standardised rate for all cancer sites combined steadily increased post World War II, but is now stable (and possibly decreasing).2-4 However, there is notable heterogeneity by cancer sites (e.g. stomach cancer rates decreased over time and haemopoietic cancers increased). 2Burden of disease studies aim to estimate the burden of each major disease for a given country or region of the world at a given time using a composite measure of mortality and morbidity, the disability adjusted life year (DALY).5 A burden of disease study has previously been conducted in NZ for 1996, and found that cancers contributed 20% of the total burden of disease, second only to cardiovascular diseases at 24%. 6A DALY represents the loss of one year of healthy life, whether it is due to premature death or living in a state of less than full health, or a combination of both. In practice, they are calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). YLLs capture life lost due to premature death from the disease. YLDs are equivalent to years of life lost as a result of living in health states other than full health, where disability weights (DW) are used to quantify the decremental loss of health.This paper aims to: estimate the burden of disease in DALYs arising from incident cancer cases diagnosed in 2006 for 27 cancer sites and show how the cancer DALY differences by sex and ethnicity vary from differences in incidence rates of cancer alone. MethodsWe modelled single year age groups (0-100 years), sex (males and females) and ethnicity (Māori and non-Māori) in terms of incidence, survival and background mortality. Due to the good quality of NZ cancer datasets, and the intended migration of this work into costeffectiveness modelling, a prospective method or incidence approach of calculating DALYs was used. That is, rather than estimating the cross-sectional burden for all prevalent cancer cases in 2006, we estimated the future burden arising from cancers diagnosed in 2006. respectively, sexes pooled).

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“…These reasons are likely to include delays in diagnosis, 5,6 reduced uptake of or access to screening 1 and treatment, 6 higher rates of co-morbidities, 6 language barriers 5 as well as differences in socioeconomic status, poorer health behavior 7 and cultural factors. 1,5,6,8 Navigating one's way through the complex health-care system for cancer care can be arduous and fraught with uncertainty and fear for any individual with cancer. 9 However, these difficulties can be exacerbated for Indigenous people, who might not always utilize or understand Western health-care systems.…”

Section: Introductionmentioning

confidence: 99%

Navigating the cancer journey: A review of patient navigator programs for Indigenous cancer patients

Whop

Valery

Beesley

et al. 2012

Asia-Pac J Clncl Oncology

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Patient navigator programs have evolved to facilitate access to care and improve outcomes for Indigenous cancer patients. We reviewed the scientific literature on patient navigator programs in Indigenous people with cancer. We conducted a review of the published literature up to 13 April 2011. PubMed, MEDLINE and CINAHL databases were searched for original articles on Indigenous patient navigation programs. The review produced eight relevant articles covering two specific programs, the Native Sisters Program and the Walking Forward Program. Program descriptions, patient navigator's roles, cultural aspects and the impact of the programs were described. Patient navigators' roles in the programs varied, as did their qualifications, but importantly, all were Indigenous. Both programs aimed to increase participation in screening, remove barriers to treatment and decrease mortality. The Native Sisters Program documented an increase in adherence to breast screening among navigated American Indian participants, although there were substantial differences in the baseline screening adherence between navigated and non-navigated participants. The Walking Forward Program yielded on average 3 fewer days of treatment delays for navigated American Indians than for non-navigated American Indians. However, adjustments for socioeconomic characteristics and disease characteristics were not described. Although preliminary outcomes are seemingly positive, further rigorous evaluation of quantitative impacts are needed.

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Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors

Cited by 117 publications

References 36 publications

Indigenous inequalities in cancer: what role for health care?

Indigenous inequalities in cancer: what role for health care?

The burden of cancer in New Zealand: a comparison of incidence and DALY metrics and its relevance for ethnic disparities

Navigating the cancer journey: A review of patient navigator programs for Indigenous cancer patients

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