Treatment and outcomes for indigenous and non‐indigenous lung cancer patients in the Top End of the Northern Territory

Abstract

Background: Lung cancer is the most common cause of cancer-related mortality for both Indigenous and non-Indigenous Australians, and the death rate of lung cancer in Indigenous Australians is increasing.Aims: To provide a comprehensive description of patterns of lung cancer presentation, diagnosis, treatment and outcomes in Indigenous and non-Indigenous Australians in the Top End of the Northern Territory.Methods: Retrospective cohort study of adult patients with a new diagnosis of lung cancer in the Top End between January 2010 and December 2014. Unadjusted survival probabilities by indigenous status were calculated. The primary end-point was all-cause mortality.Results: Despite receiving similar diagnostic procedures and treatment, Indigenous Australians with lung cancer have poorer 1-and 5-year survival (25.0% and 9.4% respectively), when compared to non-Indigenous Australians included in the study (42.0% and 16.2% respectively). Indigenous lung cancer patients were more likely to be female (51.6% of indigenous patients were female, compared to 30.5% non-indigenous), be current smokers (61.3% vs 36.9%), have more comorbidities (73.6% vs 52.7%, 24.2% vs 5.3% and 30.8% vs 14.2% for respiratory disease, renal insufficiency and diabetes mellitus respectively), and live in more socio-economically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1% vs 6.8%). They were also more likely to die at home, compared to their non-indigenous counterparts (64.3% vs 26.7%).Conclusions: Indigenous patients from the Top End diagnosed with lung cancer were more likely to have poorer survival outcomes when compared to non-indigenous people. Potential reasons for the discrepancy in survival need to be addressed urgently.

Systematic review of Aboriginal and Torres Strait Islander peoples’ experiences and supportive care needs associated with cancer

“…The thematic analysis identified several concerns influencing the experiences of cancer for Aboriginal and Torres Strait Islander peoples relating to cultural insensitivity, including lack of culturally appropriate care services, language barriers, poor understanding of Aboriginal and Torres Strait Islander peoples’ perspectives about cancer and the importance of family and community involvement [ 22 , 27 , 32 , 40 , 46 , 61 – 64 ]. The majority of the included studies reported that care providers lacked an understanding of Aboriginal and Torres Strait Islander culture and how this shaped treatment decisions [ 42 , 46 , 65 ].…”

Factors associated with cancer survival disparities among Aboriginal and Torres Strait Islander peoples compared with other Australians: A systematic review

“…Two studies ( 46 , 47 ) found that the observed (unadjusted) poorer lung cancer survival for Aboriginal and Torres Strait Islanders peoples was attenuated to become statistically non-significant after adjustment for remoteness, SES, stage at diagnosis, comorbidities, treatment and, for one study only ( 46 ), smoking status ( Table 3 ; Supplementary Materials Table S1.7 ). Another earlier study while not reporting unadjusted estimates, however found a survival differential after adjustment for these covariates ( 48 ).…”

Quantifying the number of deaths among Aboriginal and Torres Strait Islander cancer patients that could be avoided by removing survival inequalities, Australia 2005–2016

“…Underlying reasons for the survival disparities after a cancer diagnosis are multifaceted and in practice may be difficult to eliminate. Although beyond the scope of this study, it has been suggested that key contributors likely include diagnostic, clinical, access-related, behavioural, and environmental factors [4,[25][26][27][28][29][30][31][32]. Previous studies have shown that Aboriginal and Torres Strait Islander peoples are more likely to be diagnosed with advanced disease [4,27,[33][34][35].…”

“…Several studies have also shown that reducing the number of comorbidities and increasing treatment utilisation could reduce the survival disparities between Aboriginal and Torres Strait Islander peoples and other Australians diagnosed with breast [27,30], liver [32], lung [25] or cervical [33] cancer.…”