Abstract
BackgroundEthnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. We investigated ethnic and socioeconomic inequities in use of adjuvant radiotherapy and chemotherapy in a cohort of women with invasive breast cancer in New Zealand.MethodsAll women with newly diagnosed invasive breast cancer during 1999-2012 were identified from the Waikato Breast Cancer Register. Rates of chemotherapy use and radiotherapy use were assessed in women who were deemed to be eligible for chemotherapy (n = 1212) and radiotherapy (n = 1708) based on guidelines. Factors associated with use of chemotherapy and radiation therapy were analysed in univariate and multivariate regression models, adjusting for covariates.ResultsOverall, rates of chemotherapy and radiotherapy use were 69% (n = 836) and 87.3% (n = 1491), respectively. In the multivariate model, significantly lower rates of radiotherapy use were associated with Māori compared with NZ European (Odds Ratio [OR] = 0.63, 0.40-0.98), presence of comorbidity (OR = 0.49, 0.34-0.72), distance from hospital of over 100km (OR = 0.47, 0.23-0.96), mastectomy compared with breast conserving surgery (OR = 0.32, 0.17-0.56) and non-screen compared with screen detection (OR = 0.53, 0.35-0.79). No significant associations were observed between chemotherapy use and ethnic or socio-demographic factors.ConclusionsImproving access for radiotherapy, especially for women who are at a higher risk of not receiving optimum cancer therapy due to ethnicity, geography or socioeconomic status need to be recognized as a priority to reduce inequities in breast cancer care in New Zealand.
Highlights
Ethnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women
No significant differences in rates of chemotherapy use were observed between Māori and New Zealand (NZ) European women (68.3% vs. 68.7%, p = 0.916)
Chemotherapy use was significantly higher in women of younger age groups (p < 0.001), zero comorbidity score (p < 0.001), surgically treated in private hospitals (p = 0.002) and non-screen detected cancer (p = 0.033) (Table 1)
Summary
Ethnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. As in the USA, poor healthcare access among ethnic minority or Indigenous and socioeconomically deprived women has been shown to be a major factor for such breast cancer survival disparities [2]. Indigenous Māori in New Zealand are known to have lower access, receive inferior quality cancer care and experience longer cancer treatment delays compared with non-Indigenous NZ Europeans for a variety of cancers [7,8,9,10]. Māori patients have been reported to experience longer delays for surgical treatment of breast and lung cancer, and to have a lower likelihood of receiving chemotherapy for bowel cancer compared with NZ European patients [7, 8]. Data are sparse on possible ethnic differences in use, quality or timeliness of adjuvant therapy for breast cancer in New Zealand
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