Abstract
BackgroundOverall, Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than non-Indigenous Australians. The prognosis for Indigenous people with specific cancers varies however, and their prognosis for cancers of the head and neck is largely unknown. We therefore have compared clinical characteristics, treatment and survival between Indigenous and non-Indigenous people diagnosed with head and neck cancer in Queensland, Australia.MethodsRates were based on a cohort of Indigenous people (n = 67), treated in public hospitals between 1998 and 2004 and frequency-matched on age and location to non-Indigenous cases (n = 62) also treated in the public health system. Data were obtained from hospital records and the National Death Index. We used Pearson's Chi-squared analysis to compare categorical data (proportions) and Cox proportional hazard models to assess survival differences.ResultsThere were no significant differences in socioeconomic status, stage at diagnosis or number and severity of comorbidities between Indigenous and non-Indigenous patients, although Indigenous patients were more likely to have diabetes. Indigenous people were significantly less likely to receive any cancer treatment (75% vs. 95%, P = 0.005) and, when cancer stage, socioeconomic status, comorbidities and cancer treatment were taken into account, they experienced greater risk of death from head and neck cancer (HR 1.88, 1.10, 3.22) and from all other causes (HR 5.83, 95% CI 1.09, 31.04).ConclusionThese findings show for the first time that Indigenous Australians with head and neck cancer receive less cancer treatment and suggest survival disparity could be reduced if treatment uptake was improved. There is a need for a greater understanding of the reasons for such treatment and survival disparities, including the impact of the poorer overall health on cancer outcomes for Indigenous Australians.
Highlights
Overall, Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than non-Indigenous Australians
In the Indigenous population of the Northern Territory of Australia, the incidence of head and neck cancer is around 32.78 per 100,000 compared to 19.5 per 100,000 for the rest of Australia [8] and higher incidence and mortality from cancer of the oropharynx have previously been reported in the Northern Territory Indigenous population when compared to non-Indigenous people [2]
There was no significant difference in stage at diagnosis (Table 1): the majority of people were diagnosed with regional spread of their cancer (Indigenous 57%, non-Indigenous 65%) and no Indigenous or non-Indigenous people from urban regions were diagnosed with a late stage cancer
Summary
Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than non-Indigenous Australians. The prognosis for Indigenous people with specific cancers varies and their prognosis for cancers of the head and neck is largely unknown. We have compared clinical characteristics, treatment and survival between Indigenous and non-Indigenous people diagnosed with head and neck cancer in Queensland, Australia. Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than nonIndigenous Australians [1,2]. The prognosis for Indigenous people with specific cancers such as those of the head and neck is largely unknown. Whilst incidence was reportedly similar among Indigenous and non-Indigenous people with head and neck cancers in Queensland between 1997 and 2006, mortality was more than three times greater for Indigenous people [6]
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