Abstract
BackgroundAboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments.MethodsCancers registered among Aboriginal South Australians in 1990–2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death.ResultsFewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59–0.98; have surgery UOR = 0.65; 95%CI = 0.53–0.80; systemic therapies UOR = 0.64; 95%CI = 0.52–0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63–0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25–0.47 and SHR = 0.35; 95%CI = 0.25–0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26–2.63.ConclusionThe effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
Highlights
Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians
The disparities in survival are significantly influenced by widely reported factors such as comorbid conditions which pre-exist cancer diagnosis [8,9,10] and cancers often being diagnosed at relatively advanced stages with the cancer having spread to other tissue or organs [1, 2, 11]
The Aboriginal (N = 777) and matched non-Indigenous cancer cohorts were equivalent by matching variables
Summary
Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. Australia’s Aboriginal and Torres Strait Islander population experience higher burden of disease from cancer compared to other Australians [1,2,3]. This excess burden is a function of diagnosis at younger average ages but lower cancer survival rates [4,5,6,7]. Studies in New Zealand found that Indigenous people (Maori) received less surgery for colon [22], breast [23, 24] and prostate [25] cancers, which increased their risk of cancer death and even accounted for survival disparities in some analyses [22, 24]
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