Abstract
BackgroundIndigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia.MethodsA cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998–2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models.ResultsOverall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83).ConclusionIn this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.
Highlights
Indigenous Australians have lower overall cancer survival which has not yet been fully explained
Indigenous people were more likely to be socially disadvantaged than their non-Indigenous counterparts (p < 0.001) (Table 1)
Cancer stage was not recorded in the clinical notes in approximately 10% of patients in both groups; a further 3% of cases in each group were diagnosed with cancers for which a stage was not routinely recorded
Summary
Indigenous Australians have lower overall cancer survival which has not yet been fully explained To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia. A previous study in the state of Queensland found that Indigenous people with cancer were more likely to have comorbidities, to receive less treatment, and to experience worse survival than non-Indigenous counterparts [6]. We replicated this earlier matched-cohort study design where we compared Indigenous and non-Indigenous people with cancer, this time including a larger cohort, collecting more comprehensive and detailed information on cancer treatment (e.g. timing to, type and amount of treatment) and comorbidities. We examine the associations between comorbidities, cancer treatment and survival among Indigenous and non-Indigenous cancer patients in Queensland, the state with the second-largest Indigenous population in Australia
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