Are outcomes for childhood leukaemia in Australia influenced by geographical remoteness and Indigenous race?

Abstract

Background Presenting features, biology and outcome for childhood leukaemia are known to vary by ethnic origin, geographic location and socioeconomic group. This study aimed to compare presentation patterns, follow‐up and clinical outcomes in Indigenous and non‐Indigenous children with acute leukaemia in Australia, and to assess the impact of remoteness and area‐based socioeconomic disadvantage on outcome. Methods A retrospective review of children aged between 1 day and 18 years who were diagnosed with acute leukaemia in South Australia (SA), Northern Territory (NT) and Western Australia (WA) between 2009 and 2018 was performed. Data were collected from children treated at the Women's and Children's Hospital, Adelaide and Perth Children's Hospital. Results Analysis of 455 children treated for acute leukaemia showed that children from remote/very remote localities had inferior overall survival (p = .004). Five‐year overall survival was 91.7% (95% CI: 87.9–94.3%) for children with acute lymphoblastic leukaemia (ALL) and 69.8% (56.7–79.5%) for acute myeloid leukaemia (AML). A larger proportion of Indigenous children from SA/NT were diagnosed with AML compared to non‐Indigenous children (60.0% vs. 14.4%, p = .001). Indigenous children were less likely to be enrolled on clinical trials (34.5% vs. 53.1%, p = .03) and more likely to be lost to follow‐up (26.1% vs. 9.2%, p = .009). Conclusion Geographic remoteness of residence is associated with inferior overall survival for Australian children with leukaemia. Indigenous children with acute leukaemia suffer from disparities in outcomes. These findings provide evidence to guide national policy in supporting appropriate resource allocation to overcome the challenges faced by children within these groups.

Health‐care workers' understanding of and barriers to palliative care services to Aboriginal children with cancer

“…5,6 Supporting established adult data, 7 a recent study revealed Aboriginal children with cancer, particularly those from remote/ very remote communities, are more likely to be lost to follow up and have inferior survival compared to non-Aboriginal counterparts. 8 Poorer survival among Aboriginal people with cancer may be attributed to delayed presentations, higher-risk disease and/or reduced therapeutic compliance. 1,8 There are no studies relating to optimal palliative care provision to Aboriginal children, and none relating to those with cancer.…”

“…8 Poorer survival among Aboriginal people with cancer may be attributed to delayed presentations, higher-risk disease and/or reduced therapeutic compliance. 1,8 There are no studies relating to optimal palliative care provision to Aboriginal children, and none relating to those with cancer.…”

Barriers And Facilitators to Accessing Medical Services in Rural And Remote Australia: A systematic review

“…Rural communities experience lower cancer survival rates, [8] increased stroke mortality, [9] increased cardiovascular disease mortality, [10] and reduced childhood leukemia survival rates. [11] When considering disparity in care provision, rural and regional populations are required to travel further to receive care from a reduced number of available services. [12] Breast cancer patients experience reduced breast reconstruction rates and overall mortality, [13] while hepatocellular patients have a reduced likelihood of preventative treatment, surgical resection and survival.…”

Aboriginal children with cancer: The patient and healthcare worker perspective

“…There is a higher burden of disease 1,2 and poorer health outcomes 2–6 amongst Australian Aboriginal children compared to their non‐Aboriginal counterparts. Aboriginal children with leukaemia have reduced clinical trial enrolment rates and increased loss to follow‐up rates, and a trend towards inferior survival 7 . Inequalities result from reduced access to healthcare services due to geographical location, 8 cross‐cultural misunderstandings, 9 and poor understanding surrounding a cancer diagnosis 10 …”

“…Aboriginal children with leukaemia have reduced clinical trial enrolment rates and increased loss to followup rates, and a trend towards inferior survival. 7 Inequalities result from reduced access to healthcare services due to geographical location, 8 cross-cultural misunderstandings, 9 and poor understanding surrounding a cancer diagnosis. 10 To date, no prior study has taken the patient, family or healthcare worker (HCW) perspective on the journey of an Aboriginal child with a cancer diagnosis.…”