Cancer survival differentials for Aboriginal and Torres Strait Islander peoples in Queensland: the impact of remoteness

Abstract

Purpose In Australia, Aboriginal and Torres Strait Islander peoples (First Nations population) often have low overall cancer survival, as do all residents of geographically remote areas. This study aimed to quantify the survival disparity between First Nations and other Queenslanders for 12 common cancer types by remoteness areas. Methods For all Queensland residents aged 20–89 years diagnosed with a primary invasive cancer during 1997–2016, we ran flexible parametric survival models incorporating age, First Nations status, sex, diagnosis time period, area-level socioeconomic status, remoteness categories and where appropriate, broad cancer type. Three survival measures were predicted: cause-specific survival, survival differences and the comparative survival ratio, each standardised to First Nations peoples’ covariate distributions. Results The standardised five-year cause-specific cancer survival was 60% for urban First Nations and 65% for other Queenslanders, while remote residents were 54% (First Nations) and 58% (other). The absolute survival differential between First Nations and other Queenslanders was often similar, regardless of remoteness of residence. The greatest absolute difference in five-year standardised cancer survival was for head and neck cancers, followed by cervical cancer. The five-year comparative survival ratio (First Nations: other Queenslanders) for urban cancer patients was 0.91 (95% CI 0.90–0.93), similar to outer regional, inner regional and remote areas. The greatest comparative survival differential was for oesophageal cancer. Conclusion First Nations’ survival inequalities are largely independent of geographical remoteness. It remains a priority to determine the contribution of other potential factors such as the availability of culturally acceptable diagnostic, management and/or support services.

Exploring the impact of remoteness on people with head and neck cancer: Utilisation of a state‐wide dataset

“…Differences may therefore be more influenced by lower SES status and affluence levels and would be important areas for future work. This is in contrast to other work which has shown 5‐year survival is significantly lower for First Nations Australians diagnosed with HNC, 8,15 however those results were not adjusted for other variables. The data presented in this study only extended to 2‐year survival and examination of extended survival beyond this would be a valuable area for future study.…”

“…Currently, most studies specific to HNC which report on differences by First Nations status heavily focus on incidence rates, staging and survival, 13,14 with only one recent study adjusted for remoteness. In that study, 15 it was reported that 5‐year survival for urban First Nations people was 50.5% (70.4% for all other urban Queenslanders) compared with 32% for remote First Nations peoples (54.8% for all other remote Queenslanders).…”

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: a cross-sectional survey study

“…In New Zealand and Australia, approximately 630 and 4500 new cases are diagnosed each year, respectively, with a 12% 5-year survival rate [ 2 , 3 ]. Indigenous populations have worse outcomes, with Māori patients more likely to die than non-Māori, and similarly poor outcomes for Aboriginal and Torres Strait Islanders [ 3 , 4 ].…”

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: cross-sectional survey study

“…[2,3]] Indigenous populations have worse outcomes, with Māori patients more likely to die than non-Māori, and similarly poor outcomes for Aboriginal and Torres Strait Islanders. [3,4] The pancreas is responsible for both endocrine (hormone production) and exocrine processes (enzyme secretion) in the body. Pancreatic cancer disrupts the delivery of enzymes to the duodenum secondary to ductal obstruction and is one of the most common manifestations of this cancer.…”