Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study

Gurney, Jason; Sarfati, Diana; Stanley, James; Kerrison, Clarence; Koea, Jonathan

doi:10.1136/bmjopen-2021-058749

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…In New Zealand, 17.1% of the population is Māori ( 91 ), however, zero participants in our study self-identified as Māori. Compared to non-Māori, Māori patients in general face delayed treatment ( 92 ), lower life expectancies ( 93 ) and worse health outcomes ( 94 , 95 ) in the New Zealand health system. Currently, there are no published studies that assess the perceptions and experiences of diagnosis and care of Māori cohorts experiencing endometriosis (mate kirikopu).…”

Section: Discussionmentioning

confidence: 99%

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

Ellis

Munro

Wood

2022

Front. Glob. Womens Health

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Endometriosis is a chronically painful, invasive, inflammatory disease, with limited treatment options and long delays to diagnosis, which impacts 10% of females in New Zealand.IntroductionAs part of a larger group discussion study, this paper covers three themes associated with endometriosis patient experiences: intensity of pain, diagnostic tool shortcomings and perspectives of treatment options.Materials and methodsThe goal of this research was the inclusion of patient voices to guide research priorities. In early 2022, 50 New Zealand endometriosis patients participated in anonymous, asynchronous, text-based group discussions on the VisionsLive platform. The patients ranged in age from 18–48. The patients answered 50 questions, 23 text-based and 27 quantitative, and then took part in online group discussions.Results and discussionThe average age of symptom onset was 15.3 years, while the average delay from symptom onset to a working or surgically confirmed diagnosis was 7.91 years. The top five reported symptoms within the cohort were pain-based, and the participants discussed the many impacts of this pain on their work and education. The four main diagnostic tools employed on this cohort were abdominal ultrasound (72%), transvaginal ultrasound (68%), laparoscopy (82%) and sharing their symptom history with a medical practitioner (88%). The most common emotions patients experienced following receiving a diagnosis of endometriosis were relief (86%), feeling overwhelmed (54%), and anger (32%). The main treatments offered to this cohort were pain relief (96%), laparoscopic surgery (84%) and the combined oral contraceptive pill (80%). Of these three treatments, only laparoscopic surgery was viewed positively by the majority of users, with 67% considering laparoscopy an effective treatment, compared to 46% of users for pain relief, and 25% of users for the combined oral contraceptive pill.ConclusionsGathering the voice of patients revealed that long delays to diagnosis and dismissal by medical practitioners frequently manifests as a reaction of relief by patients once diagnosed. Results also showed treatment options such as pain relief and hormonal medications were often considered ineffective, but were routinely offered as the first, or only, options for patients. It is therefore important that both quicker routes to diagnosis and more effective treatment options be developed.

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Section: Discussionmentioning

confidence: 99%

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

Ellis

Munro

Wood

2022

Front. Glob. Womens Health

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“…The absence of disparities between M aori and European patients with lung cancer in the timing of surgery and systemic therapy is reassuring, particularly considering the additional barriers that M aori patients need to overcome to access these treatments (including being more likely to live in deprivation and outside of urban centers where these treatments are delivered). We recently showed that M aori patients needed to travel twice as far to access surgery for liver cancer, 21 and yet there were no differences in the timing of surgery relative to diagnosis, 22 suggesting significant resilience by M aori patients in terms of overcoming these barriers. In this study, we noted that M aori patients appeared less likely to access radiation therapy in the first 4 weeks of diagnosis and correspondingly more likely to access it 4-12 weeks postdiagnosis.…”

Section: Similar To Radiation Therapy Mmentioning

confidence: 99%

Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context

Gurney,

Davies,

Stanley

et al. 2024

JCO Glob Oncol

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PURPOSE Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis. METHODS We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. RESULTS Māori patients with lung cancer appeared less likely to access surgery than European patients (Māori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Māori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Māori patients compared with European patients, this difference was small and requires further investigation. CONCLUSION Our observation of differences in surgery rates between Māori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Māori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.

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“…When compared with non-Māori, Māori patients face delayed treatments [23], lower life expectancies [24] and worse health outcomes [25][26][27][28] in the New Zealand health system. Racial discrimination, whether intentional or unconscious, against Māori people is associated with poorer health outcomes, reduced access to healthcare, negative impacts on mental health, and poorer life satisfaction [29,30].…”

Section: Endometriosis and Māorimentioning

confidence: 99%

The Perspectives of Māori and Pasifika Mate Kirikōpū (Endometriosis) Patients in Aotearoa New Zealand

Ellis,

Tewhaiti-Smith,

Munro

et al. 2024

Societies

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Experiences with endometriosis have been understudied in indigenous and people of colour populations. This study aimed to investigate the experiences of Māori and Pasifika endometriosis patients in Aotearoa New Zealand. Twenty-seven Māori endometriosis participants from 21 iwi (tribes), and 10 Pasifika participants from 8 different island nations participated in online, asynchronous, anonymous text-based discussions about their endometriosis journeys. Their explanations were analysed qualitatively with an inductive thematic approach. The average delay from symptom onset to a confirmed or suspected endometriosis diagnosis was 11.6 ± 7.8 years in the Māori cohort and 12.4 ± 6.2 years in the Pasifika cohort. There were high levels of dissatisfaction with the availability of treatment, with 66.7% of Māori participants and 60.0% of Pasifika participants feeling that endometriosis treatment was not readily available to them. Poor experiences with the medical profession might dissuade Māori and Pasifika patients from seeking care, exacerbating a culture of distrust and perpetuating healthcare inequities. This could potentially be improved by increasing the capacity to take time for relationship building within general practice or through the incorporation of cultural advisors to support relationship establishment that emphasises holistic consideration of patient well-being and culturally safe care.

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Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study

Cited by 4 publications

References 21 publications

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

The experiences of endometriosis patients with diagnosis and treatment in New Zealand

Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context

The Perspectives of Māori and Pasifika Mate Kirikōpū (Endometriosis) Patients in Aotearoa New Zealand

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