Factors Associated With Cancer-Specific and Overall Survival Among Indigenous and Non-Indigenous Gynecologic Cancer Patients in Queensland, Australia

Diaz, Abbey; Moore, Suzanne P.; Martin, Jennifer; Green, Adèle C.; Garvey, Gail; Valery, Patricia C.

doi:10.1097/igc.0000000000000375

Cited by 20 publications

(21 citation statements)

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“…; Diaz et al . ). Patients who have no prior history of chronic disease, and thus may have limited experience with the healthcare system, may have very different SCN to those patients who have excessive comorbidity burden.…”

Section: Introductionmentioning

confidence: 97%

“…Indigenous cancer patients have a greater burden of comorbidity than other Australian patients (Valery et al 2006;Moore et al 2014;Diaz et al 2015). Patients who have no prior history of chronic disease, and thus may have limited experience with the healthcare system, may have very different SCN to those patients who have excessive comorbidity burden.…”

Section: Introductionmentioning

confidence: 99%

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Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

et al. 2016

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Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

et al. 2016

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“…[ 18 ] However, cervical cancer has a much greater impact on Aboriginal and Torres Strait Islander women (respectfully referred to hereafter as Indigenous) than other Australian women; semi-national and national analyses suggest Indigenous women are diagnosed younger (median age 46 vs. 52 years), incidence is 2.2 times higher, mortality 3.8 times higher and five-year survival is 20 percentage points lower for Indigenous women (58% vs 78%). [ 18 – 20 ] In Queensland, Indigenous women have lower cervical screening participation than non-Indigenous women (two-year participation 34% vs 56% in 2010–2011)[ 21 ] and those who develop cervical cancer are less likely to be diagnosed with localised disease (46% vs. 69%)[ 22 ] and receive cancer treatment concordant with clinical guidelines (77% vs 96%). [ 23 ]…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of many chronic diseases including coronary heart disease, diabetes, kidney disease and hypertension is higher for Indigenous Australians compared with other Australians[ 24 ] including for women with cervical cancer,[ 22 ] but the impact of comorbidity on cervical cancer survival in Australia has not been examined for Australian women generally or Indigenous women specifically. A NZ study found Māori and Pacific women diagnosed with cervical cancer had more chronic disease and excess cervical cancer mortality (i.e.…”

Section: Introductionmentioning

confidence: 99%

Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)

et al. 2018

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BackgroundLittle is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women’s higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women.MethodsData for cervical cancers diagnosed in 2003–2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women.ResultsOf 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9–3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality.ConclusionsSurvival was lowest for women with comorbidity. However, there wasn’t a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted.ImpactThe results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).

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“…The cervical cancer incidence is approximately 2 times higher (20 vs 9 per 100,000) and the mortality rates are 4 times higher (8 vs 2 deaths per 100,000) for Indigenous women versus non‐Indigenous women 1. Indigenous women are more likely to have advanced disease when they are diagnosed3 and lower survival rates than non‐Indigenous women (5‐year survival rate, 57.6% vs 78.3%) 4…”

Section: Introductionmentioning

confidence: 99%

The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000‐2011)

Whop

Garvey

Baade

et al. 2016

Cancer

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BACKGROUNDThe Australian National Cervical Screening Program, introduced more than 20 years ago, does not record the Indigenous status of screening participants. This article reports the first population‐based estimates of participation in cervical screening for Indigenous and non‐Indigenous Australian women.METHODSThis was a retrospective, population‐based study of 1,334,795 female Queensland residents, aged 20 to 69 years, who participated in cervical screening from 2000 to 2011; 26,829 were identified as Indigenous through linkage to hospitalization records. Participation rates were calculated as the number of women screened divided by the average estimated resident population, with adjustments made for hysterectomies, for each 2‐, 3‐, and 5‐year screening period. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), which were adjusted for age group, place of residence, and socioeconomic disadvantage.RESULTSIn 2010‐2011, the 2‐year participation rate was 55.7% (95% CI, 55.6%‐55.9%) for non‐Indigenous women and 33.5% (95% CI, 32.9%‐34.1%) for Indigenous women; this represented a decrease from 2000‐2001 (57.7% [95% CI, 57.6%‐57.9%] and 35.3% [95% CI, 34.5%‐36.1%], respectively). The difference between Indigenous and non‐Indigenous women was greatest for those aged 45 to 49 years. The 3‐ and 5‐year participation rates were higher within both groups, and the absolute differences between the 2 groups were larger. Significant interactions between the Indigenous status and the place of residence and socioeconomic disadvantage highlight that the Indigenous/non‐Indigenous differential was evident in all places of residence except for very remote areas (OR, 0.99; 95% CI, 0.95‐1.02) and was greatest in the most affluent areas (OR, 0.26; 95% CI, 0.24‐0.27).CONCLUSIONSIndigenous Australian women participate less than non‐Indigenous women, and this gap has not closed. These results provide important benchmarks for the new Australian cervical screening program commencing in 2017, which will provide opportunities to reduce inequities for Indigenous women and address longstanding data deficiencies in the collection of the Indigenous status. Cancer 2016;122:1560–9. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Factors Associated With Cancer-Specific and Overall Survival Among Indigenous and Non-Indigenous Gynecologic Cancer Patients in Queensland, Australia

Abstract: Improving the early diagnosis of cervical cancer in Indigenous women may increase cancer-specific survival in the year following diagnosis.

Cited by 20 publications

References 13 publications

Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need

Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)

The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000‐2011)

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