Survival of Indigenous and non‐Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study

Abstract

Objective: To compare survival of Indigenous and non‐Indigenous lung cancer patients and to investigate any corresponding differences in stage, treatment and comorbidities. Design and setting: Cohort study of 158 Indigenous and 152 non‐Indigenous patients (frequency‐matched on age, sex and rurality) diagnosed with lung cancer between 1996 and 2002 and treated in Queensland public hospitals. Main outcome measures: Survival after diagnosis of lung cancer; effects of stage at diagnosis, treatment, comorbidities and histological subtype on lung cancer‐specific survival. Results: Survival of Indigenous lung cancer patients was significantly lower than that of non‐Indigenous patients (median survival, 4.3 v 10.3 months; hazard ratio, 1.48; 95% CI, 1.14–1.92). Of 158 Indigenous patients, 72 (46%) received active treatment with chemotherapy, radiotherapy or surgery compared with 109 (72%) of the 152 non‐Indigenous patients, and this treatment disparity remained after adjusting for histological subtype, stage at diagnosis, and comorbidities (adjusted risk ratio, 0.65; 95% CI, 0.53–0.73). The treatment disparity explained most of the survival deficit: the hazard ratio reduced to 1.10 (95% CI, 0.83–1.44) after inclusion of treatment variables in the proportional hazards survival model. The remaining survival deficit was explained by the higher prevalence of comorbidities among Indigenous cancer patients, mainly diabetes. Conclusion: Survival after a diagnosis of lung cancer is worse for Indigenous patients than for non‐Indigenous patients, and differences in treatment between the two groups are mainly responsible.

Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients

“…Concomitant disease is reported to influence cancer treatment choices (dose, duration, modality), cause complications, and impede survival [9,16-18]. Excess comorbidities have been shown to contribute to lower curative treatment rates and poorer cancer survival for New Zealand Māori [18,19], and contributed to the survival disparity among Indigenous people with lung cancer in Queensland [20]. Indigenous people with lung cancer and diabetes had reportedly 40% worse survival than Indigenous people without diabetes, whereas the presence of diabetes was unrelated to survival in non-Indigenous people [21].…”

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

“…5 A South Australian study reported higher relative risk of death among Indigenous women than non-Indigenous women with cervical cancer (2.14 [95% CI, 1.17Y3.92]), 4 and a Western Australian study reported higher relative risk of death among Indigenous women compared with non-Indigenous women with ovarian cancer (HR, 2.18 [95% CI, 1.18Y4.02]). 6 The reasons for poorer survival of gynecologic cancers among Indigenous Australian women is likely to be multifaceted and may include increased late-stage diagnosis, 7 less cancer treatment, 7Y10 higher burden of comorbidities, 10,11 and increased remoteness of residence. 12 There is also evidence that survival differences between Australian Indigenous and non-Indigenous cancer patients are most prominent in the first years following diagnosis.…”

"If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia

“…This could be due to the fact that Aboriginal people are diagnosed later than their non-Aboriginal counterparts; have poorer continuity of care and a lower compliance with treatment[15,20]. They also suffer from cancers which generally have a poor prognosis but are largely preventable[15].…”