Treatment patterns for cancer in Western Australia: does being Indigenous make a difference?

Abstract

Objective: To examine whether hospital patients with cancer who were identified as Indigenous were as likely to receive surgery for the cancer as non‐Indigenous patients. Design, setting and patients: Epidemiological survey of all Western Australian (WA) patients who had a cancer registration in the state‐based WA Record Linkage Project that mentioned cancer of the breast (1982–2000) or cancer of the lung or prostate (1982–2001). Main outcome measures: The likelihoods of receiving breast‐conserving surgery or mastectomy for breast cancer, lung surgery for lung cancer, or radical or non‐radical prostatectomy for prostate cancer were compared between the Indigenous and non‐Indigenous populations using adjusted logistic regression analyses. Results: Indigenous people were less likely to receive surgery for their lung cancer (odds ratio [OR], 0.64; 95% CI, 0.41–0.98). Indigenous men were as likely as non‐Indigenous men to receive non‐radical prostatectomy (OR, 0.69; 95% CI, 0.40–1.17); only one Indigenous man out of 64 received radical prostatectomy. Indigenous women were as likely as non‐Indigenous women to undergo breast‐conserving surgery (OR, 0.86; 95% CI, 0.60–1.21). Conclusions: These results indicate a different pattern of surgical care for Indigenous patients in relation to lung and prostate, but not breast, cancer. Reasons for these disparities, such as treatment choice and barriers to care, require further investigation.

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

“…Our findings regarding treatment parallel reports from a number of international [22-24] and local [6,25-27] studies. We found that irrespective of remoteness or socioeconomic advantage, Indigenous people received less treatment than non-Indigenous counterparts (including Indigenous people who were most advantaged).…”

A study of head and neck cancer treatment and survival among indigenous and non-indigenous people in Queensland, Australia, 1998 to 2004

“…How this compares with other Indigenous populations with head and neck cancer is not known as no similar published data are available. However, treatment bias among Indigenous people with cancer in general, and with other specific cancers, has been reported in a number of studies [1,15-17]. The reasons why Indigenous people in this study were less likely to receive treatment are not precisely known but we found that those Indigenous people who do not receive treatment were likely to be older, male and socially disadvantaged compared to non-Indigenous people who did not receive treatment.…”

“…In general these details were not available from the medical records, and are therefore not assessed in this study. Reports suggest factors such as late stage at diagnosis [17], greater prevalence of comorbidities [1] and disparate treatment decisions made by health professionals based on assumptions about socioeconomic and cultural factors [21] may explain some of the treatment differential, but reports are not conclusive.…”

Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

“…Late presentation and poor survival is also influenced by communication and cultural barriers which may impact the effectiveness and choice of treatment, as well as the decision to engage in preventive and diagnostic activities including cancer screening [19,20,33]. The presence of other chronic diseases or environmental conditions also limits provision of treatment due to the risk of complications [4,21,26,34].…”