Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients
Identifieur interne : 001C35 ( Ncbi/Curation ); précédent : 001C34; suivant : 001C36Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients
Auteurs : Suzanne P. Moore [Australie, France] ; Adèle C. Green [Australie, Royaume-Uni] ; Freddie Bray [France] ; Gail Garvey [Australie] ; Michael Coory [Australie] ; Jennifer Martin [Australie] ; Patricia C. Valery [Australie]Source :
- BMC Cancer [ 1471-2407 ] ; 2014.
Abstract
Indigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia.
A cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998–2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models.
Overall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83).
In this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.
Url:
DOI: 10.1186/1471-2407-14-517
PubMed: 25037075
PubMed Central: 4223410
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Green</name><affiliation wicri:level="1"><nlm:aff id="I2">Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane</wicri:regionArea><wicri:noRegion>4006 Brisbane</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="I3">University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Manchester, Manchester Academic Health Science Centre, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation></author><author><name sortKey="Bray, Freddie" sort="Bray, Freddie" uniqKey="Bray F" first="Freddie" last="Bray">Freddie Bray</name><affiliation wicri:level="1"><nlm:aff id="I4">International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon</wicri:regionArea><wicri:noRegion>69372 Lyon</wicri:noRegion><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author><author><name sortKey="Garvey, Gail" sort="Garvey, Gail" uniqKey="Garvey G" first="Gail" last="Garvey">Gail Garvey</name><affiliation wicri:level="1"><nlm:aff id="I1">Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000</wicri:regionArea><wicri:noRegion>Brisbane 4000</wicri:noRegion></affiliation></author><author><name sortKey="Coory, Michael" sort="Coory, Michael" uniqKey="Coory M" first="Michael" last="Coory">Michael Coory</name><affiliation wicri:level="1"><nlm:aff id="I5">Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Martin, Jennifer" sort="Martin, Jennifer" uniqKey="Martin J" first="Jennifer" last="Martin">Jennifer Martin</name><affiliation wicri:level="3"><nlm:aff id="I6">School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I7">Monash University (Adjunct), Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Monash University (Adjunct), Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Valery, Patricia C" sort="Valery, Patricia C" uniqKey="Valery P" first="Patricia C" last="Valery">Patricia C. 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Moore</name><affiliation wicri:level="1"><nlm:aff id="I1">Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000</wicri:regionArea><wicri:noRegion>Brisbane 4000</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon</wicri:regionArea><wicri:noRegion>69372 Lyon</wicri:noRegion><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author><author><name sortKey="Green, Adele C" sort="Green, Adele C" uniqKey="Green A" first="Adèle C" last="Green">Adèle C. Green</name><affiliation wicri:level="1"><nlm:aff id="I2">Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane</wicri:regionArea><wicri:noRegion>4006 Brisbane</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="I3">University of Manchester, Manchester Academic Health Science Centre, Manchester, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Manchester, Manchester Academic Health Science Centre, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation></author><author><name sortKey="Bray, Freddie" sort="Bray, Freddie" uniqKey="Bray F" first="Freddie" last="Bray">Freddie Bray</name><affiliation wicri:level="1"><nlm:aff id="I4">International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon</wicri:regionArea><wicri:noRegion>69372 Lyon</wicri:noRegion><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author><author><name sortKey="Garvey, Gail" sort="Garvey, Gail" uniqKey="Garvey G" first="Gail" last="Garvey">Gail Garvey</name><affiliation wicri:level="1"><nlm:aff id="I1">Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000</wicri:regionArea><wicri:noRegion>Brisbane 4000</wicri:noRegion></affiliation></author><author><name sortKey="Coory, Michael" sort="Coory, Michael" uniqKey="Coory M" first="Michael" last="Coory">Michael Coory</name><affiliation wicri:level="1"><nlm:aff id="I5">Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Martin, Jennifer" sort="Martin, Jennifer" uniqKey="Martin J" first="Jennifer" last="Martin">Jennifer Martin</name><affiliation wicri:level="3"><nlm:aff id="I6">School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I7">Monash University (Adjunct), Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Monash University (Adjunct), Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Valery, Patricia C" sort="Valery, Patricia C" uniqKey="Valery P" first="Patricia C" last="Valery">Patricia C. Valery</name><affiliation wicri:level="1"><nlm:aff id="I1">Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000</wicri:regionArea><wicri:noRegion>Brisbane 4000</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Cancer</title><idno type="eISSN">1471-2407</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Indigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia.</p></sec><sec><title>Methods</title><p>A cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998–2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models.</p></sec><sec><title>Results</title><p>Overall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83).</p></sec><sec><title>Conclusion</title><p>In this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Condon, Jr" uniqKey="Condon J">JR Condon</name></author><author><name sortKey="Armstrong, Bk" uniqKey="Armstrong B">BK Armstrong</name></author><author><name sortKey="Barnes, A" uniqKey="Barnes A">A Barnes</name></author><author><name sortKey="Cunningham, J" uniqKey="Cunningham J">J Cunningham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cramb, Sm" uniqKey="Cramb S">SM Cramb</name></author><author><name sortKey="Garvey, G" uniqKey="Garvey G">G Garvey</name></author><author><name sortKey="Valery, Pc" uniqKey="Valery P">PC Valery</name></author><author><name sortKey="Williamson, Jd" uniqKey="Williamson J">JD Williamson</name></author><author><name sortKey="Baade, Pd" uniqKey="Baade P">PD 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Swan</name></author><author><name sortKey="Wiggins, C" uniqKey="Wiggins C">C Wiggins</name></author><author><name sortKey="Jim, Ma" uniqKey="Jim M">MA Jim</name></author><author><name sortKey="Ward, E" uniqKey="Ward E">E Ward</name></author><author><name sortKey="Wingo, Pa" uniqKey="Wingo P">PA Wingo</name></author><author><name sortKey="Howe, Hl" uniqKey="Howe H">HL Howe</name></author><author><name sortKey="Ries, La" uniqKey="Ries L">LA Ries</name></author><author><name sortKey="Miller, Ba" uniqKey="Miller B">BA Miller</name></author><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author><author><name sortKey="Ahmed, F" uniqKey="Ahmed F">F Ahmed</name></author><author><name sortKey="Cobb, N" uniqKey="Cobb N">N Cobb</name></author><author><name sortKey="Kaur, Js" uniqKey="Kaur J">JS Kaur</name></author><author><name sortKey="Edwards, Bk" uniqKey="Edwards B">BK Edwards</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Supramaniam, R" uniqKey="Supramaniam R">R Supramaniam</name></author><author><name sortKey="Grindley, H" uniqKey="Grindley H">H Grindley</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Magliano, D" uniqKey="Magliano D">D Magliano</name></author><author><name sortKey="Liew, D" uniqKey="Liew D">D Liew</name></author><author><name sortKey="Pater, H" uniqKey="Pater H">H Pater</name></author><author><name sortKey="Kirby, A" uniqKey="Kirby A">A Kirby</name></author><author><name sortKey="Hunt, D" uniqKey="Hunt D">D Hunt</name></author><author><name sortKey="Simes, J" uniqKey="Simes J">J Simes</name></author><author><name sortKey="Sundararajan, V" uniqKey="Sundararajan V">V Sundararajan</name></author><author><name sortKey="Tonkin, A" uniqKey="Tonkin A">A Tonkin</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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