Valery Patricia C, Coory Michael, Stirling Janelle, Green Adèle C
Queensland Institute of Medical Research, Queensland, Australia.
Lancet. 2006 Jun 3;367(9525):1842-8. doi: 10.1016/S0140-6736(06)68806-5.
Indigenous Australians do not have the high standard of health that Australians in general have, and have worse outcomes for several diseases such as cancer. However, few comparative data exist to prove this disparity. We assessed differences in disease stage at cancer diagnosis, treatment, and survival between these two populations in Queensland.
Indigenous people diagnosed with cancer between 1997 and 2002 were identified through the cancer registry and compared with randomly selected non-Indigenous patients who were frequency-matched for age, sex, place of residence, cancer site, and year of diagnosis. We obtained details of treatment from hospital medical records. We restricted analyses to patients treated in the public sector, since less than 5% of Indigenous cases were treated privately. We used multivariate models, mainly Cox regression analyses, to assess differences.
We studied 815 Indigenous and 810 non-Indigenous cancer patients. Stage at diagnosis differed significantly (p=0.007): 47% of Indigenous versus 53% of non-Indigenous patients had localised cancer, 22% versus 21% had distant metastases, and 12% versus 7% had no information on stage in the medical chart examined. Comorbidities such as diabetes mellitus or chronic renal disease were more common in Indigenous patients. These individuals were less likely to have had treatment for cancer (surgery, chemotherapy, radiotherapy), and waited longer for surgery (hazard ratio=0.84, 95% CI 0.72-0.97) than non-Indigenous patients. After adjustment for stage at diagnosis, treatment, and comorbidities, non-Indigenous patients had better survival than Indigenous ones (hazard ratio=1.3, 95% CI 1.1-1.5).
Non-Indigenous cancer patients survive longer than Indigenous ones, even after adjustment for stage at diagnosis, cancer treatment, and greater comorbidity in Indigenous cases. We believe that better understanding of cultural differences in attitudes to cancer and its treatment could translate into meaningful public-health and clinical interventions to improve cancer survival in Indigenous Australians.
澳大利亚原住民的健康水平不及全体澳大利亚人，在癌症等多种疾病方面的预后更差。然而，鲜有比较数据能证实这种差异。我们评估了昆士兰州这两个人群在癌症诊断、治疗阶段及生存情况方面的差异。
通过癌症登记处识别出1997年至2002年间被诊断为癌症的原住民，并与随机选取的非原住民患者进行比较，这些非原住民患者在年龄、性别、居住地点、癌症部位及诊断年份上进行了频率匹配。我们从医院病历中获取治疗细节。由于不到5%的原住民病例接受私立治疗，我们将分析限制在公共部门接受治疗的患者。我们使用多变量模型，主要是Cox回归分析来评估差异。
我们研究了815名原住民和810名非原住民癌症患者。诊断阶段存在显著差异（p = 0.007）：47%的原住民患者与53%的非原住民患者患有局限性癌症，22%的原住民患者与21%的非原住民患者有远处转移，在检查的病历中，12%的原住民患者与7%的非原住民患者没有分期信息。糖尿病或慢性肾病等合并症在原住民患者中更为常见。这些患者接受癌症治疗（手术、化疗、放疗）的可能性较小，且比非原住民患者等待手术的时间更长（风险比 = 0.84，95%可信区间0.72 - 0.97）。在对诊断阶段、治疗及合并症进行调整后，非原住民患者的生存率高于原住民患者（风险比 = 1.3，95%可信区间1.1 - 1.5）。
即使在对诊断阶段、癌症治疗及原住民病例中更高的合并症进行调整后，非原住民癌症患者的生存期仍比原住民患者长。我们认为，更好地理解对癌症及其治疗态度上的文化差异，可能转化为有意义的公共卫生和临床干预措施，以提高澳大利亚原住民的癌症生存率。
