Global Public Health Unit, University of Edinburgh, Edinburgh, United Kingdom.
Cancer. 2010 Jul 1;116(13):3205-14. doi: 10.1002/cncr.25127.
Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer.
On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status.
Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity.
Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations.
在美国已经有报道称，在结肠癌治疗方面存在种族和民族不平等现象，但在其他国家尚未有报道。本文作者比较了在一个具有全国代表性的毛利（土著）和非毛利新西兰人群体中患有结肠癌的患者的癌症治疗情况。
基于癌症登记数据，作者确定了 301 名毛利患者和 329 名随机选择的非毛利患者，这些患者在 1996 年至 2003 年间被诊断患有结肠癌。对医疗记录进行了回顾，并按土著身份比较了手术和肿瘤治疗情况。
毛利患者和非毛利患者的手术切除率相似，但毛利患者不太可能进行广泛的淋巴结清扫，且在术后期间死亡的可能性更高。患有 III 期疾病的毛利患者接受化疗的可能性明显较低（相对风险 [RR]，0.69；95%置信区间 [CI]，0.53-0.91），并且开始化疗之前经历至少 8 周延迟的可能性更高（RR，1.98；95%CI，1.23-3.16）。肿瘤特征或患者合并症的差异并不能解释治疗差异。
与非毛利患者相比，新西兰毛利人患有结肠癌时接受辅助化疗的可能性较低，且治疗质量较差。作者总结认为，需要关注卫生系统因素，以确保土著和少数民族人群获得平等的癌症治疗机会和质量。
