Cancer and Population Studies, Queensland Institute of Medical Research, Brisbane, Australia.
BMC Cancer. 2011 Oct 25;11:460. doi: 10.1186/1471-2407-11-460.
Overall, Indigenous Australians with cancer are diagnosed with more advanced disease, receive less cancer treatment and have poorer cancer survival than non-Indigenous Australians. The prognosis for Indigenous people with specific cancers varies however, and their prognosis for cancers of the head and neck is largely unknown. We therefore have compared clinical characteristics, treatment and survival between Indigenous and non-Indigenous people diagnosed with head and neck cancer in Queensland, Australia.
Rates were based on a cohort of Indigenous people (n = 67), treated in public hospitals between 1998 and 2004 and frequency-matched on age and location to non-Indigenous cases (n = 62) also treated in the public health system. Data were obtained from hospital records and the National Death Index. We used Pearson's Chi-squared analysis to compare categorical data (proportions) and Cox proportional hazard models to assess survival differences.
There were no significant differences in socioeconomic status, stage at diagnosis or number and severity of comorbidities between Indigenous and non-Indigenous patients, although Indigenous patients were more likely to have diabetes. Indigenous people were significantly less likely to receive any cancer treatment (75% vs. 95%, P = 0.005) and, when cancer stage, socioeconomic status, comorbidities and cancer treatment were taken into account, they experienced greater risk of death from head and neck cancer (HR 1.88, 1.10, 3.22) and from all other causes (HR 5.83, 95% CI 1.09, 31.04).
These findings show for the first time that Indigenous Australians with head and neck cancer receive less cancer treatment and suggest survival disparity could be reduced if treatment uptake was improved. There is a need for a greater understanding of the reasons for such treatment and survival disparities, including the impact of the poorer overall health on cancer outcomes for Indigenous Australians.
总体而言，澳大利亚原住民癌症患者的诊断疾病分期更晚，接受的癌症治疗更少，癌症生存率也低于非原住民澳大利亚人。然而，特定癌症患者的预后情况有所不同，他们的头颈部癌症预后情况在很大程度上尚未可知。因此，我们比较了在澳大利亚昆士兰州被诊断患有头颈部癌症的原住民和非原住民患者的临床特征、治疗方法和生存情况。
本研究基于一个队列，纳入了在 1998 年至 2004 年间在公立医院接受治疗的 67 名原住民患者，这些患者按照年龄和地点与同期在公立卫生系统中接受治疗的 62 名非原住民患者进行了频率匹配。数据来源于医院记录和国家死亡指数。我们使用 Pearson 卡方检验比较了分类数据（比例），并使用 Cox 比例风险模型评估了生存差异。
原住民和非原住民患者在社会经济地位、诊断时的分期或合并症的数量和严重程度方面没有显著差异，尽管原住民患者更有可能患有糖尿病。与非原住民患者相比，原住民患者接受任何癌症治疗的可能性显著更低（75%对 95%，P=0.005），当考虑癌症分期、社会经济地位、合并症和癌症治疗时，他们死于头颈部癌症（HR 1.88，1.10，3.22）和其他所有原因（HR 5.83，95%CI 1.09，31.04）的风险更高。
这些发现首次表明，澳大利亚原住民头颈部癌症患者接受的癌症治疗更少，并表明如果提高治疗参与率，可能会降低生存差异。需要进一步了解导致这种治疗和生存差异的原因，包括整体健康状况对原住民癌症结局的影响。
