Gibberd Alison, Supramaniam Rajah, Dillon Anthony, Armstrong Bruce K, O'Connell Dianne L
School of Public Health, University of Sydney, Sydney, Australia.
Cancer Research Division, Cancer Council NSW, Sydney, Australia.
BMC Cancer. 2016 Apr 25;16:289. doi: 10.1186/s12885-016-2322-1.
The aim of this study was to compare surgical treatment received by Aboriginal and non-Aboriginal people with non-small cell lung cancer (NSCLC) in New South Wales (NSW), Australia and to examine whether patient and disease characteristics are associated with any disparities found. An additional objective was to describe the adjuvant treatments received by Aboriginal people diagnosed with NSCLC in NSW. Finally, we compared the risk of death from NSCLC for Aboriginal and non-Aboriginal people.
We used logistic regression and competing risks regression to analyse population-based cancer registry records for people diagnosed with NSCLC in NSW, 2001-2007, linked to hospital inpatient episodes and deaths. We also analysed treatment patterns from a medical record audit for 170 Aboriginal people diagnosed with NSCLC in NSW, 2000-2010.
Of 20,154 people diagnosed with primary lung cancer, 341 (1.7%) were Aboriginal. Larger proportions of Aboriginal people were younger, female, living outside major cities or in areas of greater socioeconomic disadvantage, smoking at the time of diagnosis and had comorbidities. Although Aboriginal people were, on average, younger at diagnosis with non-metastatic NSCLC than non-Aboriginal people, only 30.8% of Aboriginal people received surgery, compared with 39.5% of non-Aboriginal people. Further, Aboriginal people who were not receiving surgery, at the time of diagnosis, were more likely to be younger, live in major cities and have no comorbidities. The observed risk of death from NSCLC 5 years after diagnosis was higher for 266 Aboriginal people (83.3% 95% CI 77.5-87.7) than for 15,491 non-Aboriginal people (77.6% 95% CI 76.9-78.3) and the adjusted subhazard ratio was 1.32 (95% CI 1.14-1.52). From the medical record audit, 29% of Aboriginal people with NSCLC had potentially curative treatment, 45% had palliative radiotherapy/chemotherapy and 26% had no active treatment.
There are disparities in NSCLC surgical treatment and mortality for Aboriginal people compared with non-Aboriginal people in NSW. It is imperative that Aboriginal people are offered active lung cancer treatment, particularly those who are younger and without comorbidities and are therefore most likely to benefit, and are provided with assistance to access it if required.
本研究旨在比较澳大利亚新南威尔士州（NSW）原住民和非原住民非小细胞肺癌（NSCLC）患者接受的手术治疗情况，并探讨患者和疾病特征是否与所发现的任何差异相关。另一个目标是描述新南威尔士州被诊断为NSCLC的原住民接受的辅助治疗。最后，我们比较了原住民和非原住民因NSCLC死亡的风险。
我们使用逻辑回归和竞争风险回归分析了2001年至2007年新南威尔士州被诊断为NSCLC的人群基于人群的癌症登记记录，并与医院住院病历和死亡记录相链接。我们还分析了2000年至2010年新南威尔士州170名被诊断为NSCLC的原住民的病历审核中的治疗模式。
在20154名被诊断为原发性肺癌的患者中，341名（1.7%）为原住民。原住民中较大比例的人更年轻、女性、居住在主要城市以外或社会经济劣势更大的地区、在诊断时吸烟且患有合并症。尽管原住民被诊断为非转移性NSCLC时平均比非原住民年轻，但只有30.8%的原住民接受了手术，而非原住民为39.5%。此外，在诊断时未接受手术的原住民更可能年轻、居住在主要城市且没有合并症。诊断后5年，266名原住民因NSCLC死亡的观察风险（83.3%，95%CI 77.5 - 87.7）高于15491名非原住民（77.6%，95%CI 76.9 - 78.3），调整后的亚风险比为1.32（95%CI 1.14 - 1.52）。从病历审核来看，29%的NSCLC原住民患者接受了可能治愈性的治疗，45%接受了姑息性放疗/化疗，26%未接受积极治疗。
与新南威尔士州的非原住民相比，原住民在NSCLC手术治疗和死亡率方面存在差异。必须为原住民提供积极的肺癌治疗，特别是那些年轻且无合并症、因此最可能受益的患者，并在需要时提供帮助以使其能够获得治疗。
