Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia.
BMC Health Serv Res. 2019 Oct 29;19(1):771. doi: 10.1186/s12913-019-4534-y.
Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments.
Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death.
Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63.
The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
与其他澳大利亚人相比，澳大利亚原住民和托雷斯海峡岛民的癌症预后较差。人们对原住民和托雷斯海峡岛民接受的癌症治疗类型和数量知之甚少，也不知道这些治疗对癌症生存的影响。本研究通过比较病例组和对照组的手术、系统和放疗治疗情况，以及两组对这些治疗的相对暴露情况，定量评估了治疗对癌症死亡风险的影响。
在 1990-2010 年间，南澳大利亚州的原住民癌症患者（N=777）与随机选择的非原住民病例按性别、出生和诊断年份以及原发部位进行匹配，然后与诊断前 2 个月至诊断后 13 个月期间的癌症治疗情况进行链接。竞争风险回归总结了原住民身份、地理偏远程度、合并症、癌症分期和治疗暴露与癌症死亡风险的关联。
与非原住民病例相比，原住民病例在诊断时的局部疾病比例较低（37.2%比 50.2%），并且他们更不可能：经历与癌症诊断相关的住院治疗，未调整的比值比（UOR）=0.76；95%CI=0.59-0.98；接受手术 UOR=0.65；95%CI=0.53-0.80；系统治疗 UOR=0.64；95%CI=0.52-0.78；或放射治疗，UOR=0.76；95%CI=0.63-0.94。与接受手术或系统治疗的晚期病例相比，局部疾病的癌症死亡风险较低，校正后危险比（SHR）=0.34；95%CI=0.25-0.47 和 SHR=0.35；95%CI=0.25-0.48。晚期疾病且未接受治疗的患者癌症死亡风险更高，SHR=1.82；95%CI=1.26-2.63。
治疗效果在原住民和非原住民队列之间没有差异。然而，与地理偏远、疾病晚期和诊断时合并症等相关的劣势，以及在癌症死亡方面的差异，进一步复杂化了原住民癌症病例中接受手术和系统治疗的相对较少的情况。需要采取系统层面的措施来改善获得有效治疗的机会、利用情况和治疗质量，以提高癌症诊断后的生存率。
