Sanjida Saira, Garvey Gail, Bainbridge Roxanne, Diaz Abbey, Barzi Federica, Holzapfel Sherry, Chen Michael Y, Collin Harry, Fatima Yaqoot, Hou Xiang-Yu, Ward James
Poche Centre for Indigenous Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia.
School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Queensland, Australia.
Lancet Reg Health West Pac. 2025 Mar 26;57:101527. doi: 10.1016/j.lanwpc.2025.101527. eCollection 2025 Apr.
As cancer incidence increases globally, so does the prevalence of cancer among Indigenous peoples. Indigenous peoples face significant barriers to healthcare, including access to and uptake of surgery. To date, the synthesis of access to and uptake of surgery for Indigenous peoples living with cancer has not yet been reported.
We conducted a systematic literature review and meta-analysis of access to and uptake of surgery for Indigenous peoples in Canada, Australia, New Zealand, and the United States. Five databases were searched to identify studies of Indigenous adults with cancer and those who received surgery. The Joanna Briggs Institute critical appraisal tools were used to assess the quality and inclusion of articles. Random effect meta-analyses were conducted to estimate the pooled prevalence of surgery in Indigenous people with cancer.
Of the 52 studies in the systematic review, 38 were included in the meta-analysis. The pooled prevalence of surgery in Indigenous people with cancer was 56.2% (95% confidence interval (CI): 45.4-66.7%), including 42.8% (95% CI: 36.3-49.5%) in the Native Hawaiian population, 44.5% (95% CI: 38.7-50.3%) in the Inuit and 51.5% (95%CI: 36.8-65.9%) in Aboriginal and Torres Strait Islander people. Overall, Indigenous people received marginally less cancer surgery than non-Indigenous people (3%, 95% CI: 0-6%). Indigenous people were 15% (95% CI: 6-23%) less likely to receive surgery than non-Indigenous people for respiratory cancers. Remoteness, travel distance, financial barriers, and long waiting times to receive surgery were factors cited as contributing to lower access to surgery for Indigenous people compared to non-Indigenous people.
Efforts to improve access and use of cancer services and surgery for Indigenous peoples should be multilevel to address individual factors, health services and systems, and structural barriers. These determinants need to be addressed to expedite optimal care for Indigenous peoples, especially those living in outer metropolitan areas.
The Research Alliance for Urban Goori Health (RAUGH) funded this project. GG was funded by an NHMRC Investigator Grant (#1176651).
随着全球癌症发病率的上升，原住民中的癌症患病率也在增加。原住民在获得医疗保健方面面临重大障碍，包括接受手术的机会和意愿。迄今为止，尚未有关于癌症原住民接受手术的机会和意愿的综合报道。
我们对加拿大、澳大利亚、新西兰和美国原住民接受手术的机会和意愿进行了系统的文献综述和荟萃分析。检索了五个数据库，以确定有关患癌原住民成年人及接受手术者的研究。使用乔安娜·布里格斯研究所的批判性评估工具来评估文章的质量和纳入情况。进行随机效应荟萃分析，以估计癌症原住民接受手术的合并患病率。
在系统综述的52项研究中，38项被纳入荟萃分析。癌症原住民接受手术的合并患病率为56.2%（95%置信区间（CI）：45.4 - 66.7%），其中夏威夷原住民为42.8%（95%CI：36.3 - 49.5%），因纽特人为44.5%（95%CI：38.7 - 50.3%），澳大利亚原住民和托雷斯海峡岛民为51.5%（95%CI：36.8 - 65.9%）。总体而言，原住民接受的癌症手术略少于非原住民（3%，95%CI：0 - 6%）。与非原住民相比，原住民因呼吸道癌症接受手术的可能性低15%（95%CI：6 - 23%）。与非原住民相比，偏远地区、旅行距离、经济障碍以及等待手术的时间过长被认为是导致原住民接受手术机会较低的因素。
改善原住民获得癌症服务和手术的机会及利用率的努力应是多层次的，以解决个体因素、卫生服务和系统以及结构性障碍。需要解决这些决定因素，以便为原住民，特别是那些居住在大都市外围地区的原住民加快提供最佳护理。
城市古里健康研究联盟（RAUGH）资助了该项目。GG由澳大利亚国家卫生与医学研究委员会研究员资助（#1176651）。
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