Lung, Breast, and Bowel Cancer Treatment for Aboriginal People in New South Wales: A Population-Based Cohort Study

Background: Aboriginal Australians have higher cancer mortality than non-Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this.

Aims: To investigate demographic, clinical and access factors associated with lung, breast, and bowel cancer treatment for Aboriginal people compared with non-Aboriginal people in New South Wales, Australia.

Methods: Population-based cohort study using linked routinely-collected datasets, including all diagnoses of primary lung, breast, or bowel cancer from January 2009-June 2012. Treatment (surgery, radiotherapy, or chemotherapy) within six months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer-specific multidisciplinary team, visit to a specialist, and possession of private health insurance. Logistic regression modelling was employed.

Results: There were 587 Aboriginal and 34 015 non-Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non-Aboriginal people received surgery (odds ratio (OR) 0.46 (95% confidence interval (CI) 0.29-0.73, p < 0.001)) or any treatment (surgery, chemotherapy or radiotherapy; OR 0.64, 95% CI 0.47-0.88, p = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 v 33.3%, 2865/8597, p = 0.04) compared with non-Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non-Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities.

Conclusion: Aboriginal people were significantly less likely to receive surgery for lung cancer than non-Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways. This article is protected by copyright. All rights reserved.

Keywords: Breast Cancer; Cancer treatment for Aboriginal people; Colorectal Cancer; Indigenous; Lung Cancer; Treatment.