Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.
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Stage at diagnosis and cancer survival for Stage-adjusted, cause- specific cancer
survival rates were also esti- mated from regression models.
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R ES E A R C H Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory John R Condon, Tony Barnes, Bruce K Armstrong, Sid Selva-Nayagam and J Mark Elwood ancer mortality rates are higher for ABSTRACT Indigenous Australians than for other CAustralians for many specific cancer Objective: To investigate whether Indigenous Australians with cancer have more sites. This is partly because of the higher advanced disease at diagnosis than other Australians, and whether late diagnosis incidence of some cancers (particularly lung explains lower Indigenous cancer survival rates. and other smoking-related cancers, cervical Design: Retrospective cohort study. and liver cancers), and partly because of Setting and participants: Indigenous and non-Indigenous people diagnosed with lower survival for most cancers.1-3 cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in Lower cancer survival rates for Indige- the Northern Territory of Australia in 1991–2000. nous people compared with non-Indigenous The Medical Journal of Australia ISSN: Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional people have been reported from South Aus- 0025-729X 21 March 2005 182 6 277- or distant spread), cause-specific cancer survival rates and relative risk of cancer death. tralia 280 (for all cancers combined),4 and from Results: Diagnosis with advanced disease (regional or distant spread) was more th © e N T o h rt e h M ernedi Tca e l rr Jo it urn ory a ( lf of Au or m s o tsrtalia 200 specif 5 ic common for Indigenous people (70%; 95% CI, 62%–78%) than for non-Indigenous can w cersww.mja exami .c n om ed)..a 3 u Survival rates have not people (51%; 95% CI, 53%–59%) with cancers of the colon and rectum, breast, cervix and been R r e e sear portch ed for Indigenous people else- non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% where in Australia. [95% CI, 46%–65%] v non-Indigenous, 69% [95% CI, 64%–75%]). Stage-adjusted survival In South Australia, Indigenous people rates were lower for Indigenous people for each cancer site. With few exceptions, the were more likely to have advanced disease at relative risk of cancer death was higher for Indigenous people for each category of stage diagnosis than non-Indigenous people (for at diagnosis for each cancer site. all cancers combined), but this explained only part of the difference in survival.4 Stage Conclusions: Health services apparently could, and should, be performing better for at diagnosis has not been reported for Indig- Indigenous people with cancer in the Northern Territory, and probably elsewhere in enous people elsewhere in Australia, or for Australia. This study has demonstrated that data from cancer registers, enhanced with individual cancer sites. data on stage at diagnosis, can be used to monitor health service performance for Our study investigated whether, in the Indigenous Australians in the Northern Territory; similar data is available in other States, Northern Territory (NT), Indigenous people and could be used to monitor health service performance for Indigenous people with cancer had more advanced disease at throughout Australia. diagnosis than non-Indigenous people with MJA 2005; 182: 277–280 cancer, and whether later diagnosis explains their lower cancer survival. and non-Indigenous cases to enable compari- This staging system was used as it is the only son. Cases were identified from the NT Can- system that applies to all five cancers METHODS cer Registry.5,6 Hospital and private included in the study. It classifies cancers as All residents of the NT diagnosed with can- specialists’ medical records were examined to localised, regional or distant spread. Cancer cers of the colon and rectum (including collect data on stage at diagnosis and to verify stage was also classified using the TNM anus), lung, female breast, cervix or non- data obtained from the Registry, including staging system (except for non-Hodgkin Hodgkin lymphoma in 1991–2000 were eli- Indigenous status and cause of death. lymphoma, to which TNM staging does not gible for inclusion in this study. These five apply) and site-specific staging systems cancers were chosen as they are designated Cancer staging (Dukes for colorectal cancer, FIGO for cervi- “priority” cancers in Australia, and as there Cancer stage at diagnosis was classified cal cancer and Ann Arbor for non-Hodgkin were sufficient numbers of both Indigenous using the SEER summary staging system.7 lymphoma); results for these systems were published elsewhere.8 Menzies School of Health Research, Darwin, NT. Statistical analysis John R Condon, MPH, FAFPHM, Senior Research Fellow. School of Social and Policy Research, Charles Darwin University, Darwin, NT. The proportion of Indigenous and non- Tony Barnes, MSc, Professorial Research Fellow. Indigenous people with advanced disease School of Public Health, University of Sydney, NSW. (regional or distant spread), adjusted for age Bruce K Armstrong, DPhil, Head of School. at diagnosis, was compared for each of the Department of Medicine, Royal Darwin Hospital, Darwin, NT. Sid Selva-Nayagam, FRACP, Oncologist. five cancers. National Cancer Control Initiative, Melbourne, VIC. For each cancer, Cox regression analysis J Mark Elwood, MD, Director. was used to estimate the stage-specific and Reprints will not be available from the authors. Correspondence: Dr John R Condon, Menzies stage-adjusted hazard ratios (relative risks of School of Health Research, Box 41096, Casuarina, NT 0811. john.condon@menzies.edu.au cancer death) and their 95% confidence MJA • Volume 182 Number 6 • 21 March 2005 277 Document OutlineStage at diagnosis and cancer survival for Indigenous Australians in the Northern TerritoryMethodsCancer stagingStatistical analysisResultsCancer stage at diagnosisCancer survival ratesDiscussionAcknowledgementsCompeting interestsReferences
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