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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
Med J Aust 2005; 182 (6): 277-280.

Summary

Objective: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates.

Design: Retrospective cohort study.

Setting and participants: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991–2000.

Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death.

Results: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%–78%) than for non-Indigenous people (51%; 95% CI, 53%–59%) with cancers of the colon and rectum, breast, cervix and non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%–65%] v non-Indigenous, 69% [95% CI, 64%–75%]). Stage-adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site.

Conclusions: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia.

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  • John R Condon1
  • Tony Barnes2
  • Bruce K Armstrong3
  • Sid Selva-Nayagam4
  • J Mark Elwood5

  • 1 Menzies School of Health Research, Darwin, NT.
  • 2 School of Social and Policy Research, Charles Darwin University, Darwin, NT.
  • 3 School of Public Health, University of Sydney, NSW.
  • 4 Department of Medicine, Royal Darwin Hospital, Darwin, NT.
  • 5 National Cancer Control Initiative, Melbourne, VIC.


Acknowledgements: 

We are grateful for the cooperation and support of the members of the Northern Territory Oncology Research Group, which was critical to the success of this project; the assistance during data collection of Karin Dunne, Debbie Taylor-Thompson and the staff of the Medical Records Departments in all NT hospitals; and the New South Wales Cancer Registry for providing comparative data.

John Condon was supported by postgraduate scholarships from the National Health and Medical Research Council and the Cooperative Research Centre for Aboriginal and Tropical Health. Bruce Armstrong was supported by a University of Sydney Medical Foundation Program Grant. Project funding was provided by the National Cancer Control Initiative. Staff of the National Cancer Control Initiative contributed to the design of the study, and to the preparation of this report.

Competing interests:

None identified.

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