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The first year counts: cancer survival among Indigenous and non-Indigenous Queenslanders, 1997–2006

Susanna M Cramb, Gail Garvey, Patricia C Valery, John D Williamson and Peter D Baade
Med J Aust 2012; 196 (4): 270-274. || doi: 10.5694/mja11.11194

Summary

Objective: To examine the differential in cancer survival between Indigenous and non-Indigenous people in Queensland in relation to time after diagnosis, remoteness and area-socioeconomic disadvantage.

Design, setting and participants: Descriptive study of population-based data on all 150 059 Queensland residents of known Indigenous status aged 15 years and over who were diagnosed with a primary invasive cancer during 1997–2006.

Main outcome measures: Hazard ratios for the categories of area-socioeconomic disadvantage, remoteness and Indigenous status, as well as conditional 5-year survival estimates.

Results: Five-year survival was lower for Indigenous people diagnosed with cancer (50.3%; 95% CI, 47.8%–52.8%) compared with non-Indigenous people (61.9%; 95% CI, 61.7%–62.2%). There was no evidence that this differential varied by remoteness (P = 0.780) or area-socioeconomic disadvantage (P = 0.845). However, it did vary by time after diagnosis. In a time-varying survival model stratified by age, sex and cancer type, the 50% excess mortality in the first year (adjusted HR, 1.50; 95% CI, 1.38–1.63) reduced to near unity at 2 years after diagnosis (HR, 1.03; 95% CI, 0.78–1.35).

Conclusions: After a wide disparity in cancer survival in the first 2 years after diagnosis, Indigenous patients with cancer who survive these 2 years have a similar outlook to non-Indigenous patients. Access to services and socioeconomic factors are unlikely to be the main causes of the early lower Indigenous survival, as patterns were similar across remoteness and area-socioeconomic disadvantage. There is an urgent need to identify the factors leading to poor outcomes early after diagnosis among Indigenous people with cancer.

  • Susanna M Cramb1
  • Gail Garvey2
  • Patricia C Valery2
  • John D Williamson3
  • Peter D Baade1

  • 1 Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD.
  • 2 Epidemiology and Health Services Division, Menzies School of Health Research, Brisbane, QLD.
  • 3 Policy, Strategy and Resourcing Division, Queensland Health, Brisbane, QLD.


Acknowledgements: 

We thank John Condon, Menzies School of Health Research, Charles Darwin University, for his review of a previous draft of this manuscript. Peter Baade was supported by a National Health and Medical Research Council Career Development Fellowship (No. 1005334). Patricia Valery was supported by an Australian Research Council Future Fellowship (No. FT100100511).

Competing interests:

No relevant disclosures.

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