Early diagnosis and improved treatment uptake in the first year may reduce survival disparities between Aboriginal and Torres Strait Islander and other Australian women diagnosed with gynaecological cancer

Diaz, Abbey

Early diagnosis and improved treatment uptake in the first year may reduce survival disparities between Aboriginal and Torres Strait Islander and other Australian women diagnosed with gynaecological cancer

Sunday, 17 August 2014

Exhibit hall (Dena'ina Center)

Abbey Diaz, MS , Menzies School of Health Research, Charles Darwin University, Brisbane, Australia

Suzanne P Moore, PhD , Menzies School of Health Research, Charles Darwin University, Brisbane, Australia

Jennifer H Martin, PhD , University of Queensland, Brisbane, Australia

Adele C Green, PhD , QIMR Berghofer Medical Research Institute, Brisbane, Australia

Michael Coory, PhD , Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia

Gail Garvey , Menzies School of Health Research, Charles Darwin University, Brisbane, Australia

Patricia C Valery, PhD , Menzies School of Health Research, Charles Darwin University, Brisbane, Australia

INTRODUCTION: Aboriginal and Torres Strait Islander women (respectfully referred here as Indigenous Australian women) are less likely to survive gynaecological cancer compared to other Australian women. Reasons for this disparity are not well understood. This study examines factors that may explain one-year and five-year survival differences between Indigenous and other Australian women with gynaecological cancer in the state of Queensland, Australia.

METHODS: Indigenous Australian women diagnosed with a uterine, cervical, ovarian or other gynaecological cancers during 1998-2004 in the public hospital system were included, and matched to a random sample of other Australian women diagnosed during the same period of corresponding age (-/+ 5 years), remoteness of residence, and cancer type. National Death Index data was obtained for deaths until 2006. One-year and five-year survival for Indigenous compared to other Australian women was examined using all-cause mortality and cox proportional hazards regression.

RESULTS: Indigenous women (n=137, 53%) compared to other Australian women (n=120) were less likely to have localised disease (49% vs. 65%, p=0.02), less likely to receive cancer treatment (91% vs. 98%, p=0.01) and more likely to have comorbidity (52% vs. 21%, p<0.001) at diagnosis. Indigenous women were less likely to survive the first year following diagnosis (HR 1.95, 95% CI 1.09-3.50), although this was largely explained by more advanced disease at diagnosis, less uptake of treatment, and greater comorbidity burden (HR 1.21, 95% CI 0.64-2.29). They also had poorer five-year survival compared to other Australian women (HR 1.54, 95% CI 1.02-2.33 unadjusted), although differences were no longer significant when women who did not survive year one were excluded (HR: 1.19, 95%CI: 0.65-2.16, p=0.58, unadjusted).

CONCLUSIONS: Strategies that aim to reduce survival disparities for Indigenous women with gynaecological cancer should target earlier diagnosis and earlier treatment. The influence of comorbidities on time to diagnosis and treatment should be explored further.