Lung cancer outcomes gap still wide for Indigenous Australians

Lung cancer

By Michael Woodhead

2 Jul 2020

Indigenous people with lung cancer are much more likely to die than non-Indigenous people, despite having similar stage at diagnosis and receiving similar treatments, a new study from the NT has found.

A review of outcomes for 91 Indigenous and 226 non-Indigenous people with lung cancer from the NT cancer registry found that the Indigenous Australians had poorer one- and five-year survival (25.0% and 9.4%, respectively), when compared to those of non-Indigenous Australians, which were similar to the national average (42.0% and 16.2%, respectively).

Most patients in both groups were diagnosed with advanced stage lung cancer, and there were no disparities in receipt of treatment such as surgery for curative intent.

The reasons for the disparities in survival were likely to be complex, said the study authors, and might include factors such as Indigenous people having more comorbidities such as respiratory disease (73.6% vs 52.7%) renal insufficiency (24.2% vs 5.3%) and diabetes mellitus 30.8% vs 14.2%) than non_Indigenous people.

Indigenous people with lung cancer were also more likely to be living in more socioeconomically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1 % vs 6.8%). They were also more likely to die at home, compared to their non‐Indigenous counterparts (64.3% vs 26.7%), perhaps reflecting the importance of country and family in end-of-life care choices.

It was also notable that Indigenous lung cancer patients were more likely to be female (51.6% vs  30.5% female non‐Indigenous lung cancer patients), and were current smokers (61.3% vs 36.9%).

“Social disadvantage, lower health literacy, cultural and religious factors and racism, fear and mistrust, communication barriers, stigma, and geographical isolation are some of the factors affecting patient outcomes for Indigenous Australians with cancer overall,” the study authors said

But since Indigenous people had similar diagnostic procedures and treatment rates as non-Indigenous people, the answer to the disparities in outcomes may lie in prevention strategies, including smoking cessation and health promotion, they suggested.

Public health strategies to reduce cancer-related stigma, and promote disease awareness and symptom recognition may increase the likelihood of earlier presentation, diagnosis and treatment, they said.

Both prevention and treatment approaches for lung cancer will need to be delivered in a way that is culturally sensitive and accessible for Indigenous people, they said

Also, employment of more Indigenous health workers and liaison officers in hospitals is also likely to improve Indigenous people’s access to cancer care,” they added.

“In conclusion, Indigenous patients from the Top End of the NT diagnosed with lung cancer were more likely to succumb to poorer survival outcomes when compared to non-Indigenous people and potential reasons for the discrepancy in survival need to be addressed urgently.”

The findings are published in the Internal Medicine Journal.

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