Indigenous Cancer Patients Falling Through the Cracks
Health services should be performing better for Indigenous people in the Northern Territory following revelations that a number of cancers are diagnosed later for the Indigenous population than for the non-Indigenous population, perhaps leading to higher mortality from those cancers.
Research published in the current issue of The Medical Journal of Australia showed that between 1991 and 2000 in the NT, Indigenous people with cancer of the colon and rectum, breast or cervix or non-Hodgkin lymphoma were more likely to be diagnosed with advanced disease than non-Indigenous people.
However, for lung cancer, the opposite was found, with Indigenous people less likely to have advanced disease. This was perhaps because chronic respiratory disease and tuberculosis are common among Indigenous people in the NT; consequently, they may have more frequent chest x-rays and other investigations as part of clinical management or long term follow-up and contact tracing by the tuberculosis control program.
Furthermore, cancer survival was lower for Indigenous patients than for non-Indigenous patients for all five cancer sites examined and, with few exceptions, for each stage at diagnosis for each cancer site.
Co-author of the report, Dr John Condon, Senior Research Fellow at the Menzies School of Health Research, Darwin, said that while it is possible that these cancers may be more 'aggressive' in Indigenous people, and thus spread more rapidly, it was more likely that the problem was late diagnosis, "possibly because of low awareness of potentially dangerous early symptoms and tardiness in seeking medical advice, poor access to or low quality of primary care, diagnostic or specialist services, or reluctance to seek attention when symptoms cause concern because of nihilistic beliefs about cancer and the chance of cure".
"For breast and cervical cancer, low participation of Indigenous women in screening programs may also be involved," Dr Condon said.
"The five-year cancer survival rates in non-Indigenous people were only a little lower than those for Australia as a whole for cancer diagnosed in 1992-1997. This comparison suggests that NT cancer services can perform at near to national levels for non-Indigenous patients."
Dr Condon said that, while the more advanced cancer stage at diagnosis in Indigenous patients for four of the five cancer sites may explain part of their poorer survival from cancer, it is unlikely to explain it all.
"Late diagnosis is only part of the problem; even for people with the same cancer stage at diagnosis, Indigenous people had lower survival than non-Indigenous people. Lower stage-adjusted cancer survival in Indigenous people may be due to choices against more aggressive, curative treatment (particularly if treatment requires interstate travel); delayed or incomplete treatment; or factors that make Indigenous people more susceptible to the life-threatening complications of cancer treatment. The latter could include the presence of other chronic diseases: heavy alcohol and tobacco consumption; and poor housing and environmental conditions, which increase the risk of infectious diseases during and after chemotherapy and radiotherapy," he said.
These results suggest that health services could, and should, be performing better for Indigenous people with cancer in the NT, and probably elsewhere in Australia.
Cancer registries in other parts of Australia need to better identify Indigenous people and to analyse their data according to Indigenous status so that the performance of cancer services for Indigenous Australians can be measured and improved nationally, Dr Condon concluded.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Dr John CONDON, 08 8922 8413 (w), 08 8948 1028 (h) 0407 227 254 (m)
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471