Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

An assessment of Radiotherapy utilisation, Surgery utilisation and health outcomes, comparing Aboriginal people with non-Aboriginal people with cancer in NSW 2009-2018 (#138)

Geoff P Delaney 1 2 3 , Gabriel S Gabriel 2 3 , Kalinda Griffiths 4 5 6 , Joseph Descaller 7 , Mei Ling Yap 1 2 3 8 , Shalini Vinod 1 2 3 , Jesmin Shafiq 1 2 3 , Susannah Jacob 1 2 3 , Susan Anderson 9 , Gemma McErlean 1 3 7 , David Sheehan 10 , Michael Barton 2 3
  1. South Western Sydney Local Health District, Liverpool, NSW, Australia
  2. South Western Sydney Clinical School, UNSW, Sydney, NSW
  3. Collaboration for Cancer Outcomes Research and Evaluation, Ingham Health and Medical Research Institute, Sydney, NSW, Australia
  4. Centre for Big Data, UNSW, Sydney, NSW, Australia
  5. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  6. Menzies School of Health Research, Darwin, Northern Territory, Australia
  7. Ingham Health and Medical Research Institute, Sydney, NSW, Australia
  8. The George Institute, Sydney, NSW, Australia
  9. Cancer Institute NSW, Sydney, NSW, Australia
  10. Cancer Consumer, Sydney, NSW, Australia

Aims: To assess variations in the types of cancer, degree of spread at presentation, utilisation rates of cancer surgery and radiotherapy, overall and cancer-specific survival between Aboriginal and non-Aboriginal cancer patients.

Methods: Retrospective analysis of a de-identified linked dataset that included age, sex, type of cancer, diagnosis date, surgical and radiotherapy treatment, death data, remoteness, socioeconomic status, comorbidity, and Aboriginal status. Study population consisted of all patients with registered notifiable cancer in NSW cancer registry 2009-2018. Kaplan-Meier estimates for overall, cancer-specific and non-cancer-specific survival were performed.

Main outcome measures: Types of cancer, degree of spread, radiotherapy, and surgical utilisation rates, overall and cancer-specific survival.

Results: 389,992 patients were diagnosed with cancer in NSW. 2.3% identified as Aboriginal. Aboriginal patients had a greater proportion of head and neck, oesophagus, liver, lung, cervix, testis, and kidney cancers and were significantly more likely to have regional or distant disease. Aboriginal patients had greater radiotherapy utilisation (30.3% vs 26%, p<0.001) but lower surgical utilisation (50.7% vs 56.6%, p<0.001) compared with non-Aboriginal patients. Kaplan-Meier analysis showed five-year overall and cancer-specific survivals were 60% and 67% for Aboriginal patients and 64% and 72% for non-Aboriginal patients (P<0.001).

Conclusions: Aboriginal people have different cancer types and more advanced disease at presentation resulting in different treatment utilisation and survival. The poorer survival in Aboriginal patients is driven by non-cancer deaths, differences in cancer type and more advanced disease at diagnosis, suggesting the need to improve general health care in this population. Poorer cancer survival does not appear to be related to access to, or quality of, radiotherapy or surgery.