Factors Associated With Cancer-Specific and Overall Survival Among Indigenous and Non-Indigenous Gynecologic Cancer Patients in Queensland, Australia: A Matched Cohort Study. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Diaz, Abbey; Moore, Suzanne P.; Martin, Jennifer H.; Green, Adele C.; Garvey, Gail; Valery, Patricia C.
• Is Part Of: International journal of gynecological cancer. Volume 25:Issue 3(2015:Mar.)
• Publication Date: 2015-03
• Subjects: Cancer -- Cervical -- Gynecologic -- Indigenous survival; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000000375
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objective: Aboriginal and Torres Strait Islander women have a higher mortality rate due to gynecologic cancer compared with non-Indigenous women. For cervical cancer, Australian Indigenous women are less likely to survive 5 years following diagnoses than non-Indigenous women. This study investigates the factors associated with gynecologic cancer treatment and survival among Queensland indigenous and non-Indigenous women. Methods: Australian Indigenous women diagnosed with uterine, cervical, ovarian, or other gynecologic cancers during 1998–2004 in the public hospital system were included. They were frequency matched on age (±5 years), residential remoteness, and cancer type to a random sample of non-Indigenous women. One- and 5-year cancer-specific survival was examined according to Indigenous status using Cox proportional hazards regression. Results: Indigenous women (n = 137) compared with non-Indigenous women (n = 120) were less likely to be diagnosed with localized disease (49% vs 65%, P = 0.02) and had more comorbidities (52% vs 21%, P < 0.001). Indigenous women were less likely to receive any cancer treatment compared with non-Indigenous women (91% vs 98%, P = 0.01), although when excluding those with metastatic cancer, there was no significant difference in uptake of treatment (95% vs 91%, respectively, P = 0.31). Among those who did undergo treatment, there was no difference in time to treatment (median difference 0.5 days, P = 0.98). Gynecologic cancer–specific survival differences between Indigenous and non-Indigenous women were most prominent in the first year following diagnosis (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.06–3.38) and were no longer significant 5 years after diagnosis (HR, 1.47 [95% CI, 0.97–2.25]). For cervical cancer, crude 1-year survival was poorer for Indigenous women compared with non-Indigenous women (HR, 2.46 [95% CI, 1.03–5.90]), but was no different when adjusted for stage and treatment of cancer (HR, 1.00 [95% CI, 0.45–2.24]). Conclusions: Improving the early diagnosis of cervical cancer in Indigenous women may increase cancer-specific survival in the year following diagnosis.