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Ethnicity and management of colon cancer in New Zealand

Do indigenous patients get a worse deal?

  1. Sarah Hill PhD, MBChB1,2,3,†,*,
  2. Diana Sarfati MBChB, MPH2,
  3. Tony Blakely PhD, MBChB2,
  4. Bridget Robson BA, DPH2,
  5. Gordon Purdie BSc2,
  6. Elizabeth Dennett MBChB, MedSci2,
  7. Donna Cormack PhD2,
  8. Kevin Dew PhD2,4,
  9. John Z. Ayanian MD, MPP5,6,
  10. Ichiro Kawachi PhD, MD3

Article first published online: 21 APR 2010

DOI: 10.1002/cncr.25127

Issue

Cancer

Cancer

Volume 116, Issue 13, pages 3205–3214, 1 July 2010

Additional Information

How to Cite

Hill, S., Sarfati, D., Blakely, T., Robson, B., Purdie, G., Dennett, E., Cormack, D., Dew, K., Ayanian, J. Z. and Kawachi, I. (2010), Ethnicity and management of colon cancer in New Zealand. Cancer, 116: 3205–3214. doi: 10.1002/cncr.25127

Author Information

  1. 1

    Global Public Health Unit, University of Edinburgh, Edinburgh, United Kingdom

  2. 2

    Department of Public Health, University of Otago, Wellington, New Zealand

  3. 3

    Department of Society, Human Development, and Health, Harvard School of Public Health, Harvard University, Boston, Massachusetts

  4. 4

    Department of Sociology, Victoria University, Wellington, New Zealand

  5. 5

    Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts

  6. 6

    Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

  1. †

    Fax: (011) 44-131-651-3762

*University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom

  1. †

    Fax: (011) 44-131-651-3762

Publication History

  1. Issue published online: 18 JUN 2010
  2. Article first published online: 21 APR 2010
  3. Manuscript Accepted: 29 OCT 2009
  4. Manuscript Revised: 21 OCT 2009
  5. Manuscript Received: 7 AUG 2009

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Keywords:

  • colonic neoplasms;
  • delivery of healthcare;
  • ethnic groups;
  • indigenous populations;
  • New Zealand

Abstract

BACKGROUND:

Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer.

METHODS:

On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status.

RESULTS:

Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity.

CONCLUSIONS:

Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations. Cancer 2010. © 2010 American Cancer Society.

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