Ethnicity and cancer treatment in New Zealand: do Maori patients get a worse deal?
Background
Ethnic or racial disparities in cancer treatment have been documented in several countries and cancer types. We examined and compared treatment of Mâori (Indigenous) and non-Mâori New Zealanders with colon cancer.
Methods
From the New Zealand Cancer Registry we identified a population-based cohort of 629 patients diagnosed with colon cancer between 1996 and 2003. We reviewed medical notes and compared surgical and oncology treatment in Mâori and non-Mâori patients. We adjusted treatment differences for tumour characteristics, patient comorbidity and treatment facility type.
Findings
Mâori and non-Mâori patients received similar rates of surgical resection although Mâori patients were less likely to have extensive lymph node clearance (relative risk (RR) 0.25, 95% CI 0.13 to 0.50 for removal of 30 or more nodes) and were more likely to die in the post-operative period (RR 5.31, 95% CI 1.54 to 18.32 for death following elective surgery). In patients with stage III disease Mâori were significantly less likely to receive chemotherapy (RR 0.69, 95% CI 0.53 to 0.91) and more likely to experience delay of at least eight weeks to start chemotherapy (RR 1.98, 95% CI 1.23 to 3.16). Treatment disparities were not accounted for by patient comorbidity or treatment facility type (public cancer centre, public non-cancer centre and private facility) although differences within facility types remain a potential explanatory factor.
Interpretation
Mâori and non-Mâori patients with colon cancer receive similar surgical treatment but Mâori are less likely to receive adjuvant chemotherapy and may experience a lower quality of care. Attention to health-system factors is needed to ensure equal access and quality of cancer treatment.
