Are Indigenous cancer patients treated according to clinical guidelines? — ASN Events
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Are Indigenous cancer patients treated according to clinical guidelines? (#103)

Lisa J Whop 1 , Christina Bernardes 1 , Srinivas Kondalsamy-Chennakes 2 , Deepak Darshan 2 , Naven Chetty 3 , Suzanne P Moore 1 , Gail Garvey 1 , Patricia C Valery 1
  1. Menzies School of Health Research, Brisbane, QLD, Australia
  2. Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia
  3. Royal Brisbane and Women's Hospital and Mater Adult Hospital, Brisbane, QLD, Australia

Aim: Clinical practice guidelines reflect the best evidence available for prevention, early detection and treatment. Recent studies have shown differences in the patterns of care between Indigenous and non-Indigenous cancer patients. We explored if being Indigenous was a predictor for receiving sub-optimal treatment.
Methods: This study utilised data collected for Indigenous adults diagnosed with lung and cervical cancers and a frequency matched comparison group of non-Indigenous patients from the Queensland Cancer Registry, treated between January 1998 and December 2004. Researchers reviewed the patient’s medical records including treatment history (blinded for Indigenous status), against the recommended stage specific treatment guidelines for their cancer type. Indigenous status was reassigned after patients were categorised.
Results: 105 women with cervical cancer were included, 56 were Indigenous. Higher proportion of Indigenous women than non Indigenous had treatment not in accordance with guidelines (87% vs 13%, p=0.05). Indigenous women had higher odds of receiving treatment not in accordance with clinical guidelines (unadjusted OR= 7.11 95% C.I. 1.51- 33.31) and this remained after adjusting for stage (OR 5.68 95% C.I. 1.18 – 27.32). There were 225 patients with lung cancer; 68 were excluded due to no stage being documented (n= 10), no treatment (n= 50) or the patient declined treatment (n= 8). A total of 157 patients (51.6% Indigenous) were included. The odds of receiving sub-optimal treatment appeared to be higher, but not significant, for Indigenous compared to non-Indigenous lung cancer patients (unadjusted OR 1.72 95% C.I. 0.89 – 3.31) and remained insignificant after adjusting for stage and comorbidity (adjusted OR 1.64 95% C.I. 0.82 – 3.27).
Conclusion: Assessing adherence to cancer treatment guidelines can be a measure of cancer care. Urgent action to reduce the impact of cancers amenable to prevention, and, ongoing assessment of patient treatments against gold standard is needed to improve cancer outcomes for Indigenous Australians.

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