Download Maori Surviving Prostate Cancer

Maori Surviving Prostate Cancer
The Midlands Prostate Cancer Study Kaumātua on the paepae at Turangawaewae Photograph from Waikato‐Tainui.
Nina Scott, Ngati Whatua, Waikato, FNZCPHM, MPH, MBChB
through the organised efforts of society . . . suffering from cancer is largely avoidable Prostate cancer is a priority
for Maori cancer control
Every year;
170 Maori men diagnosed
45 Maori men die
3rd most common cancer
5th most common cause of cancer death
Maori 28% less likely to be diagnosed
52% more likely to die than non-Maori
Prostate cancer is a priority
for Maori cancer control
Maori 28% less likely to be diagnosed:
84.4 per 100,000 Māori
117.9 per 100,000 non‐Māori
52% more likely to die than non-Maori:
25.5 per 100,000 Māori
16.8 per 100,000 non‐Māori
Inequities are differences which are
Unfair
Avoidable
Fixable
• Monitor the crown
• Right to health
• Quality improvement
Inequities are
low hanging
cancer control
fruit
Non‐standardised care = inequities
Inequities highlight where standardisation is needed first
Inequities
are an indicator of what could be achieved at
a minimum for Maori
tell us where we can get relatively quick gains
for cancer control
Assume inequities occur at every step
of cancer pathway . . . unless proven otherwise
Diagnosed late, referred late, seen late, offered treatment late,
receive treatment late, receive lower quality treatment
Small inequities add up to
inequities
big important
Maori 10% less likely to be diagnosed
60% more likely to die •“The most likely
explanation for this is that
Maori have a cultural
reluctance to present for
health care”
Non‐standardised care along the pathway
Maori
testing
screening
Maori
Maori
High PSA
Specialist referral
Maori
Biopsy
Maori
Inequities continued . . .
Maori
Cancer found from biopsy
Maori
Surgery for localised cancer
Maori
Radiotherapy for localised cancer
Maori
Surgical removal of testicles
Receive medication for erectile dysfunction Maori
Men diagnosed with PC in NZ over 15 yrs
1,916 Māori (5.1%) men out of 37,529 men, 40+ yrs PC diagnosed 1996‐2011 NZ Cancer Registry – NHI link ‐ Mortality Collection
NZCR – extent recorded for only ¼. Dr Zuzana Obertova
Māori %
Age at Diagnosis: < 70 yrs
older
non‐Māori %
59
49
41
51
55
69
28
22
17
10
Deprivation: 1‐3 (least deprived)
10
28
4‐7
31
43
59
29
52
61
24
16
25
22
70+ yrs
Residence: Main urban area
Less urban
Urban influence
Rural/remote area
8‐10 (most deprived)
Vital status: Alive
Died of prostate cancer
Died of other causes
More remote
2 x more deprived
More likely to have died
“a state of observable and demonstrable disadvantage relative to the local community or the wider society or nations to which an individual, family or group belongs.” (Townsend, 1987)
Factors incorporated in NZDep96 Age‐standardised incidence rate per 100,000
Diagnosis of prostate cancer 1996 ‐2010
400.0
350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Maori
non‐Maori
Total
1800
1500
1200
900
600
300
0
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
Age‐standrdised incidence rate per 100,000
Diagnosis of prostate cancer increases with age
Maori 40‐54y
Maori 55‐74y
Maori 75+y
non‐Maori 40‐54y
non‐Maori 55‐74y
non‐Maori 75+y
Survival for men diagnosed with PC in NZ 1996‐2011 Kaplan‐Meier method
100
Proportion surviving (%)
90
80
70
60
50
40
30
20
10
0
1 year
Maori AC
5 years
non‐Maori AC
Maori CS
10 years
non‐Maori CS
AC: all‐cause; CS: cancer‐specific
Prostate cancer survival has improved over time but inequities haven't
1996‐2011 Kaplan‐Meier method
Survival for men diagnosed with PC in NZ 1996‐2011 Cox proportional hazards regression model
All‐cause
Adjusted for
Hazard ratio 95% confidence interval
age
1.93
1.81 ‐ 2.07
age, year of diagnosis, residence, deprivation
1.84
1.72 ‐ 1.97
Cancer‐specific Adjusted for
Hazard ratio 95% confidence interval
age
2.09 1.90 ‐ 2.30
age, year of diagnosis, residence, deprivation
1.94
1.76 ‐ 2.14
<70 yrs 2.28 1.97 ‐ 2.64
‐ age, year of diagnosis, residence, deprivation
2.62
Regional spread 1.60, 4.31
Regional spread 2.62 1.60 ‐
4.31
‐‐ age, year of diagnosis, residence, deprivation
age, year of diagnosis, residence, deprivation
Metastatic
‐ age, year of diagnosis, residence, deprivation
1.32
1.11, 1.58
through the organised efforts of society . . . suffering from cancer is largely avoidable
“Get it right for Maori
get it right for all’
. . . identify inequities then
standardise care where inequities
occur