Ethnic Inequalities in Stomach Cancer Treatment Pathways (#47)
There are marked inequalities in stomach cancer between Māori and non-Māori New Zealanders, with Māori having higher incidence, worse mortality and poorer survival. Little is understood about a) the treatment pathway experienced by patients, b) whether differences in this pathway exist between ethnic groups, and c) whether differences contribute to poorer outcomes for Māori.
A clinical review of 362 patient notes was conducted; all Māori from the North Island of New Zealand diagnosed with stomach cancer between 2006 -2008, and a random equivalent sample of non-Māori. Patient and tumour characteristics, pathways of care and clinical outcomes were investigated in a final cohort of 335.
Some of the findings challenge traditional dogma around cancer inequalities between Māori and non-Māori: for example, there were no ethnic differences in stage at diagnosis. Non-Māori were however more likely to be diagnosed with proximal disease (age- and sex-standardised, 25% Māori, 34% non-Māori, p=0.004) and Māori with distal disease (43% Māori, 26% non-Māori, p=0.004). Two-thirds (66%) of stage I-III patients had definitive surgery, with similar rates for Māori (71%) and non-Māori (68%). Māori were however less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38% Māori, 79% non-Māori, p<0.01), and less likely to be treated in a main centre (44% Māori, 87% non-Māori, p<0.01). . Few patients overall received chemotherapy in conjunction with surgery (15% pre-op and 25% post-op). Māori appeared 20% more likely to die of their stomach cancer (Hazard ratio 1.199, 95% CI 0.914-1.575, adjusted for age, sex, stage and comorbidity).
Although a small sample size, there is evidence of differential access to specialised surgical services for Māori compared to non-Māori. There is also evidence of differential survival despite no significant difference in stage of disease at diagnosis.