An Assessment of Radiotherapy and Surgery Utilisation and Health Outcomes, in Aboriginal and Non-Aboriginal People With Cancer in NSW, Australia, 2009–2018

Introduction: Aboriginal patients face barriers to accessing cancer care. Few studies have evaluated the utilisation of radiotherapy or surgery in Aboriginal people. This study aims at assessing variation in types of cancer, degree of spread (DOS) at presentation, utilisation rates of cancer surgery and radiotherapy between Aboriginal and non-Aboriginal cancer patients.

Methods: Retrospective analysis of de-identified linked datasets. All patients with registered notifiable cancer in the NSW cancer registry 2009–2018 separated by Aboriginality status were included. 

Results: Totally 389,992 people were diagnosed in NSW during study period; 8970 people (2.3%) identified as Aboriginal. In univariate analysis, Aboriginal people presented at diagnosis with statistically significant younger age, greater comorbidity, advanced (DOS) and greater proportions living in most disadvantaged areas than non-Aboriginal people. Based on univariate analysis, Aboriginal patients received radiotherapy more frequently than non-Aboriginal patients (30.3% versus 26.0%, p < 0.01). Non-Aboriginal patients underwent cancer surgery more frequently than Aboriginal patients (57.0% versus 51.2%, p < 0.01). When stratified by tumour type and adjustment for patient and clinical factors, radiotherapy and surgery utilisation varied by type of cancer. 

Conclusions: The degree of cancer spread, and the presence of comorbidities remains a greater issue for Aboriginal people. Access to radiotherapy increased significantly for Aboriginal patients during the past 10 years. However, differences in surgical and radiotherapy utilisation exist. These differences can be partially explained by the greater DOS and presence of comorbidity in Aboriginal patients leading to less surgical intervention and greater requirement for radiotherapy.