The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery
Patricia M Davidson A D , Moyez Jiwa B , Michelle L DiGiacomo A B , Sarah J McGrath A , Phillip J Newton A , Angela J Durey B , Dawn C Bessarab B and Sandra C Thompson B C
+ Author Affiliations
- Author Affiliations
A Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 235-253 Jones Street (PO Box 123), Broadway, NSW 2007, Australia. Email: michelle.digiacomo@uts.edu.au; sarah.mcgrath@uts.edu.au; phillip.newton@uts.edu.au
B Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email: m.jiwa@curtin.edu.au; m.digiacomo@curtin.edu.au; a.durey@curtin.edu.au; d.bessarab@curtin.edu.au; sandra.thompson@cucrh.uwa.edu.au
C Combined Universities Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street (PO Box 109), Geraldton, WA 6531, Australia. Email: sandra.thompson@cucrh.uwa.edu.au
D Corresponding author. Email: patriciamary.davidson@uts.edu.au
Australian Health Review 37(1) 70-78 https://doi.org/10.1071/AH10955
Submitted: 18 August 2010 Accepted: 4 May 2012 Published: 19 November 2012
Abstract
Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer.
Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention.
Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar.
Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery.
Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities.
What is known about the topic? Aboriginal Australians suffer a disproportionate burden of ill health including poor outcomes from lung cancer.
What does this paper add? This paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung cancer care and management for Aboriginal Australians. This paper describes barriers within the context of individual beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to reduce the lung cancer burden in Aboriginal Australians.
What are the implications for practitioners? This paper highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care practitioners are key to reducing the burden of lung cancer in Aboriginal Australians.
Additional keywords: health policy, health services, Indigenous.
References
[1] Australian Bureau of Statistics, Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: ABS, AIHW2008 Contract No.: ABS Cat. No. 4704.0. AIHW Cat. No. IHW 21.[2] Condon JR, Barnes T, Armstrong BK, Selva-Nayagam S, Elwood JM. Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory. Med J Aust 2005; 182 277–80.
| 15777142PubMed |
[3] Ring I, Firman D. Reducing indigenous mortality in Australia: lessons from other countries. Med J Aust 1998; 169 528–33.
| 1:STN:280:DyaK1M%2FnvV2jsQ%3D%3D&md5=14e421e7ad8d7967880ac853c2848986CAS | 9861910PubMed |
[4] Australian Bureau of Statistics. Causes of death. Australia. 2008. Canberra: ABS; 2010 [3303.0]; Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02008?OpenDocument [Verified 18 September 2012].
[5] Condon JR, Armstrong BK, Barnes T, Zhao Y. Cancer incidence and survival for indigenous Australians in the Northern Territory. Aust N Z J Public Health 2005; 29 123–8.
| Cancer incidence and survival for indigenous Australians in the Northern Territory.Crossref | GoogleScholarGoogle Scholar | 15915615PubMed |
[6] Crombie IK. The pocket guide to critical appraisal: a handbook for health care professionals. London: BMJ Publishing Group; 1997.
[7] Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005; 10 45–53B.
| Synthesising qualitative and quantitative evidence: a review of possible methods.Crossref | GoogleScholarGoogle Scholar | 15667704PubMed |
[8] Coory MD, Green AC, Stirling J, Valery PC. Survival of Indigenous and non-Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study. Med J Aust 2008; 188 562–6.
| 18484926PubMed |
[9] Coory M, Thompson A, Ganguly I. Cancer among people living in rural and remote Indigenous communities in Queensland. Med J Aust 2000; 173 301–4.
| 1:STN:280:DC%2BD3crgvV2gtg%3D%3D&md5=bb32aed14b181d9f78cff6a986b1ab9fCAS | 11061399PubMed |
[10] Condon JR, Armstrong BK, Barnes A, Cunningham J. Cancer in Indigenous Australians: a review. Cancer Causes Control 2003; 14 109–21.
| Cancer in Indigenous Australians: a review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s3isl2rug%3D%3D&md5=55f9e92c2a28fdbca59f5db478860f05CAS | 12749716PubMed |
[11] Condon JR, Barnes T, Cunningham J, Armstrong BK. Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Med J Aust 2004; 180 504–7.
| 15139826PubMed |
[12] Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol 2008; 9 585–95.
| Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia.Crossref | GoogleScholarGoogle Scholar | 18510990PubMed |
[13] Stumpers S, Thomson N. Review of cancer among Indigenous people. 2009 [cited 2010 June 20]; Available from: http://www.healthinfonet.ecu.edu.au/chronic-conditions/cancer/reviews/our-review[Verified 18 September 2012].
[14] Cottrell J, Street J, Chong A, Roder D. Comparing cancer profiles and survival of aboriginal and non-aboriginal patients in South Australia: where are the opportunities for improving Aboriginal health? Asian Pac J Cancer Prev 2007; 8 495–501.
| 18260718PubMed |
[15] Boffa JD. Cancer care for Indigenous Australians. Med J Aust 2008; 188 560–1.
| 18484925PubMed |
[16] Supramaniam R, Grindley H, Pulver LJ. Cancer mortality in Aboriginal people in New South Wales, Australia, 1994–2002. ANZ J of Pub Health 2006; 30 453–6.
[17] Roder D. Epidemiology of cancer in Indigenous Australians: implications for service delivery. Can Forum 2007; 31 85–90.
[18] Chong A, Roder D. Exploring differences in survival from cancer among Indigenous and non-Indigenous Australians: implications for health service delivery and research. Asian Pac J Cancer Prev 2010; 11 953–61.
| 21133607PubMed |
[19] Cancer Australia. A national cancer data strategy for Australia. Canberra: Cancer Australia; 2008.
[20] Passey M, Gale J, Holt B, Leatherday C, Roberts C, Kay D. et al. Stop smoking in its tracks: understanding smoking by rural Aboriginal women. 10th National Rural Health Conference; 17–20 May 2009; Cairns, QLD.
[21] Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander health survey, 2004–05. Canberra: ABS; 2006 [cited 2010 25 February]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0 [Verified 18 September 2012]
[22] Ivers RG. A review of tobacco interventions for Indigenous Australians. Aust N Z J Public Health 2003; 27 294–9.
| A review of tobacco interventions for Indigenous Australians.Crossref | GoogleScholarGoogle Scholar | 14705285PubMed |
[23] Harvey D, Tsey K, Cadet-James Y, Minniecon D, Ivers R, McCalman J, et al An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland. ANZ J of Pub Health 2002; 26 426–31.
[24] Briggs VL, Lindorff KJ, Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. Tobacco Control 2003; 12 ii5–ii8.
| 12878767PubMed |
[25] Thomas DP, Briggs V, Anderson I, Cunningham J. The social determinants of being an Indigenous non-smoker. ANZ J of Pub Health 2008; 32 110–6.
[26] Condon JR, Cunningham J, Barnes T, Armstrong BK, Selva-Nayagam S. Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for Indigenous Australians. Intern Med J 2006; 36 498–505.
| Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for Indigenous Australians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28vksVWjsQ%3D%3D&md5=913a3a1fe71f18fd3512f276b39af4e5CAS | 16866654PubMed |
[27] Lowenthal RM, Grogan PB, Kerrins ET. Reducing the impact of cancer in indigenous communities: ways forward. Med J Aust 2005; 182 105–6.
| 15698352PubMed |
[28] Shahid S, Finn L, Bessarab D, Thompson S. Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Serv Res 2009; 9 132–40.
| Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services.Crossref | GoogleScholarGoogle Scholar | 19643031PubMed |
[29] McGrath P, Holewa H, Ogilvie K, Rayner R, Patton MA. Insights on Aboriginal peoples’ views of cancer in Australia. Contemp Nurse 2006; 22 240–54.
| Insights on Aboriginal peoples’ views of cancer in Australia.Crossref | GoogleScholarGoogle Scholar | 17026431PubMed |
[30] Prior D. Don’t mention the ‘C’ word: aboriginal women’s view of cancer. Aborig Isl Health Work J 2005; 29 7–10.
[31] Keleher H, Hagger V. Health literacy in primary health care. Aust J Primary Health 2007; 13 24–30.
| Health literacy in primary health care.Crossref | GoogleScholarGoogle Scholar |
[32] Devitt J, Cass A, Cunningham J, Preece C, Anderson K, Snelling P. Study Protocol – Improving Access to Kidney Transplants(IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC Health Serv Res 2008; 8 31–54.
| Study Protocol – Improving Access to Kidney Transplants(IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease.Crossref | GoogleScholarGoogle Scholar | 18248667PubMed |
[33] Gill J. The lung story. Aborig Isl Health Work J 1999; 23 7–8.
[34] Hall SE, Holman CDJ, Threlfall T, Sheiner H, Phillips M, Katriss P, et al Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia. Aust J Rural Health 2008; 16 355–62.
| Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia.Crossref | GoogleScholarGoogle Scholar | 19032208PubMed |
[35] Ivers R. Indigenous Australians and tobacco: a literature review. Darwin: Menzies School of Health Research and Cooperative Research Centre for Aboriginal and Tropical Health; 2001.
[36] Shahid S, Thompson SC. An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US. Aust N Z J Public Health 2009; 33 109–18.
| An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US.Crossref | GoogleScholarGoogle Scholar | 19413852PubMed |
[37] Abbott P, Gordon E, Davison J. Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition. Contemp Nurse 2008; 27 157–64.
| Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition.Crossref | GoogleScholarGoogle Scholar | 18457516PubMed |
[38] Hall SE, Bulsara CE, Bulsara MK, Leahy TG, Culbong MR, Hendrie D, et al Treatment patterns for cancer in Western Australia: does being indigenous make a difference? Med J Aust 2004; 181 191–4.
| 15310252PubMed |
[39] Shahid S, Beckmann KR, Thompson SC. Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils. Aust Health Rev 2008; 32 56–65.
| Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils.Crossref | GoogleScholarGoogle Scholar | 18241149PubMed |
[40] Roder D. Comparative cancer incidence, mortality and survival in Indigenous and non-Indigenous residents of South Austalia and the Northern Territory. Can Forum 2005; 29 7–9.
[41] Valery PC, Coory M, Stirling J, Green AC. Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. Lancet 2006; 367 1842–8.
| Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study.Crossref | GoogleScholarGoogle Scholar | 16753487PubMed |
[42] Davidson PM, Jiwa M, Goldsmith AJ, McGrath SJ, DiGiacomo M, Phillips JL, et al Decisions for lung cancer chemotherapy: the influence of physician and patient factors. Support Care Cancer 2011; 19 1261–1266.
| Decisions for lung cancer chemotherapy: the influence of physician and patient factors.Crossref | GoogleScholarGoogle Scholar | 21614670PubMed |
[43] McGrath P, Holewa H, McGrath Z. Practical problems for aboriginal palliative care service provision in rural and remote areas: equipment, power and travel issues. Collegian Collegian 2007; 14 21–6.
| Practical problems for aboriginal palliative care service provision in rural and remote areas: equipment, power and travel issues. CollegianCrossref | GoogleScholarGoogle Scholar | 18074768PubMed |
[44] Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Aust N Z J Public Health 2010; 34 S87–92.
| Reducing racism in Aboriginal health care in Australia: where does cultural education fit?Crossref | GoogleScholarGoogle Scholar | 20618302PubMed |
[45] McGrath P. ‘I don’t want to be in that big city; this is my country here’: research findings on Aboriginal peoples’ preference to die at home. Aust J Rural Health 2007; 15 264–8.
| ‘I don’t want to be in that big city; this is my country here’: research findings on Aboriginal peoples’ preference to die at home.Crossref | GoogleScholarGoogle Scholar | 17617091PubMed |
[46] Productivity Commission. Public and Private Hospitals, Research Report. Canberra: Productivity Commission; 2009.
[47] Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin 2002; 52 134–49.
| Health literacy and cancer communication.Crossref | GoogleScholarGoogle Scholar | 12018928PubMed |
[48] Shahid S, Finn LD, Thompson SC. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust 2009; 190 574–9.
| 19450207PubMed |
[49] Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 2003; 118 293–302.
| 12815076PubMed |
[50] Fredericks BL, Thompson M. Collaborative voices: ongoing reflections on cultural competency and the health care of Australian Indigenous people. J Aust Indig Iss 2010; 13 10–20.
[51] Durie M. An indigenous model of health promotion. Health Promot J Austr 2004; 15 36–50.
[52] Lindorff K. Tobacco time for action: National Aboriginal and Torres Strait Islander Tobacco Control Project. Canberra: NACCHO; 2002.
[53] McCulloch J. The mine at Baryulgil: work, knowledge, and asbestos disease. Labour Hist 2007; 92 113–28.
| The mine at Baryulgil: work, knowledge, and asbestos disease.Crossref | GoogleScholarGoogle Scholar |
[54] Musk AW, Nicholas HK, Jan LE, Janice H, Keith BS. Malignant mesothelioma in Pilbara Aborigines. Aust J Public Health 1995; 19 520–2.
| Malignant mesothelioma in Pilbara Aborigines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zkt1CktQ%3D%3D&md5=578f18e3ca8b60e0ce1a7f3d0dcacf5aCAS | 8713204PubMed |
[55] Erren TC, Jacobsen M, Piekarski C. Synergy between asbestos and smoking on lung cancer risks. Epidemiology 1999; 10 405–11.
| Synergy between asbestos and smoking on lung cancer risks.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzivVejsA%3D%3D&md5=42059a19f0e8ac222631b960134fb33eCAS | 10401875PubMed |
[56] United States Surgeon General. The health consequences of smoking - cancer and chronic lung disease in the workplace. Rockville, MD: US Department of Health and Human Services; 1985.
[57] Gilchrist D. Smoking prevalence among Aboriginal women. Aborig Isl Health Work J 1998; 22 4–6.
[58] U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General – Executive Summary. Washington, D.C.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion and the Office on Smoking and Health; 2006.
[59] Thompson SC, Davidson PM, DiGiacomo M, Pilkington L, Shahid S. 2010 Cancer Council environmental scan on Aboriginal and Torres Strait Islander health initiatives: documenting progress in Aboriginal and Torres Strait Islander cancer control. Perth: Cancer Council WA; 2011.
[60] DiGiacomo M, Davidson PM, Taylor KP, Smith JS, Dimer L, Ali M, et al Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study. Qual Prim Care 2010; 18 17–26.
| 20359409PubMed |
[61] Paradies Y, Harris R, Anderson I. The impact of racism on Indigenous health in Australia and Aotearoa: towards a research agenda. Discussion paper no. 4. Darwin: Cooperative Research Centre for Aboriginal Health; 2008.
[62] Johnstone MJ, Kanitsaki O. The spectrum of ‘new racism’and discrimination in hospital contexts: a reappraisal. Collegian Collegian 2009; 16 63–9.
| The spectrum of ‘new racism’and discrimination in hospital contexts: a reappraisal. CollegianCrossref | GoogleScholarGoogle Scholar | 19583175PubMed |
[63] Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012; 42 17–22.
| Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC387nsFShsQ%3D%3D&md5=0256acc92c1f043bb6a2835ff28d009bCAS | 22032537PubMed |
[64] Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2012; 19 144–152.
| 22530862PubMed |
[65] Taylor K, Smith J, Dimer L, Ali M, Wilson N, Thomas T, et al “You’re always hearing about the stats. death happens so often”: new perspectives on barriers to Aboriginal participation in cardiac rehabilitation. Med J Aust 2010; 192 602
| 20477740PubMed |
[66] Nagel T, Thompson C. Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the ‘Top End’. Australas Psychiatry 2006; 14 291–4.
| 16923041PubMed |
[67] Newman C, Butow P, Knight R, McMillan K, Treloar DC, Kippax S, et al Cancer and Aboriginal people in Australia: a review of the literature. Crit Public Health 2008; 18 65–75.
| Cancer and Aboriginal people in Australia: a review of the literature.Crossref | GoogleScholarGoogle Scholar |
[68] Croager EJ, Eades T, Pratt IS, Slevin T. Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia’s Aboriginal health professionals. Aust N Z J Public Health 2010; 34 S76–9.
| Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia’s Aboriginal health professionals.Crossref | GoogleScholarGoogle Scholar | 20618300PubMed |
[69] Shahid S, Bleam R, Bessarab D, Thompson SC. Research ”If you don’t believe it, it won’t help you”: use of bush medicine in treating cancer among Aboriginal people in Western Australia. J Ethnobiol Ethnomed 2010; 6
| Research ”If you don’t believe it, it won’t help you”: use of bush medicine in treating cancer among Aboriginal people in Western Australia.Crossref | GoogleScholarGoogle Scholar | 20569478PubMed |
[70] Dwyer JM, Lavoie J, O’Donnell K, Marlina U, Sullivan P. Contracting for Indigenous health care: towards mutual accountability. Aust J Pub Admin 2011; 70 34–46.
| Contracting for Indigenous health care: towards mutual accountability.Crossref | GoogleScholarGoogle Scholar |
[71] Underhill C, Bartel R, Goldstein D, Snodgrass H, Begbie S, Yates P, et al Mapping oncology services in regional and rural Australia. Aust J Rural Health 2009; 17 321–9.
| Mapping oncology services in regional and rural Australia.Crossref | GoogleScholarGoogle Scholar | 19930199PubMed |
