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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Prevalence of invasive cancer in a large general practice patient population in New Zealand

Dong Hyun Kim 1 , Lynne Chepulis 2 , Rawiri Keenan 2 , Chunhuan Lao 2 , Fraser Hodgson 3 , Chris Bullen 4 , Ross Lawrenson 2 5 6
+ Author Affiliations
- Author Affiliations

1 School of Medicine, University of Auckland, Auckland, New Zealand

2 Waikato Medical Research Centre, University of Waikato, Private Bag 3105, Hamilton, New Zealand

3 Pinnacle Health, Hamilton, New Zealand

4 School of Population Health, University of Auckland, Auckland, New Zealand

5 Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand

6 Corresponding author. Email: Ross.Lawrenson@waikatodhb.health.nz

Journal of Primary Health Care 12(3) 215-224 https://doi.org/10.1071/HC19113
Published: 9 September 2020

Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Abstract

INTRODUCTION: The prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment.

AIM: To determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients.

METHODS: Data were sourced from the patient management system of a large general practice (n = 11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018.

RESULTS: There were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%).

DISCUSSION: Results suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.

KEYwords: Cancer prevalence, New Zealand, cancer survivors, primary health care, registries


References

[1]  Rubin G, Berendsen A, Crawford SM, et al. The expanding role of primary care in cancer control. Lancet Oncol. 2015; 16 1231–72.
The expanding role of primary care in cancer control.Crossref | GoogleScholarGoogle Scholar | 26431866PubMed |

[2]  Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010–2040. Br J Cancer. 2012; 107 1195–202.
Projections of cancer prevalence in the United Kingdom, 2010–2040.Crossref | GoogleScholarGoogle Scholar | 22892390PubMed |

[3]  de Moor JS, Mariotto AB, Parry C, et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev. 2013; 22 561–70.
Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care.Crossref | GoogleScholarGoogle Scholar |

[4]  Brewer N, Atkinson J, Guilford P, et al. An estimate of limited duration cancer prevalence in New Zealand using ‘big’ data. N Z Med J. 2020; 133 49–62.
| 32379739PubMed |

[5]  Hoekstra RA, Heins MJ, Korevaar JC. Health care needs of cancer survivors in general practice: a systematic review. BMC Fam Pract. 2014; 15 94
Health care needs of cancer survivors in general practice: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24885266PubMed |

[6]  Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010; 2010 25–30.
The interface between primary and oncology specialty care: treatment through survivorship.Crossref | GoogleScholarGoogle Scholar | 20386051PubMed |

[7]  Richards M, Corner J, Maher J. The National Cancer Survivorship Initiative: new and emerging evidence on the ongoing needs of cancer survivors. Br J Cancer. 2011; 105 S1–4.
The National Cancer Survivorship Initiative: new and emerging evidence on the ongoing needs of cancer survivors.Crossref | GoogleScholarGoogle Scholar | 22048027PubMed |

[8]  Michaud LB. Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer. Am J Health Syst Pharm. 2010; 67 S20–30.
Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer.Crossref | GoogleScholarGoogle Scholar | 20332495PubMed |

[9]  Seicean S, Seicean A, Plana JC, et al. Effect of statin therapy on the risk for incident heart failure in patients with breast cancer receiving anthracycline chemotherapy: an observational clinical cohort study. J Am Coll Cardiol. 2012; 60 2384–90.
Effect of statin therapy on the risk for incident heart failure in patients with breast cancer receiving anthracycline chemotherapy: an observational clinical cohort study.Crossref | GoogleScholarGoogle Scholar | 23141499PubMed |

[10]  Rehammar JC, Jensen M-B, McGale P, et al. Risk of heart disease in relation to radiotherapy and chemotherapy with anthracyclines among 19,464 breast cancer patients in Denmark, 1977–2005. Radiother Oncol. 2017; 123 299–305.
Risk of heart disease in relation to radiotherapy and chemotherapy with anthracyclines among 19,464 breast cancer patients in Denmark, 1977–2005.Crossref | GoogleScholarGoogle Scholar | 28365142PubMed |

[11]  Louzada ML, Carrier M, Lazo-Langner A, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation. 2012; 126 448–54.
Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism.Crossref | GoogleScholarGoogle Scholar | 22679142PubMed |

[12]  Beaugerie L, Carrat F, Colombel J-F, et al. Risk of new or recurrent cancer under immunosuppressive therapy in patients with IBD and previous cancer. Gut. 2014; 63 1416–23.
Risk of new or recurrent cancer under immunosuppressive therapy in patients with IBD and previous cancer.Crossref | GoogleScholarGoogle Scholar | 24162591PubMed |

[13]  Czarnecki D, Staples M, Mar A, et al. Recurrent nonmelanoma skin cancer in Southern Australia. Int J Dermatol. 1996; 35 410–2.
Recurrent nonmelanoma skin cancer in Southern Australia.Crossref | GoogleScholarGoogle Scholar | 8737875PubMed |

[14]  Koroukian SM, Murray P, Madigan E. Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. J Clin Oncol. 2006; 24 2304–10.
Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care.Crossref | GoogleScholarGoogle Scholar | 16710028PubMed |

[15]  Chen RC, Royce TJ, Extermann M, et al., editors. Impact of age and comorbidity on treatment and outcomes in elderly cancer patients. Seminars in Radiation Oncology. Elsevier; 2012.

[16]  Burg MA, Adorno G, Lopez ED, et al. Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer. 2015; 121 623–30.
Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II.Crossref | GoogleScholarGoogle Scholar | 25581252PubMed |

[17]  Walker T, Signal L, Russell M, et al. The road we travel: Māori experience of cancer. N Z Med J. 2008; 121 27–35.
| 18709045PubMed |

[18]  Slater T, Matheson A, Davies C, et al. ‘It’s whanaungatanga and all that kind of stuff’: Maori cancer patients’ experiences of health services. J Prim Health Care. 2013; 5 308–14.
‘It’s whanaungatanga and all that kind of stuff’: Maori cancer patients’ experiences of health services.Crossref | GoogleScholarGoogle Scholar | 24294619PubMed |

[19]  Teng AM, Atkinson J, Disney G, et al. Ethnic inequalities in cancer incidence and mortality: census-linked cohort studies with 87 million years of person-time follow-up. BMC Cancer. 2016; 16 755
Ethnic inequalities in cancer incidence and mortality: census-linked cohort studies with 87 million years of person-time follow-up.Crossref | GoogleScholarGoogle Scholar | 27669745PubMed |

[20]  Hill S, Sarfati D, Robson B, et al. Indigenous inequalities in cancer: what role for health care? ANZ J Surg. 2013; 83 36–41.
Indigenous inequalities in cancer: what role for health care?Crossref | GoogleScholarGoogle Scholar | 23253098PubMed |

[21]  Soeberg M, Blakely T, Sarfati D. Trends in ethnic and socioeconomic inequalities in cancer survival, New Zealand, 1991–2004. Cancer Epidemiol. 2015; 39 860–2.
Trends in ethnic and socioeconomic inequalities in cancer survival, New Zealand, 1991–2004.Crossref | GoogleScholarGoogle Scholar | 26651447PubMed |

[22]  Tin Tin S, Elwood JM, Brown C, et al. Ethnic disparities in breast cancer survival in New Zealand: which factors contribute? BMC Cancer. 2018; 18 58
Ethnic disparities in breast cancer survival in New Zealand: which factors contribute?Crossref | GoogleScholarGoogle Scholar | 29310606PubMed |

[23]  Robson B, Cormack D, Purdie G. Unequal impact II: Māori and Non-Māori cancer statistics by deprivation and rural-urban status 2002–2006: Te Rōpū Rangahu Hauora a Eru Pōmare. Wellington: University of Otago; 2010.

[24]  Elers P. Māori health: issues relating to health care services. Te Kaharoa. 2014; 7 163–72.
Māori health: issues relating to health care services.Crossref | GoogleScholarGoogle Scholar |

[25]  Ruhl J, Callaghna C, Hurlbut A, et al. Summary stage 2018: codes and coding instructions. Bethesda, MD. Available from: https://seer.cancer.gov/tools/ssm/2018-Summary-Stage-Manual.pdf.

[26]  Sarfati D, Gurney J, Stanley J, et al. Cancer-specific administrative data–based comorbidity indices provided valid alternative to Charlson and National Cancer Institute Indices. J Clin Epidemiol. 2014; 67 586–95.
Cancer-specific administrative data–based comorbidity indices provided valid alternative to Charlson and National Cancer Institute Indices.Crossref | GoogleScholarGoogle Scholar | 24582212PubMed |

[27]  Ahmad OB, Boschi-Pinto C, Lopez AD, et al. Age standardization of rates: a new WHO standard. Vol. 9(10). Geneva: World Health Organization; 2001.

[28]  Australian Institute of Health and Welfare Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Asia Pac J Clin Oncol. 2013; 9 29–39.
Cancer survival and prevalence in Australia: period estimates from 1982 to 2010.Crossref | GoogleScholarGoogle Scholar | 23418847PubMed |

[29]  Spenser T. Cancer prevalence in Israeli family practice: The Cancer Research Group. Scand J Prim Health Care. 1994; 12 20–3.
Cancer prevalence in Israeli family practice: The Cancer Research Group.Crossref | GoogleScholarGoogle Scholar |

[30]  Ministry of Health. Selected Cancer 2015, 2016, 2017. [cited 2019 October 10]. Available from: https://www.health.govt.nz/publication/selected-cancers-2015-2016-2017

[31]  Heins M, Schellevis F, Rijken M, et al. Determinants of increased primary health care use in cancer survivors. J Clin Oncol. 2012; 30 4155–60.
Determinants of increased primary health care use in cancer survivors.Crossref | GoogleScholarGoogle Scholar | 23071230PubMed |

[32]  Hudson SV, Miller SM, Hemler J, et al. Adult cancer survivors discuss follow-up in primary care:‘not what I want, but maybe what I need’. Ann Fam Med. 2012; 10 418–27.
Adult cancer survivors discuss follow-up in primary care:‘not what I want, but maybe what I need’.Crossref | GoogleScholarGoogle Scholar | 22966105PubMed |

[33]  Potosky AL, Han PK, Rowland J, et al. Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med. 2011; 26 1403–10.
Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors.Crossref | GoogleScholarGoogle Scholar | 21785923PubMed |

[34]  Cassim S, Chepulis L, Keenan R, et al. Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC Cancer. 2019; 19 25
Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review.Crossref | GoogleScholarGoogle Scholar | 30621616PubMed |

[35]  Walton L, McNeill R, Stevens W, et al. Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement. Fam Pract. 2013; 30 436–44.
Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement.Crossref | GoogleScholarGoogle Scholar | 23377608PubMed |

[36]  Slater T, Matheson A, Davies C, et al. The role and potential of community-based cancer care for Māori in Aotearoa/New Zealand. N Z Med J. 2016; 129 29–38.
| 26914420PubMed |

[37]  Hill S, Sarfati D, Blakely T, et al. Survival disparities in indigenous and non-indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors. J Epidemiol Community Health. 2010; 64 117–23.
Survival disparities in indigenous and non-indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors.Crossref | GoogleScholarGoogle Scholar | 20056966PubMed |

[38]  Dickson G, Cunningham CW, Parry S. The prevalence of colorectal adenomas in Māori and New Zealand Europeans parallels colorectal cancer rates. N Z Med J. 2010; 123 45–9.
| 20720602PubMed |

[39]  Kidd J, Gibbons V, Lawrenson R, et al. A whanau ora approach to health care for Maori. J Prim Health Care. 2010; 2 163–4.
A whanau ora approach to health care for Maori.Crossref | GoogleScholarGoogle Scholar | 20690309PubMed |

[40]  Mehnert A, Brähler E, Faller H, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol. 2014; 32 3540–6.
Four-week prevalence of mental disorders in patients with cancer across major tumor entities.Crossref | GoogleScholarGoogle Scholar | 25287821PubMed |

[41]  Linden W, Vodermaier A, MacKenzie R, et al. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord. 2012; 141 343–51.
Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age.Crossref | GoogleScholarGoogle Scholar | 22727334PubMed |

[42]  Ministry of Health. Cancer psychological and social support initiative. Wellington, NZ: Ministry of Health. [cited 2019 November 20]. Available from https://www.health.govt.nz/our-work/diseases-and-conditions/national-cancer-programme/cancer-initiatives/cancer-psychological-and-social-support-initiative

[43]  Ministry of Health. Obesity statistics. Wellington, NZ: Ministry of Health. [cited 2019 November 20]. Available from: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics

[44]  Ministry of Health. Diabetes. Wellington, NZ: Ministry of Health. [cited 2019 November 20]. Available from: https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/diabetes

[45]  Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. CA Cancer J Clin. 2010; 60 207–21.
Diabetes and cancer: a consensus report.Crossref | GoogleScholarGoogle Scholar | 20554718PubMed |