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Cancer survival in Indigenous and non-Indigenous Australian children: what is the difference?

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Abstract

Purpose

This study assessed variation in childhood cancer survival by Indigenous status in Australia, and explored the effect of place of residence and socio-economic disadvantage on survival.

Methods

All children diagnosed with cancer during 1997–2007 were identified through the Australian Pediatric Cancer Registry. Cox regression analysis was used to assess the adjusted differences in survival.

Results

Overall, 5-years survival was 75.0 % for Indigenous children (n = 196) and 82.3 % for non-Indigenous children (n = 6,376, p = 0.008). Compared to other children, Indigenous cases had 1.36 times the risk of dying within 5 years of diagnosis after adjustments for rurality of residence, socio-economic disadvantage, cancer diagnostic group, and year of diagnosis (95 % CI 1.01–1.82). No significant survival differential was found for leukemias or tumors of the central nervous system; Indigenous children were 1.83 times more likely (95 % CI 1.22–2.74) than other children to die within 5 years from ‘other tumors’ (e.g., lymphomas, neuroblastoma). Among children who lived in ‘remote/very remote/outer regional’ areas, and among children with a subgroup of ‘other tumors’ that were staged, being Indigenous significantly increased the likelihood of death (HR = 1.69, 95 % CI 1.10–2.59 and HR = 2.99, 95 % CI 1.35–6.62, respectively); no significant differences by Indigenous status were seen among children with stage data missing.

Conclusions

Differences in place of residence, socio-economic disadvantage, and cancer diagnostic group only partially explain the survival disadvantage of Indigenous children. Other reasons underlying the disparities in childhood cancer outcomes by Indigenous status are yet to be determined, but may involve factors such as differences in treatment.

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Acknowledgments

The clinical advice from Dr Tim Hassall, Royal Children Hospital, Brisbane, and the support and assistance of staff at Australian State and Territory Cancer Registries, the Australian Institute of Health and Welfare, and the Medical Records department at each of the national pediatric oncology treating hospitals are gratefully acknowledged. The Australian Pediatric Cancer Registry is funded by Cancer Council Queensland. PC Valery was supported by an Australian Research Council Future Fellowship (#FT100100511). AC Green is partly supported by a Fellowship from the Medical Research Council (#89912). PD Baade was supported by a National Health and Medical Research Council Career Development Fellowship (#1005334). Throughout the study, the Queensland Aboriginal and Islander Health Council acted as a community resource to provide consultation and support. Necessary approvals for this work were obtained from the ethics committees of the Queensland Institute of Medical Research, the University of Queensland, the cancer registries in all States and Territories, and all hospitals who assisted in the data collection.

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Authors and Affiliations

  1. Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Spring Hill, QLD, 4000, Australia

    Patricia C. Valery & Peter D. Baade

  2. Cancer Council Queensland, Kelvin Grove, Brisbane, Australia

    Danny R. Youlden, Peter D. Baade, Leisa J. Ward & Joanne F. Aitken

  3. School of Public Health, Queensland University of Technology, Brisbane, Australia

    Peter D. Baade

  4. Griffith Health Institute, Griffith University, Gold Coast, Australia

    Peter D. Baade

  5. School of Translational Medicine, University of Manchester, Manchester, UK

    Adele C. Green

  6. Cancer and Population Studies, Queensland Institute of Medical Research, Brisbane, Australia

    Adele C. Green

  7. School of Population Health, University of Queensland, Brisbane, Australia

    Joanne F. Aitken

Authors
  1. Patricia C. Valery
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  2. Danny R. Youlden
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  3. Peter D. Baade
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  4. Leisa J. Ward
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  5. Adele C. Green
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  6. Joanne F. Aitken
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Correspondence to Patricia C. Valery.

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Valery, P.C., Youlden, D.R., Baade, P.D. et al. Cancer survival in Indigenous and non-Indigenous Australian children: what is the difference?. Cancer Causes Control 24, 2099–2106 (2013). https://doi.org/10.1007/s10552-013-0287-9

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  • DOI: https://doi.org/10.1007/s10552-013-0287-9

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