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Inequalities in Cancer Outcomes by Indigenous Status and Socioeconomic Quintile: an Integrative Review

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Inequalities in Cancer Outcomes by Indigenous Status and Socioeconomic Quintile: an Integrative Review Inequalities in cancer outcomes by Indigenous status and socioeconomic quintile: An integrative review Authors: Annie Bygrave, Kate Whittaker, Professor Sanchia Aranda AM Cancer Council Australia For more information contact: [email protected] Published by Cancer Council Australia Level 14, 477 Pitt Street, Sydney, NSW 2000, Australia www.cancer.org.au [email protected] © Cancer Council Australia 2020 This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed toreproducethewholeoranypartofthisworkinanyway(electronicorotherwise)withoutfirstbeinggiventhe specificwrittenpermissionfromCancerCouncilAustraliatodoso.Requestsandinquiriesconcerningreproduction and rights are to be sent to the contact details provided. Published 21 July 2020 Authors: Annie Bygrave, Kate Whittaker, and Professor Sanchia Aranda AM Layout: Tamsin Curtis Suggested citation: Bygrave A, Whittaker K, Aranda S (2020). Inequalities in cancer outcomes by Indigenous status and socioeconomic quintile: An integrative review. Sydney: Cancer Council Australia. In the spirit of reconciliation Cancer Council Australia acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today. Journey of Hope ArtworkbyRikiSalam–WeAre27Creative Abstract Objective: To utilise current Australian research to identify inequalities in cancer outcomes by Indigenous status and socioeconomic quintile and discuss the influencing factors. Methods: Whittemore and Knafl’s (2005) methodology for an integrative review was applied. Results: A total of 48 papers were included. First Nations people and people living in the most disadvantaged areas were 39% and 33% more likely to die from cancer, respectively. The disparity in cancer mortality among First Nations people has widened by 82 deaths (per 100,000) since 1998. Differences in cancer treatment reported by First Nations people increased their risk of death from breast, lung and colorectal cancer, which was also influenced by the presence of comorbidities, stage at diagnosis, and participation in diagnostic and treatment services. Implications for public health: Recognising that inequalities in cancer outcomes exist is important in enabling health service and system responses, particularly the identification of where and why disparities occur across the cancer control continuum. Conclusions: Inequalities in cancer mortality exist among disadvantaged populations, differing by cancer type. Differences in treatment influence risk of cancer death and therefore, improving accessibility to health services by addressing social determinants, must be a priority to reduce inequalities in cancer mortality. Keywords: First Nations people, Socioeconomic, Cancer, Inequalities, Access to healthcare Cancer Council Australia 1. Background Cancer survival rates in Australia are among the live and interact influence outcomes. This could include highest in the world, [1] improving by 18.9% since 1986. [2] personal beliefs, fears and attitudes about cancer, This may be due to population-wide cancer prevention, lower cancer symptom awareness, poor health literacy, screening and early detection initiatives, and universal discrimination based on race or socioeconomic status, health coverage, which have supported Australians communication difficulties and geographic isolation. to access best practice cancer treatment and care. More research is needed to identify clear associations However, inequalities in cancer outcomes persist between individual or combined factors and higher among certain groups of people. cancer mortality for these populations. First Nations people and those living in the most While potential reasons for inequalities in cancer disadvantaged areas report higher cancer incidence outcomes have been posed by descriptive literature, and mortality, and lower survival than other Australians minimal synthesis has been done. This integrative and those living in the least disadvantaged areas. [2] review aimed to utilise current Australian research to Higher prevalence of risk factors and presence of identify inequalities in cancer outcomes by Indigenous comorbidities, more advanced cancer at diagnosis, and status and socioeconomic quintile, and discuss the less participation in national cancer screening programs factors influencing them. The approach enabled the and receipt of treatment have been reported as possible use of different sources of information to develop a factors that influence higher cancer mortality for comprehensive understanding of where inequalities in particular populations. [3–6] While these factors relate to cancer outcomes exist, and the variability and extent accessibility to health services, the social, economic and of these disparities among these disadvantaged cultural environments within which these populations populations. [7] Methods Whittemore and Knafl’s (2005) methodology guided Literature search this integrative review. It consists of five stages: To identify papers for inclusion, three electronic (1) problem identification; (2) literature search; (3) data databases were searched: EMBASE, PubMed and evaluation; (4) data analysis; and (5) presentation. Google (Figure 1) . Key search terms included cancer, Aboriginal and Torres Strait Islander peoples engaged inequality, Indigenous, socioeconomic and Australia. The with Cancer Council Australia, provided advice that search was conducted in April 2018. the terminology ‘First Nations people’ is used when Inclusion and exclusion criteria: describing their experiences with cancer and outcomes. Criteria for inclusion were: (i) First Nations participants An area-based measure (the Index of Relative and/or participants living in the most disadvantaged Socioeconomic Disadvantage [IRSD]) of areas in Australia as defined by IRSD; (ii) participants socioeconomic status was chosen because it diagnosed with cancer or a subset disease of cancer; summarises information about the environmental, (iii) cancer outcomes within a First Nations and/ social and geographical conditions of people and or socioeconomic disadvantaged population; (iv) households in a specified area, including individual- peer-reviewed and grey literature papers; (v) papers level information on income and employment. [8] IRSD published between 2008 and 2018, unless trend data in is one of four Socioeconomic Indexes for Areas (SEIFA) grey literature were available; and (vi) papers available developed by the Australian Bureau of Statistics and in English. indicates the relative disadvantage of specified areas. Non-empirical studies including editorials, letters, It reports on Census Collection Districts level data – commentaries and narrative reviews were excluded. the smallest geographic unit of SEIFA information. [8] Search results: Problem identification The electronic database search yielded 2,325 records. The poorer cancer outcomes reported for First Nations Duplicates were removed, and 1,751 titles and people and those living in the most disadvantaged abstracts were screened. Applying the inclusion and areas compared to the general Australian population exclusion criteria above, 297 full-text papers were indicate that a combination of factors may be reviewed. Reference lists of the included papers (n=42) contributors. To gain a better understanding of the were scanned and 6 additional papers were included. factors and their influence, this review focused on Forty-eight papers were included, a combination of issues within the health system and their impact peer-reviewed and grey literature. on risk of cancer death by Indigenous status and socioeconomic quintile. 2. Inequalities in cancer outcomes by Indigenous status and socioeconomic quintile Figure 1: Process of inclusion and Records identified by Records identified EMBASE and PubMed by advanced Google exclusion. (n=2,218) search(n=107) Identification Duplicates removed (n=574) Title and abstracts of Screening Recordsexcludedbasedontitleor records screened abstract (n=1,454) (n=1,751) Full-text papers excluded with reasons (n=255): International context n=1 Full-text papers Non-cancer related n=9 assessed for eligibility Irrelevant population group n=146 (n=297) No relevant outcome n=51 Eligibility Publication date n=1 Study design n=12 Unable to obtain n=6 Other n=10 Papers included in the Additional papers from integrative review referencelistsidentifiedthrough (n=48) hand-search (n=6) Included Data evaluation Data analysis and presentation The National Health Medical and Research Council’s Whittemore and Knafl’s (2005) model for an integrative level of evidence and Cochrane’s risk of bias tool used review demonstrates data analysis consists of multiple to evaluate the quality of peer-reviewed literature phases and constant comparison between different were considered however, not formally applied to population groups. [7] Data were extracted
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