Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

The receipt of surgery versus radiation therapy by Aboriginal and Torres Strait Islander people diagnosed with prostate cancer in NSW (#282)

Mei Ling Yap 1 2 3 4 , Rebecca Murray 3 , Gabriel Gabriel 5 6 , Joseph Descallar 5 6 , Susan Anderson 7 , Geoff Delaney 1 3 , Viet Do 3 6 , Karen Wong 3 6 , Henry Woo 8 9 , Keziah Bennett-Brook 10 , Julieann Coombes 10
  1. Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia
  2. The Cancer Program, The George Institute for Global Health, Barangaroo, NSW, Australia
  3. Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW
  4. School of Medicine, Western Sydney University, Campbelltown, NSW
  5. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  6. South-West Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
  7. Aboriginal Consumer, Sydney, NSW
  8. Department of Urology, Blacktown & Mt Druitt Hospitals, Blacktown, NSW, Australia
  9. Department of Uro-oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  10. Guunu-maana (Heal) Aboriginal & Torres Strait Islander Health Program, The George Institute for Global Health, Barangaroo, NSW, Australia

Aims: Prostate cancer is the most common cancer diagnosed in Aboriginal and Torres Strait Islander men. Surgery and radiotherapy are curative options which lead to equivalent survival but different side effects and financial costs. We aim to determine the uptake of surgery and/or radiotherapy for prostate cancer by First Nations people within NSW.

 

Methods: This was an individualised patient linked-data study which used the NSW Cancer Registry (to Dec 2018), NSW Admitted Patient Data Collection (to Dec 2021), Outpatient Radiation Oncology Data (Dec 2020) and Register of Births Deaths and Marriages (to March 2021). Multivariable proportional hazards models were used to estimate cause-specific hazards separately for time to radiotherapy and time to prostatectomy with a competing risk of death.

 

Results: There were 60037 people diagnosed with prostate cancer between 2009-2018; 1061(1.8%) were First Nations people. The median follow-up for the cohort was 6.3 years. A total of 22945 (41.4%) patients received a prostatectomy; in the First Nations population, it was lower at 362(36.6%) patients.  A total of 17196(31.0%) received radiation therapy and for First Nations people, 349 (35.2%) received radiotherapy. First Nations people received surgery in public hospitals (N=275, 76%) more commonly than the rest of NSW (N=12868, 57%). In multivariable analysis, First Nations people were less likely to receive a radical prostatectomy (HR 0.9 p<0.05) than the rest of the NSW population. Other factors associated with less uptake included not holding private insurance and lower area-level socio-economic status. First Nations people were more likely to receive radiotherapy (HR 1.2, p<0.001).

 

Conclusion: First Nations people are more likely to receive radiotherapy but less likely to receive surgery for prostate cancer, than the rest of the NSW population. Given the increasing privatisation of cancer care in Australia, it is imperative there is equitable access to treatment options for First Nations people.