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Maori cancer death rate rockets after childhood

Nov 17th, 2011 | By | Category: Featured Article, Front Page Layout, News

CHILDREN in Aotearoa now have a high chance of surviving the most common forms of childhood cancer, no matter what their ethnic background.

But when they reach adulthood a huge gulf opens.

The death rate for Maori adults diagnosed with cancer is 78% higher than for Pakeha, and doctors think that a lack of support systems and limited resources may be the reasons for this disparity.

Adults from the Pacific Islands are also much more likely to die from cancer than adults of any other ethnicity.

Only 150 children are diagnosed with cancer each year, meaning resources are more readily available to each patient.

This may explain overall differences in survival rates between children and adults, but it does not explain why Maori and Pacific Island adults are so much more likely to die from cancer than non-Maori.

The new data comes from analysis of a child cancer registry set up in New Zealand 11 years ago and shows that 90% of Maori tamariki (children) will survive the most common form of childhood cancer, leukaemia, compared with 88% of their Pakeha peers.

The data, presented at last month’s International Society of Paediatric Oncology congress in Tamaki/Auckland, reveals a success that is a notable exception in the field of Maori health, where there are typically large disparities in health outcomes between Maori and non-Maori.

Dr Scott Macfarlane (left), chair of the Paediatric Oncology Steering Group and Cancer Control Council member, says although the results are very exciting with regard to children, they do raise questions about cancer treatment outcomes for Maori adults.

“Since there are no obvious differences between races in NZ as to incidence of those (most common adult) cancers, it doesn’t really make sense that one ethnic group should get cancer at a different rate or have different survival rates if they have exactly the same risk factors,” he says.

“There is probably a biological basis to it, but super-imposed on that we think that something in the way in which we deliver services to families of children who have cancer actually cancels out some of the inequities that exist in our health service.”

Dr Michael Sullivan (right), senior lecturer in paediatric oncology at the Christchurch School of Medicine, says psycho-social factors – like the support systems available to families – are probably a major cause of the difference between cancer survival rates between Maori children and adults.

Although he warns against over-interpreting the impact of these factors, Dr Sullivan says identifying cultural factors that impact on treatment outcomes for Maori cancer patients is extremely important.

There are no differences in treatment based on ethnicity for child cancer patients, and Dr Sullivan says the ‘wrap around’, total care environment means patients are engaged from “clinical trial to taxi chit”, meaning every aspect and phase of their treatment is managed carefully.

Furthermore, treatment providers have a “shared-care” mentality. Paediatric oncology departments at Starship and Christchurch hospital work closely with regional healthcare providers to manage a patient’s treatment.

It’s a different story when you look at the care provided to adult cancer patients.

“The most common childhood cancers will come to attention reasonably early, so children don’t have long delays in diagnosis…however, for adults there are often delays for a whole range of reasons,” says Dr Sullivan.

“Some may be personal factors, they may not be part of a screening programme or they may not pay close attention to or be aware of the symptoms to watch for.”

However, Ministry of Health data suggest late diagnosis for Maori adults explains some but not all of the survival disparity.

Both Dr Macfarlane and Dr Sullivan agree the contrast in results between Maori tamariki and Maori adults suggest there is room for improvement in healthcare factors such as access to service, referral pathways, ‘wrap-around’ care facilities, and patient-service provider engagement.

“If you can achieve those outcomes for Maori children, then you have to look at what can be applied to improve outcomes for Maori adults,” says Dr Sullivan.

Dr Macfarlane says to a large extent it is a numbers game.

“There are only 150 children in NZ from 0-14 diagnosed with cancer each year. That’s a relatively small number and we have a well-trained, reasonably-sized work force able to deal with it.

“If you wanted to duplicate that for adult cancer treatment…you may have to increase the resources available to treatment providers by about 30 times.

“That’s about the difference in number of patients that our adult oncology colleagues see compared to our paediatric services.”

He says a better-resourced service is able to work with a child’s family, government services, and NGO’s like CanTeen and Ronald McDonald House to explore their individual requirements and tailora treatment plan to the family.

“When you are able to do this, I believe a lot of the ethnic disparities fall away,” he says.

“When you talk to groups of Maori, you hear some stories of people who got a sense the service doesn’t quite fit them.

“They engage less than enthusiastically, and for treatments for cancer you have to have a family wholly engaged and completely on board, singing from the same song-sheet as the team that is treating the patient.

“In fact, they have to be a really integral part of the treatment if you are going to get a successful outcome.”

Dr Macfarlane says NZ should be considering how to approach Maori families in a culturally sensitive way that enables them to engage and stay engaged with treatment providers.

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is I am a Whitireia Polytechnic journalism student. I have an academic background in politics and international relations, and worked as a policy analyst across government before deciding to pursue a career in journalism.
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