Mei Ling Yap, Gabriel Gabriel, Joseph Descallar, Susan Anderson, Geoff P Delaney, Viet Do, Rebecca Murray, Karen Wong, Henry H Woo, Kalinda Griffiths, Keziah Bennett-Brook, Julieann Coombes
Aboriginal and Torres Strait Islander people are more likely to receive radiotherapy but less likely to receive surgery than the rest of the NSW population, with socio-economic factors associated with the treatment received. It is imperative there is equitable and affordable access to treatment options for Aboriginal and Torres Strait Islander people.
BACKGROUND: Prostate cancer is the most common cancer diagnosed in Aboriginal and Torres Strait Islander men. Surgery and radiotherapy are curative options, with equivalent survival but different side effects and financial costs. We aim to determine the uptake of surgery and/or radiotherapy for prostate cancer by Aboriginal and Torres Strait Islander people within New South Wales (NSW).
METHODS: This was an individualised patient linked-data study which used the NSW Cancer Registry (2009-2018), NSW Admitted Patient Data Collection, Outpatient Radiation Oncology Data and Register of Births, Deaths and Marriages. Fine-Gray Competing Risk models were used to estimate cause-specific hazards for time to radiotherapy and time to prostatectomy with a competing risk of death.
FINDINGS: There were 59,621 people diagnosed with prostate cancer; 1061 (1.8%) were Aboriginal and Torres Strait Islander people. The median follow-up time was 6.3 years. A total of 22,946 (41.4%) patients received a prostatectomy; in Aboriginal and Torres Strait Islander people, it was lower at 362 (36.6%) patients. A total of 17,196 (31.0%) received external beam radiation therapy and for Aboriginal and Torres Strait Islander people, 349 (35.3%) received radiotherapy. In univariate analysis, Aboriginal and Torres Strait Islander people were less likely to receive a radical prostatectomy (HR 0.9, p < 0.05) than the rest of the population. However this association was lost when adjusting for possession of private insurance and comorbidities. Aboriginal and Torres Strait Islander people were more likely to receive radiotherapy on multivariable analysis (HR 1.2, p = 0.001).
INTERPRETATION: Aboriginal and Torres Strait Islander people are more likely to receive radiotherapy but less likely to receive surgery than the rest of the NSW population, with socio-economic factors associated with the treatment received. It is imperative there is equitable and affordable access to treatment options for Aboriginal and Torres Strait Islander people.
FUNDING: This study was funded by the 2023 UNSW Health Systems Theme Collaborative grant.