Abstract
Background: Racial and ethnic inequalities in colon cancer treatment have been reported in the United States but not elsewhere. The authors of this report compared cancer treatment in a nationally representative cohort of Māori (indigenous) and non-Māori New Zealanders with colon cancer.
Methods: On the basis of cancer registry data, 301 Māori patients and 329 randomly selected non-Māori patients were identified who were diagnosed with colon cancer between 1996 and 2003. Medical notes were reviewed, and surgical and oncology treatments were compared by indigenous status.
Results: Māori and non-Māori patients had similar rates of surgical resection, although Māori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Māori patients were significantly less likely to receive chemotherapy for stage III disease (relative risk [RR], 0.69; 95% confidence interval [CI], 0.53-0.91) and were more likely to experience a delay of at least 8 weeks before starting chemotherapy (RR, 1.98; 95%CI, 1.23-3.16). Treatment disparities were not explained by differences in tumor characteristics or patient comorbidity.
Conclusions: Māori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Māori patients. The authors concluded that attention to health system factors is needed to ensure equal access and quality of cancer treatment for indigenous and ethnic minority populations.