Abstract
Over the course of this two-year project, this project has identified a number of areas across the lung cancer clinical pathway where Māori are faring worse than our majority European population. Some of these observations reinforce knowledge that already existed, either within the broad context of cancer, or specifically for lung cancer, while some were relatively novel. Our key recommendations to improve survival outcomes for Māori – and address the unchanging state of survival disparities compared to Europeans – are to 1) intervene in ways that will work for Māori to shift the distribution of lung cancer stage back toward earlier stage disease, 2) improve Māori access to surgical pathways, by shifting stage of disease, preventing and managing comorbidity, and constant improvement to how well our surgical pathways work for Māori, 3) recognise and address the disproportionate burden of travel faced by Māori with lung cancer, principally due to the systematic centralisation of services for this cancer, 4) make our broader lung cancer services as available, affordable and acceptable for Māori as possible, through interventions including a comprehensive and well-resourced Māori cancer navigator service; and 5) improve the completeness and quality of our centralised health data in the context of lung cancer, with prioritisation of complete clinical stage data and reporting of all treatment, regardless of whether it was publicly or privately funded. Iterative changes to our health system across these five areas must be prioritised within health policy and budgeting at a central government level if we are to expect any improvements in lung cancer survival outcomes for Māori – let alone the achievement of equity of survival outcomes for Māori by 2030.