title: Ethnicity and management of colon cancer in New Zealand: do indigenous patients get a worse deal?
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 Maori (indigenous) and non-Maori New Zealanders with colon cancer.
  
  
  METHODS
  On the basis of cancer registry data, 301 Maori patients and 329 randomly selected non-Maori 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
  Maori and non-Maori patients had similar rates of surgical resection, although Maori patients were less likely to undergo extensive lymph node clearance and were more likely to die during the postoperative period. Maori 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
  Maori New Zealanders with colon cancer were less likely to receive adjuvant chemotherapy and experienced a lower quality of care compared with non-Maori 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.
authors.affiliation: Global Public Health Unit, University of Edinburgh, Edinburgh, United Kingdom. s.e.hill@ed.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Hill
authors.forename: Diana
authors.initials: D
authors.lastname: Sarfati
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.forename: Bridget
authors.initials: B
authors.lastname: Robson
authors.forename: Gordon
authors.initials: G
authors.lastname: Purdie
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dennett
authors.forename: Donna
authors.initials: D
authors.lastname: Cormack
authors.forename: Kevin
authors.initials: K
authors.lastname: Dew
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D006303:Health Services, Indigenous; D054625:Healthcare Disparities; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011787:Quality of Health Care