title: The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery.
abstract: BACKGROUND
  Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer.
  
  
  OBJECTIVE
  To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention.
  
  
  METHODS
  Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar.
  
  
  RESULTS
  Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery.
  
  
  CONCLUSIONS
  It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples' engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities.
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia. patriciamary.davison@uts.edu.au
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Digiacomo
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: McGrath
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Durey
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Bessarab
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D015897:Comorbidity; D003466:Cultural Characteristics; D016206:Databases, Bibliographic; D057210:Delayed Diagnosis; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006303:Health Services, Indigenous / Q000592:standards / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology; D016540:Smoking Cessation / Q000208:ethnology / Q000379:methods / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D000078329:Workforce