title: Cancer in Australian Aboriginal children: room for improvement.
abstract: OBJECTIVE
  The study aims to analyse clinical data and outcome in Aboriginal and non-Aboriginal children with cancer.
  
  
  METHODS
  This is a retrospective case-note review of biological features, treatment outcome and survival in Aboriginal and non-Aboriginal children with a malignancy who were treated at the Women's and Children's Hospital, a tertiary referral hospital, from January 1997 through March 2011. Two separate analyses were performed: firstly, for each Aboriginal patient comparisons were made with two age, sex and diagnosis-matched control patients; then secondly, results for the Aboriginal group of patients were compared with the whole non-Aboriginal group of patients.
  
  
  RESULTS
  In the first analysis, Aboriginal children had a significantly higher 'remoteness index' (6.14 vs. 0.95; P < 0.001) and were less likely to be enrolled on clinical trials. Survival analysis of the Aboriginal patients and their matched controls showed a trend towards inferior overall survival for the Indigenous children (P = 0.066). In the second analysis, Aboriginal children tended to have a higher proportion of leukaemias and lymphomas and had an overrepresentation of acute myeloid leukaemia (AML) (P = 0.009). The mean age among Aboriginal children with AML and lymphoma was lower (AML: 3.5 vs. 8 years, P = 0.065; lymphoma: 7.5 vs. 11.9 years, P = 0.01). A higher proportion of Aboriginal children died (P = 0.004).
  
  
  CONCLUSIONS
  Aboriginal children present with a somewhat different pattern of cancer, are less likely to be enrolled on studies and seem to have increased mortality. There is a need for improvement in study enrolment, treatment delivery, care coordination and suitably supported residential facilities.
authors.affiliation: Paediatric Haematology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Rotte
authors.forename: Jordan
authors.initials: J
authors.lastname: Hansford
authors.forename: Maria
authors.initials: M
authors.lastname: Kirby
authors.forename: Michael
authors.initials: M
authors.lastname: Osborn
authors.forename: Ram
authors.initials: R
authors.lastname: Suppiah
authors.forename: Petra
authors.initials: P
authors.lastname: Ritchie
authors.forename: Heather
authors.initials: H
authors.lastname: Tapp
authors.forename: Michael
authors.initials: M
authors.lastname: Rice
authors.forename: Tamas
authors.initials: T
authors.lastname: Revesz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016555:Matched-Pair Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D015876:Northern Territory / Q000453:epidemiology; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome