title: Factors associated with cancer-specific and overall survival among Indigenous and non-Indigenous gynecologic cancer patients in Queensland, Australia: a matched cohort study.
abstract: OBJECTIVE
  Aboriginal and Torres Strait Islander women have a higher mortality rate due to gynecologic cancer compared with non-Indigenous women. For cervical cancer, Australian Indigenous women are less likely to survive 5 years following diagnoses than non-Indigenous women. This study investigates the factors associated with gynecologic cancer treatment and survival among Queensland indigenous and non-Indigenous women.
  
  
  METHODS
  Australian Indigenous women diagnosed with uterine, cervical, ovarian, or other gynecologic cancers during 1998-2004 in the public hospital system were included. They were frequency matched on age (±5 years), residential remoteness, and cancer type to a random sample of non-Indigenous women. One- and 5-year cancer-specific survival was examined according to Indigenous status using Cox proportional hazards regression.
  
  
  RESULTS
  Indigenous women (n = 137) compared with non-Indigenous women (n = 120) were less likely to be diagnosed with localized disease (49% vs 65%, P = 0.02) and had more comorbidities (52% vs 21%, P < 0.001). Indigenous women were less likely to receive any cancer treatment compared with non-Indigenous women (91% vs 98%, P = 0.01), although when excluding those with metastatic cancer, there was no significant difference in uptake of treatment (95% vs 91%, respectively, P = 0.31). Among those who did undergo treatment, there was no difference in time to treatment (median difference 0.5 days, P = 0.98). Gynecologic cancer-specific survival differences between Indigenous and non-Indigenous women were most prominent in the first year following diagnosis (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.06-3.38) and were no longer significant 5 years after diagnosis (HR, 1.47 [95% CI, 0.97-2.25]). For cervical cancer, crude 1-year survival was poorer for Indigenous women compared with non-Indigenous women (HR, 2.46 [95% CI, 1.03-5.90]), but was no different when adjusted for stage and treatment of cancer (HR, 1.00 [95% CI, 0.45-2.24]).
  
  
  CONCLUSIONS
  Improving the early diagnosis of cervical cancer in Indigenous women may increase cancer-specific survival in the year following diagnosis.
authors.affiliation: *Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia, and Schools of †Population Health and ‡Medicine, University of Queensland, Brisbane, Queensland, Australia; and §QIMR Berghofer Queensland Institute of Medical Research, Brisbane, Queensland, Australia; and ∥University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Abbey
authors.initials: A
authors.lastname: Diaz
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Moore
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Martin
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D005833:Genital Neoplasms, Female / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011793:Queensland / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D015996:Survival Rate; D061665:Time-to-Treatment; D000095283:Australian Aboriginal and Torres Strait Islander Peoples