Inequity in cancer care at every turn for Māori

7:15 pm on 26 November 2020

Māori are more likely to get cancer, will get it younger, are diagnosed later, have poorer access to treatment, and are much more likely to die from cancer than non-Māori, because of inequity in the health system.

Cancer Treatment generic concept.

Photo: 123RF

That's the grim warning from the Māori Cancer Leadership Network in a recent presentation to Waikato District Health Board, which has struggled in past years to achieve equity for its highly Māori population.

It follows revelations by Local Democracy Reporting that doctors at neighbouring Lakes District Health Board are diagnosing cancer at Rotorua Hospital's emergency department (ED).

In Te Manawa Taki (Midland) region, which takes in the five DHBs of Waikato, Lakes, Taranaki, Hauora Tairāwhiti and Bay of Plenty - with a population of 920,000 - 55 percent of patients with lung, brain, or stomach cancer were diagnosed in an emergency department.

The Midland Cancer Network figures from a project that mapped diagnosis routes between 2015 and 2018, showed only 29 percent of those diagnosed with lung cancer in a hospital ED survived longer than one year compared to 60 percent referred by a GP.

That's because an ED diagnosis is usually discovered when the cancer is advanced, leaving treatment less effective.

Compounding matters in the Waikato, space for cancer treatment in the district would be exceeded by next year with only one chemotherapy chair available for every 13,545 patients, compared to one in 7361 in Rotorua and one in 6000-plus in Tauranga and Gisborne.

Radiation therapy treatment would also reach capacity by 2026.

The Hei Āhuru Mōwai Māori Cancer Leadership Network presentation to Waikato DHB's community and public health advisory committee in late September made for sobering reading.

Cancer was the leading cause of premature death in New Zealand, killing 29 percent of the population and leaving a further 13 percent battling the disease.

Historically cancer affected one in four New Zealanders, but that has increased to one in three and by 2030 it's expected one in two will face a cancer diagnosis.

The statistics were even more dire for Māori, according to the presenter, Māori Cancer Leadership Network chair and Waikato DHB clinical director Māori public health, Nina Scott.

"Māori are generally diagnosed at a later stage, are 20 percent more likely to get cancer and are twice as likely to die of cancer," Dr Scott said.

The drivers for the trends included inequity in cancer control, leadership, decision-making, and resourcing and action, which resulted in "institutional racism".

Lung and breast cancers were the most diagnosed cancers in Māori nationally, with 401 and 373 cases each year respectively, much higher than for any other ethnicity.

Of those, 311 Māori died of lung cancer annually - accounting for almost a third of all cancer deaths in Māori - and 77 died of breast cancer.

Māori women were screened less than non-Māori in Waikato for breast cancer, and those who were diagnosed outside of a screening programme faced access delays to treatment.

Māori women also waited longer for chemotherapy and radiation.

Inequity was notable at every opportunity in a study of patients with stage three colon cancer with fewer Māori were referred to or reviewed by an oncologist, offered and given chemotherapy, and starting treatment within eight weeks.

"This is clearly not due to genetics or a cultural reluctance to present for care and is not fixable by information pamphlets."

Better access to diagnosis and treatment for Māori was crucial for achieving survival equity, the presentation said.

It gave a list of priorities for New Zealand including lowering the bowel cancer screening age to 50 for Māori, increasing breast screening rates - especially in the Waikato - replacing cervical smears with self-swabbing, decreasing screening harm and eliminating treatment inequities in prostate cancer, and establishing a Māori-led national lung screening programme.

Te Aho o Te Kahu Cancer Control Agency chief executive Professor Diana Sarfati told Local Democracy Reporting achieving equity was a particular focus for Waikato DHB, but it was also a national issue.

"Over the last couple of decades or more, there hasn't been a strong enough focus on achieving equity, nor has there been the capacity for strong national leadership in cancer control."

Te Aho o Te Kahu Cancer Control Agency chief executive Professor Diana Sarfati.

Te Aho o Te Kahu Cancer Control Agency chief executive Professor Diana Sarfati. Photo: Supplied

This was one of the catalysts for Te Aho o Te Kahu, which absorbed the Midland Cancer Network and three other regional cancer hubs when it was launched in December last year.

Prof Sarfati said the proportion of people diagnosed with cancer in an emergency department was higher for Māori and Pacific people and the agency was monitoring this.

It would also target stretched capacity in cancer treatment nationally due to a growing and ageing population.

Waikato DHB, which is being run by commissioners after its board was sacked for high debt and dysfunction in May last year, will spend $64 million on cancer-related services this financial year.

The DHB said it was working to increase capacity by creating extra space and increasing the number of cancer treatment chairs.

While its oncology service had lowered the number of Māori patients who did not attend an appointment, inequitable health outcomes remained, and the DHB was committed to turning that around.

It was doing this by employing a clinical nurse specialist to improve access to services, increasing services to rural patients, creating a radiation health equity working group, and establishing a radiation oncology service at Rotorua Hospital to take pressure off the Regional Cancer Centre at Waikato Hospital.

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