Caring for cancer patients with comorbidity

Transcription

1 Caring for cancer patients with comorbidity Comorbidity among Indigenous Australian cancer patients Chair: Diana Sarfati Speaker: Patricia Valery Session code: CTS

2 Aboriginal and Torres Strait Islander Peoples Not one group 3% of Australian population 90% Aboriginal people 6% Torres Strait Islander 4% both Over-represented in rural Australia Younger than the non-indigenous population More likely to be of low socio economic status Higher burden of chronic disease

3 Compared to non-indigenous Australians, Aboriginal and Torres Strait Islander people have Higher overall cancer incidence All cancers Higher overall cancer mortality Poorer overall cancer survival Less likely to receive cancer treatment High and specific unmet supportive care needs

4 Factors impacting on poorer outcomes of Indigenous cancer patients Patients views and understanding of cancer & cancer treatment Patients Financial problems Transportation Attitudes towards service providers Out of town / country Previous experiences Remoteness Co-morbidities Appropriateness of service / service providers Lack of confidence in system, staff & treatments Communication (misunderstanding) Housing Literacy Patient disability Family & community commitments Access to supportive care services Shame and fear of disease Late diagnosis (stage at diagnosis) Medical Practitioner (gender, technical and communication skills) Disempowerment Collective society Health Care System Traditional healers Reduced uptake of treatment Attitudes of staff (language, body language, tone of voice, how questions are asked) Short consultation time Language (interpreter) Socio-Cultural Support person (the right person) Mistrust High unmet support needs Cultural & Spiritual beliefs un- or under-insured (high co-pays) Historical implications Lack of respect Experience of others Discrimination No holistic treatment Location of health facilities One system to fit all (no valuing of diversity) Waiting times for appointments when there

5 The impact of comorbidities upon cancer treatment and survival Outcome Study Results Treatment Ananda et al Comorbidities negatively impact upon treatment Survival Baade et al., 2006 Qld, Australia Comorbidities negatively impact upon survival Survival Valery et al., 2006 Qld, Australia Survival Coory et al., 2008 Qld, Australia Comorbidity partially explained Indigneous:non-Indigenous differentials Comorbidity partially explained Indigneous:non-Indigenous differentials in lung cancer survival Treatment Brooks et al Comorbidity partially explained racial disparities Treatment Mundt et al Comorbidity partially explained racial disparities Survival Sarfati et al., 2011 New Zealand Survival Tammemagi et al USA Comorbidity partially explained racial disparities Comorbidity partially explained racial disparities between black breast cancer patients vs. white counterparts

6 Queensland studies examining the impact of comorbidities on cancer outcomes for Indigenous Australians 1- Patterns of care study 1a. Indigenous vs. non-indigenous comparison 1b. Cancer treatment and survival by comorbidity level within the Indigenous population 2- Supportive care needs study

7 1- Patterns of care study Methods Frequency-matched cohort design (age, sex, place of residence and cancer type) 956 Indigenous / 869 non-indigenous people Diagnosed with cancer during Treated in Queensland public hospitals Clinical data obtained from medical records Charlson Comorbidity Index

8 1a. Indigenous vs. non-indigenous comparison

9 Results Similar distribution age sex cancer type

10 Cancer treatment and comorbidities

11 Odds of receiving cancer treatment by comorbidity score

12 All-cause survival ahr=1.22 (95%CI ) Cancer-specific survival ahr= 1.10 (95% CI )

13 1b. Cancer treatment and survival by comorbidity level within the Indigenous population

14 Outcome Comorbidity# Unadjusted OR Adjusted OR* Advanced stage Mild comorbidity 1.2 (95%CI ) 1.1 (95%CI ) Moderate-severe comorbidity 1.2 (95%CI ) 1.0 (95%CI ) Any treatment Mild comorbidity 0.5 (95%CI ) 0.7 (95%CI ) Moderate-sever comorbidity 0.4 (95%CI ) 0.8 (95%CI ) # compared to the without any comorbidity / specific comorbidity group * Adjusted for age, cancer stage, cancer type, cancer treatment

15 Outcome Comorbidity# Unadjusted OR Adjusted OR* Advanced stage Diabetes 1.3 (95%CI ) 1.4 (95%CI ) Cardiovascular disease 1.1 (95%CI ) 1.0 (95%CI ) Respiratory disease 0.9 (95%CI ) 0.6 (95%CI ) Any treatment Diabetes 1.0 (95%CI ) 1.5 (95%CI ) Cardiovascular disease 0.4 (95%CI ) 0.7 (95%CI ) Respiratory disease 0.4 (95%CI ( ) 0.7 (95%CI ) # compared to those without any comorbidity/specific comorbidity * Adjusted for cancer type, age and stage of disease

16 Outcome Comorbidity# Unadjusted HR Adjusted HR* Cancer-specific survival Mild 1.5 (95%CI ) 1.4 (95%CI ) Moderate-severe 1.9 (95%CI ) 1.4 (95%CI ) Any-cause survival Mild 1.4 (95%CI ) 1.3 (95%CI ) Moderate-severe 2.0 (95%CI ) 1.4 (95%CI ) Unadjusted Adjusted

17 Outcome Comorbid Condition# Unadjusted HR Adjusted HR* Cancer-specific survival Diabetes 1.2 (95%CI ) 1.2 (95%CI ) Cardiovascular disease 1.4 (95%CI ) 1.1 (95%CI ) Respiratory disease 1.8 (95%CI ) 1.0 (95%CI ) Any-cause survival Diabetes 1.3 (95%CI ) 1.2 (9%CI ) Cardiovascular disease 1.4 (95%CI ) 1.2 (95%CI ) Respiratory disease 1.7 (95%CI ) 1.0 (95%CI )

18 2- Supportive care needs study Impact of comorbidities on supportive care needs amongst Indigenous Australian cancer patients Cross-sectional study 4x major public hospitals 248 Indigenous adult cancer patients Data collection Face-to-face interviews Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) Medical chart reviews comorbidity data Charlson Comorbidity Index

19 Results Most commonly reported need items were: money worries (22%) concerns about those close to you (15%) worry about illness spreading (14%) feeling down or sad (13%) anxiety (12%) worry about results of treatment (12%) Mean Standardised Likert summated scores Physical and psychological needs = 20.8 Hospital care needs = 8.3 Information and communication needs = 13.0 Practical and cultural needs = 14.6 Physical and psychological needs

20 Mean standardised domain scores (0-100) for Indigenous cancer patients in Queensland Australia, by comorbidity status Domain 1: Physical and psychological Domain 2: Hospital care Domain 3: Information Domain 4: Practical and Cultural

21 Patients with comorbidity vs. patients without comorbidity

22 Conclusions Indigenous people have more advanced stage at diagnosis, more comorbidities, and have poorer survival than non-indigenous people. The odds of receiving cancer treatment was lower for Indigenous vs. non-indigenous people even for those with no comorbidity. As in other studies, presence of comorbidity only partially explain the Indigenous/non- Indigenous differentials in cancer outcomes Among Indigenous cancer patients presence of comorbidity is associated with: cancer treatment and survival unmet supportive care needs Personalised cancer care, which addresses the social and overall health requirements (including comorbidities and unmet needs) of Indigenous patients, may improve their cancer outcomes

23 E-poster 4.1 Scientific Studies - Survivorship Title A cross-sectional study assessing the association of unmet supportive care needs and comorbidity among Indigenous cancer patients in Queensland, Australia Thrursday 10 am

24 Funding PC Valery was supported by an Australian Research Council Future Fellowship (No ). SP Moore was supported by a National Health and Medical Research Council Training Scholarship for Indigenous Australian Health Research (No ) and an International Agency for Research on Cancer-Cancer Council Australia post-doctoral fellowship. NHMRC Project Grants (Nos and ) These work was produced as part of the In-Kind activities of the Lowitja Institute incorporating the Cooperative Research Centre for Aboriginal and Torres Strait Islander Health. Supportive care needs study: Acknowledgments Interviewers: Louise Lawrie, Desley Barbab, Beverley Marcusson, Bridget Appleyard, Caroline Jaremczuk, Catherine Jacka, Gilon Sam, Lisa Fergusson, Stephanie Wodford, and Vanessa Clements. Hospital staff: Royal Brisbane and Women s Hospital - Wendy May Lewis, Nathan Goss and Stella Laidown (Indigenous Liaison Officers); Andrew Riley and James Muller Princess Alexandra Hospital - Gary Cowburn and Tanya Kitchener (Indigenous Liaison Officers); Vivienne Lloyd (lists); Dr Jennifer Martin Cairns Base Hospital - Cindy Sinclair (Indigenous Liaison Officer); Jan Bolton, Margie Shearer (Nurse Unit Manager) and Janiece Coats (Cancer Care Coordinator) The Townsville Hospital - Liela Murison (Indigenous Liaison Officer); Dr Sabe Sabesan We thank the members of the Indigenous Reference Group established to inform the study investigators about cultural matters and translation of results to the community. Most importantly, I would like to thank the Aboriginal and Torres Strait Islander people who took part in the Supportive Care Needs study.