Ethnic differences in the management of lung cancer in New Zealand

Background: Major ethnic disparities in lung cancer survival exist in New Zealand, with Maori having a higher case-fatality ratio than non-Maori. Aim: To assess whether secondary care management of lung cancer differed by ethnicity and could contribute to ethnic survival disparities. Methods: An audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 permitted comparison of the management of lung cancer in different ethnic groups. Results: The 565 eligible cases comprised: European 378 (67%), Maori 95 (17%), Pacific Peoples 56 (10%), Asian 23 (4%), and other or unknown ethnicity 13 (2%). In multivariate analysis (adjusting for tumor and patient factors including comorbidity), Maori were 2.5 times more likely to have locally advanced disease than localized disease compared with Europeans (p < 0.01), and four times less likely to receive curative rather than palliative anticancer treatment compared with Europeans (p < 0.01). Maori had longer transit times from diagnosis to treatment (p < 0.001). Maori were more likely to decline treatment and miss appointments than Europeans, although this only partially explained management differences. Conclusion: Multiple factors are potentially responsible for the higher case-fatality ratio in Maori. Such factors include presentation with more advanced disease, lower rates of curative treatment for nonmetastatic disease, and longer transit times from diagnosis to treatment. In this retrospective study, socioeconomic deprivation, comorbidity levels, and failure to accept treatment did not fully explain ethnic differences in management. Further assessment of the underlying issues by prospective evaluation is warranted.