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Cancer in Australian Aboriginal children: room for improvement
Laura Rotte1, Jordan Hansford, Maria Kirby
1Paediatric Haematology, Utrecht University, Utrecht, The Netherlands.
Insights
Indigenous children with cancer face unique challenges, including different cancer types and higher mortality rates. Improving clinical trial enrollment and care coordination is crucial for better outcomes in Aboriginal children with cancer.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Indigenous Health
Background:
- Childhood cancer incidence and outcomes can vary significantly across different populations.
- Understanding disparities in cancer care for Aboriginal children is essential for improving health equity.
Purpose of the Study:
- To analyze clinical data and treatment outcomes in Aboriginal versus non-Aboriginal children diagnosed with cancer.
- To identify differences in cancer patterns, clinical trial enrollment, and survival rates between these groups.
Main Methods:
- Retrospective case-note review of pediatric malignancies treated between 1997 and 2011.
- Matched-pair analysis comparing Aboriginal children with two controls, followed by comparison of the Aboriginal group with the entire non-Aboriginal cohort.
Main Results:
- Aboriginal children exhibited a higher 'remoteness index' and lower clinical trial enrollment.
- A trend towards inferior overall survival was observed in Aboriginal children.
- Aboriginal children had a higher proportion of leukaemias and lymphomas, including acute myeloid leukaemia (AML), often at a younger age, and a higher mortality rate.
Conclusions:
- Aboriginal children present with distinct cancer profiles and experience increased mortality.
- There is a critical need to enhance study enrollment, treatment delivery, and care coordination for Indigenous children with cancer.
Aim:
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.
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