As we recognise National Close the Gap day across the country this week, Cancer Council NSW has renewed calls for an increased Aboriginal cancer workforce to help improve cancer survival in Aboriginal communities. This comes as new Cancer Council NSW research reveals that Aboriginal people are 68 per cent more likely to die from bowel cancer after surgery than non-Aboriginal people.
Trends in bowel cancer survival
Our study, published in the Medical Journal of Australia, analysed data from the NSW Cancer Registry from 2001-2007 and identified 29,800 cases of bowel cancer, with 278 diagnosed in Aboriginal people.
At 18 months after diagnosis, survival rates between the two groups were similar, but after five years we discovered that Aboriginal people were at a far greater risk of death from their cancer than non-Aboriginal people.
Despite this gap in survival, we found no overall differences in time to surgery, surgical rates, post-surgery complications, three year follow-up, or rates of adjuvant radiotherapy and chemotherapy between the two groups.
Why is there a survival gap?
While our study didn’t look specifically at the reasons for this gap, there are a number of factors that may explain our findings. This includes a potential lack of long-term follow-up tests undertaken by Aboriginal people, reduced access to health services, poor support mechanisms, cultural and practical barriers within the health system and poorer health literacy.
Compared with non-Aboriginal people, our study found that Aboriginal people diagnosed with bowel cancer were younger and more likely to live outside major cities, and in areas with low socioeconomic status and to have diabetes and chronic lung disease at the time of diagnosis.
We know that there are significant cultural barriers for Aboriginal people within the current health system. These barriers mean that Aboriginal people may be reluctant to access a cancer service and complete their treatment due to a lack of cultural safety, inadequate support and an unwelcoming environment.
Understanding trends in Aboriginal cancer
This study is one of many that has come out of the Aboriginal Patterns of Cancer Care project (APOCC). This project looked at cancer treatment and survival in Aboriginal communities, as well as the individual experiences of Aboriginal people with cancer. APOCC has led to cancer being widely recognised as one of the major chronic diseases facing Aboriginal communities.
Together, the studies illuminated the large gap in cancer survival outcomes between Aboriginal people and non-Aboriginal people. When it comes to prostate and breast cancer, Aboriginal people have a 50 and 30 percent higher chance of dying from their disease, respectively, compared with non-Aboriginal people.
As part of APOCC, qualitative interviews were conducted with three groups: Aboriginal people who had been diagnosed with cancer, carers of Aboriginal people with cancer, and both Aboriginal and non-Aboriginal health workers. The APOCC team worked with cultural mentors and advisors to ensure that cultural protocols were recognised and adhered to in the data collection, analysis and interpretation processes. The key themes that came out of these interviews were:
Aboriginal health workers are required to ensure that Aboriginal people are given more timely information and culturally appropriate support at each stage of their cancer journey
The silence around cancer has allowed myths to develop, making people hesitant to have surgery or get treatment. Cancer awareness campaigns targeted at the Aboriginal community are required to position cancer as a key health issue.
Little is known about what cultural difference means to professionals who care for Aboriginal cancer patients. Facilitating talk about cultural difference has the potential to promote a more inclusive culture in cancer care.
” Closing the Gap is a term that many in our community, including myself have heard mentioned in the news, by politicians, and in the paper, but what does it mean and what impact does this have on Aboriginal people, day to day?
I am not sure that people using this term really understand the connection of Aboriginal people to this word, “the gap”. We know how this impacts on our life, as it is around us daily. For some there is no respite.
Statistics stated in a presentation are not real until you see the high suicide rates on our young people, the poverty experienced, death of love ones – years before non-Aboriginal people, sadness, sickness, grief.
Resilient we are, but history is one for ramifications that still linger in our communities and in our families today.
The gap will close, maybe in another two or three life times, maybe longer. I know that as a passionate, community grounded person that we all need to work together to close this gap, so that it does not become a commonly used trendy statement, but real changes are made within my lifetime. “
Robert Salt (pictured above) is a volunteer advocate with Cancer Council NSW, advocating for more Aboriginal people in the cancer workforce. Strengthening the Aboriginal cancer workforce is crucial if we are going to close the cancer outcomes, but also to ensure that the cancer journey is made culturally safe for Aboriginal people.
What can be done to close the gap?
Increasing the number of Aboriginal people working in cancer services is an important part of reducing this gap. Aboriginal people have told us that this would make a difference. The NSW Government is currently revisiting its NSW Health Aboriginal Workforce Strategic Framework, and Cancer Council NSW has called for the inclusion of Aboriginal workforce targets specifically for cancer services.
Cancer Council NSW is taking this opportunity to remind the State Government of this important opportunity to help close the gap in cancer outcomes between Aboriginal and non-Aboriginal people and we look forward to seeing their Framework.
Cancer Council NSW encourages Aboriginal people affected by cancer, their family, carers and health professionals to access our Aboriginal Cancer website. Designed in consultation with the Aboriginal community, the website provides culturally appropriate information and resources to help navigate and support their cancer journey.