Our research aims to delineate the biological, cultural, social, and health-service determinants of morbidity and mortality in Aboriginal Western Australians with cancer. We are exploring differences in geographical access to services, and social and cultural barriers to optimal care. However, as we are also cancer treatment specialists and tumour biologists, we are also looking at treatments received, and differences in tumour and host biology which sets our work apart from others.
Considering Australian cancer statistics together with advice from the WA Cancer Collaborative and Aboriginal people with a lived experience of cancer, research to date has focused on 3 of the most fatal cancers among Aboriginal people including breast, head and neck, and lung.
National Australian statistics consistently show that Aboriginal women with breast cancer have worse outcomes relative to non-Aboriginal women. Although modern medical practices have brought their advantages, unquestionably Aboriginal Australian health outcomes have been negatively impacted by colonisation and racism with attendant cultural disruption and socioeconomic disparity.
After 15 years of working in Aboriginal cancer together with the Aboriginal Breast Cancer Reference Group and the WA Cancer Collaborative, important biological and clinical findings are emerging that are actionable and are being leveraged to change practice.
Real World Example:
- The Problem: WA breast cancer data showed clusters of cases in the Broome/Derby and Port Hedland/Karratha regions, each over 1000km from the most northerly centre where intravenous therapy is available in Geraldton.
- The Solution: We have successfully established tele-video parenteral treatment clinics in Karratha and Broome to address this problem. Further adaptations are currently being considered.
Publications are being written or under review and culturally appropriate community stories are being generated.
Aboriginal Australians have not benefited from improvements in cancer cure rates to the degree experienced by non-Aboriginal Australians. Our research has confirmed, for the first time, that mortalities for Western Australian Aboriginal people with head and neck cancer exceed national rates with 5-year mortality deficits of 28% (p<0.001) when compared with remoteness- and age-matched non-Aboriginal Western Australian people.
Although this work is still in its infancy, data shows that Aboriginal people with curable head and neck cancer and are suitable for chemotherapy preferentially opt for palliation (p<0.007). Further, of those who start chemotherapy/radiotherapy, significantly more Aboriginal people do not complete treatment (p,0.003).
Potential service adaptions are actively being considered based on these findings to increase ease of access to chemotherapy/radiotherapy for regional and remote Aboriginal patients.
Emerging scientific data suggests that Aboriginal people with head and neck cancer may have unique biological drivers. Specifically, cancer genes, immune cells and other factors appear to be different to what has been observed among non-Aboriginal people. Work is ongoing and outputs will be available soon.
Lung cancer is the leading cause of cancer death in Aboriginal Australians with worse outcomes observed for patients in remote dwelling. Work has recently begun to explore biological and clinical-related factors driving this disparity with plans to target diagnostic, planning, treatment and survivorship services to close the gap.
Work to investigate Aboriginal Bowel Cancer is scheduled to start in 2025.
