Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context

Abstract

PURPOSELung cancer is the biggest cancer killer of indigenous peoples worldwide, including M?ori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between M?ori and non-M?ori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between M?ori and European patients, as well as timing of treatment relative to diagnosis.METHODSWe included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records.RESULTSM?ori patients with lung cancer appeared less likely to access surgery than European patients (M?ori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (M?ori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for M?ori patients compared with European patients, this difference was small and requires further investigation.CONCLUSIONOur observation of differences in surgery rates between M?ori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that M?ori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.