Wendy Stevens

Ethnic Differences in the Management of Lung Cancer in New Zealand

Background: Major ethnic disparities in lung cancer survival exist in New Zealand, with Mäori having a higher case-fatality ratio than non-Mäori. 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%), Mäori 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), Mäori 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). Mäori had longer transit times from diagnosis to treatment (p < 0.001). Mäori 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 Mäori. 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.

Lung Cancer in New Zealand: Patterns of Secondary Care and Implications for Survival

Introduction: The survival of patients with lung cancer in New Zealand is poor compared with Australia and the United States. To determine whether these poorer outcomes were related to secondary care management or to other factors, we documented stage of disease, comorbidities, and initial secondary care management for patients diagnosed with lung cancer in 2004, in Auckland and Northland (New Zealand). These data were compared with international data. Methods: Cases were identified from regional databases and the New Zealand Cancer Registry. Patient, tumor, and management details were collected from clinical records. Results: Five hundred sixty-five eligible cases were identified: 55% were male, the median age was 69 years, 9% were never-smokers, 81% had documented comorbidity, and 32% belonged to the most deprived socioeconomic quintile. Histopathology was non-small cell lung cancer (NSCLC) in 70%, small-cell lung cancer (SCLC) in 13%, 2% other types, and 15% clinicoradiological diagnoses. At presentation, 70% of NSCLC cases had locally advanced/metastatic disease, and 65% of SCLC cases had extensive disease. Overall, 70% of cases were referred to an anticancer service, and 50% received initial anticancer treatment. Potentially curative treatment was received by 20% of cases: 56% stage I/II, 10% stage III NSCLC, and 58% limited-stage SCLC. Conclusions: This cohort was characterized by high comorbidity and advanced disease. Although similar to the United Kingdom, initial treatment rates were low in comparison with Australia and the United States, despite similar stage distributions. Overall, 50% of patients, including 30% with early-stage disease, did not receive initial anticancer treatment. Low anticancer treatment rates may contribute to poorer survival outcomes in New Zealand.

Comparison of recommendations for radiotherapy from two contemporaneous thoracic multidisciplinary meeting formats: co‐located and video conference

Thoracic multidisciplinary meetings (TMDM) are a key component of lung cancer patient management. The optimal design, organisation and function of TMDM are uncertain, and different models may serve different purposes. In the Auckland/Northland region, there are two contemporaneous weekly TMDM using different formats; one is a co‐located TMDM (C‐TMDM), and the other is a video conference TMDM (V‐TMDM) connecting different locations.

Varied routes of entry into secondary care and delays in the management of lung cancer in New Zealand

Aim:  To determine secondary care transit times for lung cancer patients, whether these times conformed to international guidelines and the major factors which influenced these times.

Patterns of care for cervical cancer in Auckland, New Zealand, 2003–2007

Introduction: The purpose of this review is to document current patterns of care for the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IVA cervical cancer in a New Zealand cancer centre.

Concordance between thoracic multidisciplinary meeting recommendations for radiation therapy and actual treatment for lung cancer

Introduction There is limited evidence whether decisions of Thoracic Multidisciplinary Meetings (TMDMs) are reflected in the treatment lung cancer patients actually receive. Aims were to determine concordance between TMDM recommendations for radiotherapy (RT) and actual RT administered and to compare cases that received RT that were referred or not referred from TMDMs. Method A retrospective review of demographic and clinical data for all lung cancer cases within the Auckland-Northland region referred for RT from TMDMs (January–June 2009) and all cases that received RT but were not referred from TMDMs (January–August 2009). Results Of 110 cases referred for RT from TMDMs, 86 (78%) were offered RT (76 with the same treatment intent) and 78 (71%) received RT. Ten (9%) cases were deemed unsuitable for RT; 7 (6%) deteriorated; 4 (4%) declined or did not attend; 3% other. Fifty-one other cases received RT without TMDM presentation. Cases with remote domicile or recurrent disease were significantly less likely to have been presented at TMDMs. TMDM presentation did not significantly increase transit time to RT. The proportion of RT cases referred from TMDMs had increased substantially since 2004. Conclusion The concordance between TMDM recommendations for RT and both the RT administered and the intent of treatment suggests a useful role for TMDMs. Concordance could be increased by improving RT timeliness and improved education of other disciplines and patients regarding the role of RT. Strategies to increase presentation at TMDM include attention to geographically isolated groups.There is limited evidence whether decisions of Thoracic Multidisciplinary Meetings (TMDMs) are reflected in the treatment lung cancer patients actually receive. Aims were to determine concordance between TMDM recommendations for radiotherapy (RT) and actual RT administered and to compare cases that received RT that were referred or not referred from TMDMs.

Management pathway for patients with cervical cancer in the Auckland region 2003–2007

Introduction: This review was performed to describe the patient pathway and timelines involved in the treatment of FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IVA cervical cancer in a New Zealand cancer centre.