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dc.contributor.authorDiaz, A
dc.contributor.authorBaade, PD
dc.contributor.authorValery, PC
dc.contributor.authorWhop, LJ
dc.contributor.authorMoore, SP
dc.contributor.authorCunningham, J
dc.contributor.authorGarvey, G
dc.contributor.authorBrotherton, JML
dc.contributor.authorO'Connell, DL
dc.contributor.authorCanfell, K
dc.contributor.authorSarfati, D
dc.contributor.authorRoder, D
dc.contributor.authorBuckley, E
dc.contributor.authorCondon, JR
dc.date.accessioned2020-12-17T04:15:37Z
dc.date.available2020-12-17T04:15:37Z
dc.date.issued2018-05-08
dc.identifierpii: PONE-D-17-37907
dc.identifier.citationDiaz, A., Baade, P. D., Valery, P. C., Whop, L. J., Moore, S. P., Cunningham, J., Garvey, G., Brotherton, J. M. L., O'Connell, D. L., Canfell, K., Sarfati, D., Roder, D., Buckley, E. & Condon, J. R. (2018). Comorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012). PLOS ONE, 13 (5), https://doi.org/10.1371/journal.pone.0196764.
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/11343/255230
dc.description.abstractBACKGROUND: Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women's higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. METHODS: Data for cervical cancers diagnosed in 2003-2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. RESULTS: Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9-3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. CONCLUSIONS: Survival was lowest for women with comorbidity. However, there wasn't a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. IMPACT: The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).
dc.languageEnglish
dc.publisherPUBLIC LIBRARY SCIENCE
dc.titleComorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)
dc.typeJournal Article
dc.identifier.doi10.1371/journal.pone.0196764
melbourne.affiliation.departmentMelbourne School of Population and Global Health
melbourne.source.titlePLoS One
melbourne.source.volume13
melbourne.source.issue5
dc.rights.licenseCC BY
melbourne.elementsid1331178
melbourne.contributor.authorBrotherton, Julia
dc.identifier.eissn1932-6203
melbourne.accessrightsOpen Access


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