GPs can help reduce cancer rates in Aboriginal and Torres Strait Islander population

Neelima Choahan

15/06/2018 2:09:17 PM

A Menzies researcher is calling on the World Health Organization and governments to prioritise improvements in cancer control for Indigenous people globally.

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Professor Gail Garvey says GPs have a vital role in bridging the gap in cancer control between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

GPs can play a vital role in prevention and early detection of cancer in Aboriginal and Torres Strait Island people and help stem rising deaths, a leading researcher says.
Professor Gail Garvey, Menzies School of Health Research, has co-authored an open letter to the World Health Organization (WHO) and governments to prioritise improvements in cancer control for Indigenous people globally.
Published in the international medical journal, The Lancet Oncology, the letter from Australian, New Zealand and Pacific researchers says there is an urgent need for a comprehensive, adequately resourced, and sustained effort to improve Indigenous health outcomes.
Professor Garvey, a Kamilaroi woman from NSW, told newsGP the researchers wanted to highlight that globally, and in Australia, Indigenous people have an increasing burden due to cancer.
‘If we look at cancer deaths overtime [in Australia], so from 1998 to 2014, mortality has increased for Indigenous people from cancer by 21%, for non-Indigenous people it has decreased by 13%,’ Professor Garvey said.
‘So this gap is growing … the disparities between Indigenous and non-Indigenous people are increasing over time. So we need to give it more attention.’
The researchers have urged authorities to provide better support for the health and wellbeing of Indigenous peoples in the region – Australian, New Zealand and the Pacific – by developing, implementing and maintaining cancer control plans, which include the monitoring of and reporting on progress.
Professor Garvey said the change can start locally.
‘GPs can play a particularly important role around prevention and early detection,’ she said.
‘The more informed they are and the more engaged in regards to the importance of cancer and the disparities between Indigenous and non-Indigenous [people], it might mean they can put a bit more focus on it and engage with Indigenous people and cancer agencies to try and address it at a local level.’
Professor Garvey said one of the ways to address the disparity is to accurately report and record Indigenous status in cancer administrative and other health data.
‘Population-level cancer surveillance provides data to set priorities, inform policies and monitor progress over time,’ she said.
‘However, some Indigenous cancer patients are effectively invisible; Australia cannot report national cancer incidence and mortality for all Indigenous people as not all jurisdictions or administrative datasets accurately report their Indigenous status.’
Professor Garvey said GPs and primary healthcare services have a role to play in accurately recording the status of Aboriginal and Torres Strait Islander people.
‘We know about 50% of Aboriginal and Torres Strait Islander people access Indigenous-specific primary healthcare services, but the other 50% access general primary healthcare services,’ she said.
‘I think asking all of your clients about Indigenous status is particularly important because GPs have a really big role to play in regards to prevention and early detention of cancer.’
Professor Garvey said the participation of Aboriginal and Torres Strait Islander peoples in national screening programs is also low and GPs can encourage their patients to take part.
‘We know at the moment that participation from Indigenous people in the National Bowel Cancer Screening Program is about 19.5%, Professor Garvey said.
‘Whereas for the general population it’s almost 43%.’
She said colorectal cancer is the third-most common cancer for Aboriginal and Torres Strait Islander people and their survival rate is also lower than non-Indigenous Australians.
Professor Garvey said the many barriers against participation in screening include inappropriate delivery of the program.
‘You get a kit in the mail when you turn 50; the information is quite complex, you don’t have anyone to have a discussion with. The delivery is not well suited to some population groups like those with lower health literacy, non-English speaking background and Indigenous Australians,’ she said.
‘So we are working with the Department of Health about conducting a national pilot to deliver that program for Indigenous people via primary healthcare services, because we know when there is a one-on-one discussion with a trusted health professional that Indigenous people are more likely to uptake screenings.
‘Then if patients are uncertain about what the test is, they need further clarification, they can talk to their Aboriginal health worker or their GP.’
Professor Garvey said once a patient is diagnosed with cancer, GPs can coordinate care between the tertiary, cancer and primary healthcare services to ensure the Aboriginal and Torres Strait Islander person continues to engage in treatment.
Dr Tim Senior, a GP with a special interest in Aboriginal and Torres Strait Islander health, said one of the barriers is a lack of culturally-appropriate care.
‘I see too many patients where they feel badly treated in the hospital system, so are really reluctant to seek care,’ said he told newsGP.
‘Right from the initial diagnosis to the treatment … I think making it that much simpler and clearer for people … so they have control over their options.
‘Often people have plenty more calls on their time, from relatives and community and cultural obligations. If treatment can be flexible about including those, then people are much more likely to be able to go through treatment as opposed to feeling disengaged.’

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