CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
  Journal of the Australian Healthcare & Hospitals Association
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Board
For Advertisers
Online Early
Current Issue
Just Accepted
All Issues
Sample Issue
For Authors
General Information
Instructions to Authors
Submit Article
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image
facebook   TwitterIcon

red arrow Connect with CP
blank image
facebook twitter youtube


Article << Previous     |     Next >>   Contents Vol 37(1)

The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery

Patricia M Davidson A D , Moyez Jiwa B , Michelle L DiGiacomo A B , Sarah J McGrath A , Phillip J Newton A , Angela J Durey B , Dawn C Bessarab B and Sandra C Thompson B C

A Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 235-253 Jones Street (PO Box 123), Broadway, NSW 2007, Australia. Email: michelle.digiacomo@uts.edu.au; sarah.mcgrath@uts.edu.au; phillip.newton@uts.edu.au
B Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email: m.jiwa@curtin.edu.au; m.digiacomo@curtin.edu.au; a.durey@curtin.edu.au; d.bessarab@curtin.edu.au; sandra.thompson@cucrh.uwa.edu.au
C Combined Universities Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street (PO Box 109), Geraldton, WA 6531, Australia. Email: sandra.thompson@cucrh.uwa.edu.au
D Corresponding author. Email: patriciamary.davidson@uts.edu.au

Australian Health Review 37(1) 70-78 http://dx.doi.org/10.1071/AH10955
Submitted: 18 August 2010  Accepted: 4 May 2012   Published: 19 November 2012

 Full Text
 PDF (159 KB)
 Export Citation

Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer.

Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention.

Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar.

Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery.

Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities.

What is known about the topic? Aboriginal Australians suffer a disproportionate burden of ill health including poor outcomes from lung cancer.

What does this paper add? This paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung cancer care and management for Aboriginal Australians. This paper describes barriers within the context of individual beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to reduce the lung cancer burden in Aboriginal Australians.

What are the implications for practitioners? This paper highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care practitioners are key to reducing the burden of lung cancer in Aboriginal Australians.

Additional keywords: health policy, health services, Indigenous.


[1]  Australian Bureau of Statistics, Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: ABS, AIHW2008 Contract No.: ABS Cat. No. 4704.0. AIHW Cat. No. IHW 21.

[2]  Condon JR, Barnes T, Armstrong BK, Selva-Nayagam S, Elwood JM. Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory. Med J Aust 2005; 182: 277–80.
| PubMed |

[3]  Ring I, Firman D. Reducing indigenous mortality in Australia: lessons from other countries. Med J Aust 1998; 169: 528–33.
| CAS | PubMed |

[4]  Australian Bureau of Statistics. Causes of death. Australia. 2008. Canberra: ABS; 2010 [3303.0]; Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02008?OpenDocument [Verified 18 September 2012].

[5]  Condon JR, Armstrong BK, Barnes T, Zhao Y. Cancer incidence and survival for indigenous Australians in the Northern Territory. Aust N Z J Public Health 2005; 29: 123–8.
CrossRef | PubMed |

[6]  Crombie IK. The pocket guide to critical appraisal: a handbook for health care professionals. London: BMJ Publishing Group; 1997.

[7]  Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005; 10: 45–53B.
CrossRef | PubMed |

[8]  Coory MD, Green AC, Stirling J, Valery PC. Survival of Indigenous and non-Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study. Med J Aust 2008; 188: 562–6.
| PubMed |

[9]  Coory M, Thompson A, Ganguly I. Cancer among people living in rural and remote Indigenous communities in Queensland. Med J Aust 2000; 173: 301–4.
| CAS | PubMed |

[10]  Condon JR, Armstrong BK, Barnes A, Cunningham J. Cancer in Indigenous Australians: a review. Cancer Causes Control 2003; 14: 109–21.
CrossRef | CAS | PubMed |

[11]  Condon JR, Barnes T, Cunningham J, Armstrong BK. Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory. Med J Aust 2004; 180: 504–7.
| PubMed |

[12]  Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol 2008; 9: 585–95.
CrossRef | PubMed |

[13]  Stumpers S, Thomson N. Review of cancer among Indigenous people. 2009 [cited 2010 June 20]; Available from: http://www.healthinfonet.ecu.edu.au/chronic-conditions/cancer/reviews/our-review[Verified 18 September 2012].

[14]  Cottrell J, Street J, Chong A, Roder D. Comparing cancer profiles and survival of aboriginal and non-aboriginal patients in South Australia: where are the opportunities for improving Aboriginal health? Asian Pac J Cancer Prev 2007; 8: 495–501.
| PubMed |

[15]  Boffa JD. Cancer care for Indigenous Australians. Med J Aust 2008; 188: 560–1.
| PubMed |

[16]  Supramaniam R, Grindley H, Pulver LJ. Cancer mortality in Aboriginal people in New South Wales, Australia, 1994–2002. ANZ J of Pub Health 2006; 30: 453–6.

[17]  Roder D. Epidemiology of cancer in Indigenous Australians: implications for service delivery. Can Forum 2007; 31: 85–90.

[18]  Chong A, Roder D. Exploring differences in survival from cancer among Indigenous and non-Indigenous Australians: implications for health service delivery and research. Asian Pac J Cancer Prev 2010; 11: 953–61.
| PubMed |

[19]  Cancer Australia. A national cancer data strategy for Australia. Canberra: Cancer Australia; 2008.

[20]  Passey M, Gale J, Holt B, Leatherday C, Roberts C, Kay D. et al. Stop smoking in its tracks: understanding smoking by rural Aboriginal women. 10th National Rural Health Conference; 17–20 May 2009; Cairns, QLD.

[21]  Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander health survey, 2004–05. Canberra: ABS; 2006 [cited 2010 25 February]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0 [Verified 18 September 2012]

[22]  Ivers RG. A review of tobacco interventions for Indigenous Australians. Aust N Z J Public Health 2003; 27: 294–9.
CrossRef | PubMed |

[23]  Harvey D, Tsey K, Cadet-James Y, Minniecon D, Ivers R, McCalman J, et al An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland. ANZ J of Pub Health 2002; 26: 426–31.

[24]  Briggs VL, Lindorff KJ, Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. Tobacco Control 2003; 12: ii5–ii8.
| PubMed |

[25]  Thomas DP, Briggs V, Anderson I, Cunningham J. The social determinants of being an Indigenous non-smoker. ANZ J of Pub Health 2008; 32: 110–6.

[26]  Condon JR, Cunningham J, Barnes T, Armstrong BK, Selva-Nayagam S. Cancer diagnosis and treatment in the Northern Territory: assessing health service performance for Indigenous Australians. Intern Med J 2006; 36: 498–505.
CrossRef | CAS | PubMed |

[27]  Lowenthal RM, Grogan PB, Kerrins ET. Reducing the impact of cancer in indigenous communities: ways forward. Med J Aust 2005; 182: 105–6.
| PubMed |

[28]  Shahid S, Finn L, Bessarab D, Thompson S. Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Serv Res 2009; 9: 132–40.
CrossRef | PubMed |

[29]  McGrath P, Holewa H, Ogilvie K, Rayner R, Patton MA. Insights on Aboriginal peoples’ views of cancer in Australia. Contemp Nurse 2006; 22: 240–54.
CrossRef | PubMed |

[30]  Prior D. Don’t mention the ‘C’ word: aboriginal women’s view of cancer. Aborig Isl Health Work J 2005; 29: 7–10.

[31]  Keleher H, Hagger V. Health literacy in primary health care. Aust J Primary Health 2007; 13: 24–30.
CrossRef |

[32]  Devitt J, Cass A, Cunningham J, Preece C, Anderson K, Snelling P. Study Protocol – Improving Access to Kidney Transplants(IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC Health Serv Res 2008; 8: 31–54.
CrossRef | PubMed |

[33]  Gill J. The lung story. Aborig Isl Health Work J 1999; 23: 7–8.

[34]  Hall SE, Holman CDJ, Threlfall T, Sheiner H, Phillips M, Katriss P, et al Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia. Aust J Rural Health 2008; 16: 355–62.
CrossRef | PubMed |

[35]  Ivers R. Indigenous Australians and tobacco: a literature review. Darwin: Menzies School of Health Research and Cooperative Research Centre for Aboriginal and Tropical Health; 2001.

[36]  Shahid S, Thompson SC. An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US. Aust N Z J Public Health 2009; 33: 109–18.
CrossRef | PubMed |

[37]  Abbott P, Gordon E, Davison J. Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition. Contemp Nurse 2008; 27: 157–64.
CrossRef | PubMed |

[38]  Hall SE, Bulsara CE, Bulsara MK, Leahy TG, Culbong MR, Hendrie D, et al Treatment patterns for cancer in Western Australia: does being indigenous make a difference? Med J Aust 2004; 181: 191–4.
| PubMed |

[39]  Shahid S, Beckmann KR, Thompson SC. Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils. Aust Health Rev 2008; 32: 56–65.
CrossRef | PubMed |

[40]  Roder D. Comparative cancer incidence, mortality and survival in Indigenous and non-Indigenous residents of South Austalia and the Northern Territory. Can Forum 2005; 29: 7–9.

[41]  Valery PC, Coory M, Stirling J, Green AC. Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study. Lancet 2006; 367: 1842–8.
CrossRef | PubMed |

[42]  Davidson PM, Jiwa M, Goldsmith AJ, McGrath SJ, DiGiacomo M, Phillips JL, et al Decisions for lung cancer chemotherapy: the influence of physician and patient factors. Support Care Cancer 2011; 19: 1261–1266.
CrossRef | PubMed |

[43]  McGrath P, Holewa H, McGrath Z. Practical problems for aboriginal palliative care service provision in rural and remote areas: equipment, power and travel issues. Collegian Collegian 2007; 14: 21–6.
CrossRef | PubMed |

[44]  Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Aust N Z J Public Health 2010; 34: S87–92.
CrossRef | PubMed |

[45]  McGrath P. ‘I don’t want to be in that big city; this is my country here’: research findings on Aboriginal peoples’ preference to die at home. Aust J Rural Health 2007; 15: 264–8.
CrossRef | PubMed |

[46]  Productivity Commission. Public and Private Hospitals, Research Report. Canberra: Productivity Commission; 2009.

[47]  Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin 2002; 52: 134–49.
CrossRef | PubMed |

[48]  Shahid S, Finn LD, Thompson SC. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust 2009; 190: 574–9.
| PubMed |

[49]  Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 2003; 118: 293–302.
| PubMed |

[50]  Fredericks BL, Thompson M. Collaborative voices: ongoing reflections on cultural competency and the health care of Australian Indigenous people. J Aust Indig Iss 2010; 13: 10–20.

[51]  Durie M. An indigenous model of health promotion. Health Promot J Austr 2004; 15: 36–50.

[52]  Lindorff K. Tobacco time for action: National Aboriginal and Torres Strait Islander Tobacco Control Project. Canberra: NACCHO; 2002.

[53]  McCulloch J. The mine at Baryulgil: work, knowledge, and asbestos disease. Labour Hist 2007; 92: 113–28.
CrossRef |

[54]  Musk AW, Nicholas HK, Jan LE, Janice H, Keith BS. Malignant mesothelioma in Pilbara Aborigines. Aust J Public Health 1995; 19: 520–2.
CrossRef | CAS | PubMed |

[55]  Erren TC, Jacobsen M, Piekarski C. Synergy between asbestos and smoking on lung cancer risks. Epidemiology 1999; 10: 405–11.
CrossRef | CAS | PubMed |

[56]  United States Surgeon General. The health consequences of smoking - cancer and chronic lung disease in the workplace. Rockville, MD: US Department of Health and Human Services; 1985.

[57]  Gilchrist D. Smoking prevalence among Aboriginal women. Aborig Isl Health Work J 1998; 22: 4–6.

[58]  U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General – Executive Summary. Washington, D.C.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion and the Office on Smoking and Health; 2006.

[59]  Thompson SC, Davidson PM, DiGiacomo M, Pilkington L, Shahid S. 2010 Cancer Council environmental scan on Aboriginal and Torres Strait Islander health initiatives: documenting progress in Aboriginal and Torres Strait Islander cancer control. Perth: Cancer Council WA; 2011.

[60]  DiGiacomo M, Davidson PM, Taylor KP, Smith JS, Dimer L, Ali M, et al Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study. Qual Prim Care 2010; 18: 17–26.
| PubMed |

[61]  Paradies Y, Harris R, Anderson I. The impact of racism on Indigenous health in Australia and Aotearoa: towards a research agenda. Discussion paper no. 4. Darwin: Cooperative Research Centre for Aboriginal Health; 2008.

[62]  Johnstone MJ, Kanitsaki O. The spectrum of ‘new racism’and discrimination in hospital contexts: a reappraisal. Collegian Collegian 2009; 16: 63–9.
CrossRef | PubMed |

[63]  Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Intern Med J 2012; 42: 17–22.
CrossRef | CAS | PubMed |

[64]  Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2012; 19: 144–152.
| PubMed |

[65]  Taylor K, Smith J, Dimer L, Ali M, Wilson N, Thomas T, et al “You’re always hearing about the stats. death happens so often”: new perspectives on barriers to Aboriginal participation in cardiac rehabilitation. Med J Aust 2010; 192: 602.
| PubMed |

[66]  Nagel T, Thompson C. Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the ‘Top End’. Australas Psychiatry 2006; 14: 291–4.
| PubMed |

[67]  Newman C, Butow P, Knight R, McMillan K, Treloar DC, Kippax S, et al Cancer and Aboriginal people in Australia: a review of the literature. Crit Public Health 2008; 18: 65–75.
CrossRef |

[68]  Croager EJ, Eades T, Pratt IS, Slevin T. Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia’s Aboriginal health professionals. Aust N Z J Public Health 2010; 34: S76–9.
CrossRef | PubMed |

[69]  Shahid S, Bleam R, Bessarab D, Thompson SC. Research ”If you don’t believe it, it won’t help you”: use of bush medicine in treating cancer among Aboriginal people in Western Australia. J Ethnobiol Ethnomed 2010; 6: .
CrossRef | PubMed |

[70]  Dwyer JM, Lavoie J, O’Donnell K, Marlina U, Sullivan P. Contracting for Indigenous health care: towards mutual accountability. Aust J Pub Admin 2011; 70: 34–46.
CrossRef |

[71]  Underhill C, Bartel R, Goldstein D, Snodgrass H, Begbie S, Yates P, et al Mapping oncology services in regional and rural Australia. Aust J Rural Health 2009; 17: 321–9.
CrossRef | PubMed |


Legal & Privacy | Contact Us | Help


© CSIRO 1996-2015