Aboriginal and Torres Strait Islander men diagnosed with prostate cancer are less likely to receive surgery than other Australian men and more likely to face financial barriers to treatment, according to the largest Australian study of its kind.
Researchers from The George Institute for Global Health and UNSW Sydney examined a decade of linked health data covering more than 59,000 men diagnosed with prostate cancer in New South Wales (NSW), including 1061 Aboriginal and Torres Strait Islander men. The study, led by an Aboriginal and Torres Strait Islander Steering Committee, is the first in Australia to examine both surgery and radiotherapy uptake in this population together.
The study found 36.6 per cent of Aboriginal and Torres Strait Islander men received surgery to remove the prostate, compared with 41.5 per cent of non-Indigenous men.
Cost and private health insurance ownership appears to play a significant role. Of those who did have surgery, just 55 per cent of Aboriginal and Torres Strait Islander men had it done in a private hospital, compared with 76 per cent of non-Indigenous men.
Out of pocket costs for prostate surgery in NSW are the highest in the country, typically around $9,200 per patient.
Researchers say the relative lack of public surgical outpatient clinics in NSW compared to other states means many patients are pushed towards the private system to access timely care.
Lead researcher Associate Professor Mei Ling Yap from The George Institute for Global Health said the findings point to a system that isn't offering equal access to treatment.
"We know surgery and radiotherapy are both effective treatments for prostate cancer but they come with different costs and different side effects," Associate Professor Yap said.
"What this study tells us is that Aboriginal and Torres Strait Islander men are less likely to get surgery, and a big part of that comes down to whether they have private insurance and whether they can afford it. The possession of insurance should not be a driver of why one treatment is received over another."
Referral pathways may also play a part. Previous research has shown that only 1 in 8 men with prostate cancer see a radiation oncologist before undergoing surgery, meaning some patients may not be offered a full picture of their treatment options before a decision is made.
Study co-author Dr Julieann Coombes, from The George Institute's Guunu-maana (Heal) Aboriginal and Torres Strait Islander Health Program, said the research was led from the outset by Aboriginal and Torres Strait Islander researchers, health workers and community members.
"This isn't just about the numbers. It's about making sure our mob get the same shot at the right treatment as everyone else, no matter where they live or what's in their bank account," Dr Coombes said.
"We need publicly funded surgical services that are actually within reach for our communities, including in regional and remote areas."
Despite the difference in treatment received, the study found no significant difference in survival outcomes between Aboriginal and Torres Strait Islander men and the rest of the NSW population five years on.
The researchers say the findings point to the need for publicly funded surgical services as well as radiation oncology services, including in regional and remote areas, to ensure Aboriginal and Torres Strait Islander men can access the treatment that's right for them, regardless of where they live or what they can afford.
The study was published in The Lancet, Regional Health Western Pacific.
