Pūkahukahu – Lung Cancer

Published by other organisations

• The document is on cancer.org.nz

  Cancer Society of New Zealand – Te Kāhui Matepukupuku o Aotearoa

  Understanding Lung Cancer | Matepukupuku pūkahukahu: A guide for people with lung cancer

  Booklet· 2022

• JCO Global Oncology

  The document is on ascopubs.org

  JCO Global Oncology

  Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context

  Research paper· 2024

• The New Zealand Medical Journal

  The document is on nzmj.org.nz

  The New Zealand Medical Journal

  Vol. 137 No. 1603 (27 September 2024)

  Research paper· 2024

Research

12 papers on lung cancer, from the research assessed for this site. Each is summarised below in words written for this site, not the authors’ own.

1. Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context (opens on the publisher’s website)

   2024

   What it found

   Using the same national dataset of 27,869 New Zealand lung cancer registrations from 2007 to 2019, this study compared access to and timing of treatment between Māori and European patients. Māori patients were less likely to receive surgery than European patients (14% versus 20%), including curative surgery (10% versus 16%), and this gap was not explained by stage, tumour type or comorbidity. Once age was accounted for, there were no significant differences between Māori and European patients in access to radiation therapy or systemic therapy, nor in how quickly treatment started. The authors conclude that Māori patients who may be good candidates for surgery are missing out on it more often than European patients, for reasons the available data could not explain.

   How it was done

   national registry cohort, 27,869 lung cancer registrations, 2007–2019

   Why it matters

   An unexplained gap in surgery access, in a universal health system, is a harder equity finding to argue away than a gap explained by geography or stage at diagnosis. It points at decision-making in the surgical pathway itself as a place to look.

   What it does not settle

   Built from the abstract, so the paper's own stated limitations have not been seen. Shares its dataset with the Supportive Care in Cancer travel-equity paper above.

   Abstract onlyAbstract only.

2. Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand (opens on the publisher’s website)

   Supportive Care in Cancer · 2024

   Gurney J, Davies A, Stanley J, Whitehead J, Costello S, Dawkins P, Henare K, Jackson CGCA, Lawrenson R, Scott N, Koea J

   What it found

   Māori travelled further than Europeans to reach both treatments. For surgery, median distance was 57 km for Māori against 34 km for Europeans (median time 59 versus 40 minutes); Māori were more likely to live over 200 km from the surgical centre (24% versus 16%, adjusted odds ratio 1.83). For radiation therapy the gap was wider: median distance 75 km for Māori against 35 km for Europeans (69 versus 41 minutes), with 20% of Māori versus 15% of Europeans living over 200 km away (adjusted odds ratio 1.41). Māori patients were also more likely to have received surgery at a high-volume centre.

   How it was done

   national retrospective cohort, 27,869 people diagnosed with lung cancer 2007-2019 (5,601 Māori, 19,698 European), GIS road-network analysis of home-to-treatment travel

   Why it matters

   This travel burden falls on people who are also more likely to be diagnosed at a later stage, and it sits on top of the treatment itself rather than instead of it.

   What it does not settle

   The cohort is limited to people who actually received treatment, so it cannot show whether travel distance kept anyone from being treated at all. Private hospital data was excluded, and radiation therapy type (curative versus palliative) could not be distinguished.

   Full textFull text, via the open-access copy at PMC (PMC10879218).

   Read it free: Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand (opens on another organisation’s website)DOI 10.1007/s00520-024-08375-9

3. Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand (opens on the publisher’s website)

   Internal Medicine Journal · 2024

   Nguyen H, Lao C, Keenan R, Laking G, Elwood M, McKeage M, Wong J, Aitken D, Chepulis L, Lawrenson R

   What it found

   Māori patients in this region had a markedly higher age-standardised incidence of lung cancer than non-Māori, were more likely to be diagnosed at an advanced stage, and were close to twice as likely to have small cell lung cancer, a subtype with a poorer outlook. Māori patients also had more coexisting health conditions and higher socioeconomic deprivation than non-Māori patients in the same cohort.

   How it was done

   retrospective regional cohort, 4,933 patients (1,575 Māori, 3,358 non-Māori) newly diagnosed with lung cancer

   Why it matters

   It quantifies, for one region, the scale of the stage-at-diagnosis gap behind Māori lung cancer mortality, which is the kind of figure that supports a case for targeted early-diagnosis or screening effort.

   What it does not settle

   Built from the abstract, so the paper's own stated limitations have not been seen. Published as Intern Med J 2024 Mar;54(3):421-429, so it was likely online in 2023 ahead of the 2024 print issue.

   Abstract onlyAbstract only.

   DOI 10.1111/imj.16202

4. Invitation methods for Indigenous New Zealand Māori in lung cancer screening: Protocol for a pragmatic cluster randomized controlled trial (opens on the publisher’s website)

   2023

   What it found

   This is a trial protocol, not a results paper. It sets out a plan to compare two ways of inviting people to lung cancer screening, invitations sent from the person's own primary care clinic against invitations sent from a centralised hub, in Māori aged 55 to 74 who currently or formerly smoke and meet a calculated risk threshold. The protocol anticipates around 4,412 invitation letters, with roughly 500 to 550 people going on to a CT scan. The primary measures are the proportion completing a risk assessment and the proportion completing a CT scan in each arm.

   How it was done

   protocol for a pragmatic cluster randomised controlled trial, up to 48 clinics paired and randomised 1:1, with a nested COPD-assessment cohort

   Why it matters

   Māori carry a substantially higher lung cancer burden, and this protocol treats the way people are invited, not just whether screening exists, as something worth testing properly before a national programme is built around one approach.

   What it does not settle

   As a protocol, there are no screening-uptake results yet. The paper does not spell out its own limitations in the sections read; it does state the trial is designed and governed with Māori leadership throughout, including a Māori steering committee, dedicated engagement roles, and data sovereignty protections aligned with Te Mana Raraunga principles, and follows the CONSIDER reporting standard for Indigenous health research.

   Full textFull text, via the PLOS ONE article page.

5. Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities (opens on the publisher’s website)

   BMC Cancer, Volume 21, Article 121 · 2021

   Jacquie Kidd, Shemana Cassim, Anna Rolleston, Lynne Chepulis, Brendan Hokowhitu, Rawiri Keenan, Janice Wong, Melissa Firth, Karen Middleton, Denise Aitken, Ross Lawrenson

   What it found

   Two broad themes emerged: barriers within specialist services/treatment, and the whānau journey. Reported barriers included long waits and delayed referral for diagnostic imaging, poor communication between hospital departments and district health boards, insensitive specialist interactions, thin health-literacy support, and services that did not accommodate tikanga or whānau involvement. Reported enablers included whānau advocacy and proactive engagement, and health literacy passed between generations within families.

   How it was done

   qualitative kaupapa Māori study: 9 community hui (108 participants - patients, whānau, community members) and 9 provider hui (27 primary-care staff), thematic analysis with independent double-coding

   Why it matters

   Names specific, fixable points in the secondary-care pathway - referral delays, inter-agency communication, cultural fit of specialist services - where rural Māori lung cancer patients are currently losing time to diagnosis.

   What it does not settle

   Confined to five rural Midland localities, so the specific barriers found may not generalise to urban Māori communities or other regions. The paper's own limitations section was not read, so the caveats the authors state there are not reported here.

   Full textFull text, via the open-access copy at PMC.

   Read it free: Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities (opens on another organisation’s website)DOI 10.1186/s12885-021-07862-0

6. Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience (opens on the publisher’s website)

   2021

   What it found

   This paper describes how Te Aho o Te Kahu coordinated cancer services through the first year of the COVID-19 pandemic. New cancer registrations fell by around 40% during the March-April 2020 lockdown but recovered to 2019 levels by September 2020. Surgery, medical oncology, radiation oncology and haematology services continued through lockdown, largely at pre-pandemic volumes, and telehealth use for oncology follow-up appointments rose sharply during the lockdown month. The paper reports that overall service disruption for Māori was not worse than for non-Māori, with one exception it flags for further attention: lung cancer registrations for Māori fell by around 7.5% relative to 2019.

   How it was done

   descriptive national service-data report, 2020 compared with prior years

   Why it matters

   It suggests that a coordinated national response with an explicit equity focus can hold cancer treatment access steady for Māori through a major health system shock, while still leaving gaps - here in lung cancer diagnosis - that need separate attention.

   What it does not settle

   This covers New Zealand's first pandemic year only; the paper does not claim these patterns held through later waves or once the country moved away from an elimination strategy.

   Full textFull text, via the open-access copy at PMC.

7. The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination (opens on the publisher’s website)

   2021

   What it found

   Using national data on cancer registrations, diagnostic testing (including endoscopy) and treatment volumes, the authors compare 2020 against 2018-2019, split by ethnicity. Registrations dropped by around 40% during the March-April 2020 lockdown, then recovered to pre-lockdown levels by around August-September 2020. Surgery and medical oncology saw comparatively little disruption; radiation therapy volumes were down about 8% year-on-year, which the authors attribute partly to a shift toward shorter treatment courses rather than fewer patients treated. Outcome patterns were broadly similar across ethnic groups, though lung cancer diagnosis for Māori is again flagged as an area of concern.

   How it was done

   descriptive national service-data report, 2020 compared with 2018-2019, stratified by ethnicity

   Why it matters

   It offers early evidence that a country pursuing COVID-19 elimination was able to protect its cancer diagnostic and treatment pathway through the pandemic's first year, in contrast to countries that saw sustained falls in cancer diagnosis during 2020.

   What it does not settle

   This covers 2020 only and does not speak to later, more sustained periods of community transmission after New Zealand moved away from elimination.

   Full textFull text, via the open-access copy at PMC.

8. Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis (opens on the publisher’s website)

   BMJ Open · 2020

   McLeod M, Sandiford P, Kvizhinadze G, Bartholomew K, Crengle S

   What it found

   Modelled the cost-effectiveness of a national biennial low-dose CT screening programme for lung cancer in current and former heavy smokers aged 55-74. The programme was cost-effective overall at roughly NZ$34,400 per health-adjusted life-year (HALY) gained, and more cost-effective for Māori specifically (about NZ$27,400 per HALY) than for non-Māori (about NZ$36,300 per HALY). Per-person health gains were about twice as large for Māori women as for non-Māori women, and about 25% larger for Māori men than non-Māori men. The authors conclude the programme would narrow the absolute gap in health outcomes between Māori and non-Māori, though relative differences in survival by cancer stage at diagnosis would persist.

   How it was done

   modelling study – Markov macrosimulation using linked New Zealand administrative and health data

   Why it matters

   Gives a costed case that a national lung screening programme would narrow, not widen, the harm lung cancer does to Māori, which is directly useful for advocacy on programme design and funding.

   What it does not settle

   A modelling study with wide uncertainty intervals reported alongside each ICER; results depend on assumptions about screening uptake, eligibility criteria and stage-shift, and are estimates rather than observed programme outcomes.

   Full textFull text, via the open-access copy at PMC (PMC7517554).

   Read it free: Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis (opens on another organisation’s website)DOI 10.1136/bmjopen-2020-037145

9. The most commonly diagnosed and most common causes of cancer death for Māori New Zealanders (opens on the publisher’s website)

   New Zealand Medical Journal, vol 133, no 1521, pages 77-96 (4 September 2020) · 2020

   Jason K Gurney, Bridget Robson, Jonathan Koea, Nina Scott, James Stanley, Diana Sarfati

   What it found

   Ranks the most commonly diagnosed cancers and the most common causes of cancer death for Māori using registry and mortality data from 2007-2016. Lung cancer was both the most diagnosed (around 401 registrations a year, 42 per 100,000) and the leading cause of death (around 311 deaths a year, 32 per 100,000), ahead of breast, prostate and colorectal for diagnoses, and breast and colorectal for deaths. Māori incidence exceeded non-Māori for most of these cancers, most markedly for lung, and the paper documents a broader survival gap across cancer types.

   How it was done

   descriptive epidemiology, national cancer registry and mortality data for Māori, 2007-2016

   Why it matters

   Gives a ranked, Māori-specific picture of where the cancer burden actually falls, useful for prioritising advocacy and services rather than working from unranked or non-Māori-specific figures.

   What it does not settle

   Data run to 2016, now roughly a decade old, so more recent registry updates may have shifted the exact figures even if the ranking holds.

   Full textFull text, via nzmj.org.nz (open access).

   Read it free: The most commonly diagnosed and most common causes of cancer death for Māori New Zealanders (opens on another organisation’s website)

10. Characteristics and outcomes of lung cancer patients presenting through the emergency department: a Waikato District Health Board study (opens on the publisher’s website)

    What it found

    Just under 40% of patients attended the emergency department before their lung cancer diagnosis. Māori were 1.27 times more likely than non-Māori to be diagnosed this way rather than through a GP referral. Patients diagnosed via the emergency department had more advanced disease and lower 12-month survival than those who were not, and survival was worse again for patients with two or more ED visits.

    How it was done

    retrospective cohort, 2,397 lung cancer patients

    Why it matters

    An emergency department diagnosis is a marker of a system that did not catch the cancer earlier, and this paper shows Māori patients are more likely to be caught by it.

    What it does not settle

    The authors note they could not classify why patients attended ED rather than a GP, and flag that more advanced disease at ED presentation may partly reflect reasons other than diagnostic delay.

    Abstract onlyAbstract only, via the NZMJ article page.

11. Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence (opens on the publisher’s website)

    What it found

    Across the four countries reviewed, Indigenous peoples face disparities in access to lung cancer services at multiple points in the pathway. The clearest and most consistent disparities were in early detection and access to surgery. Evidence on other parts of the pathway, such as chemotherapy or radiotherapy access, was mixed or too thin to draw firm conclusions.

    How it was done

    narrative literature review, 36 manuscripts and reports included from 1,459 screened, to July 2022

    Why it matters

    Because this pulls together evidence across four countries, including Aotearoa, it gives a wider frame for interpreting the New Zealand-specific lung cancer findings elsewhere in this set.

    What it does not settle

    The authors themselves describe the underlying evidence as relatively scant globally, and call for better data collection and monitoring of Indigenous cancer outcomes.

    Full textFull text, via PMC (PMC11564377).

12. Stage at diagnosis for Māori cancer patients, disparities, similarities and data limitations (opens on the publisher’s website)

    What it found

    An analysis of New Zealand Cancer Registry records for 196,967 patients diagnosed between 2007 and 2016, checked against separate clinical audit data for breast, colon, rectal, lung and stomach cancer. Māori patients were less likely to be diagnosed with localised disease for several cancers, most markedly prostate (odds ratio 0.50) and lung (odds ratio 0.53), though this did not hold for every cancer type. The registry also understated how many patients had no recorded stage: clinical audits found 38% of Māori lung cancer patients were unstaged, well above what the registry showed. A survival gap between Māori and non-Māori remained even after accounting for stage.

    How it was done

    retrospective registry analysis cross-checked against clinical audit data, 196,967 patients, 2007–2016

    Why it matters

    The registry undercounting missing stage data means Māori cancer outcomes cannot be fully monitored from that registry alone, which is a data problem sitting underneath the clinical one.

    What it does not settle

    Built from the abstract, so detail beyond the stated results and the headline odds ratios has not been seen.

    Abstract onlyAbstract only, via the NZMJ journal page.