Stomach cancer

Research

1. Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: A national cohort study (opens on the publisher’s website)

   BMJ Open · 2022

   Jason Gurney, Diana Sarfati, James Stanley, Clarence Kerrison, Jonathan Koea

   What it found

   Maaori and European patients had similar overall rates of curative surgery for both cancers, but access diverged on specific procedures. For liver cancer, Maaori patients were about 66% less likely than European patients to receive a transplant (adjusted OR 0.33, 95% CI 0.19-0.60). For stomach cancer, Maaori patients were around twice as likely to have a palliative bypass procedure (enteroenterostomy) rather than curative surgery (adjusted OR 1.98, 95% CI 1.31-2.99). Only around a third of all liver cancer patients, Maaori or European, had documented surgical treatment of any kind.

   How it was done

   national cohort study using linked NZ Cancer Registry and National Minimum Dataset records, 2007-2019; 866 Maaori vs 2,460 European liver cancer patients, 953 Maaori vs 3,192 European stomach cancer patients

   Why it matters

   It shows the inequity for these two cancers sits inside specific treatment decisions - who gets a transplant, who gets a curative resection versus a palliative bypass - rather than in whether surgery happens at all.

   What it does not settle

   Registry-based analysis; the paper cannot say why the transplant and bypass gaps exist, only that they exist. Read as full text.

   Full textfull text (via BMJ Open, which is open access)

   Read it free: Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: A national cohort study (opens on another organisation’s website)DOI 10.1136/bmjopen-2021-058749

2. Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand (opens on the publisher’s website)

   PLOS ONE · 2022

   Jason Gurney, Jesse Whitehead, Clarence Kerrison, James Stanley, Diana Sarfati, Jonathan Koea

   What it found

   For liver cancer, Maaori patients travelled much further for surgery than European patients: a median 121km versus 56km, and a median 123 minutes versus 59 minutes. Maaori patients were more likely to travel over 200km (36% versus 29%, adjusted OR 1.48, 95% CI 1.09-2.01). For stomach cancer the paper found no significant difference in travel distance between the two groups, both travelling a median of around 21-22km.

   How it was done

   national registry analysis using GIS to calculate travel distance and time, 2007-2019; same cohort as the companion surgery-access paper - 866 Maaori vs 2,460 European liver cancer patients, 953 Maaori vs 3,192 European stomach cancer patients

   Why it matters

   Travel burden for liver cancer surgery falls unevenly on Maaori patients specifically, while stomach cancer - where surgery is more geographically distributed - shows no such gap, pointing to where centralised care creates an access cost.

   What it does not settle

   Registry-based, distance calculated by GIS rather than reported by patients; does not capture cost, time off work or whether a patient travelled with whaanau. Read as full text.

   Full textfull text (PLOS ONE is open access)

   Read it free: Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand (opens on another organisation’s website)DOI 10.1371/journal.pone.0269593

3. Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis (opens on the publisher’s website)

   What it found

   H. pylori testing rates were lowest for Māori and Pacific people compared with sole-European, even though positivity when tested was higher for Pacific, MELAA and Māori. Treatment rates were broadly similar across groups but lower for Pacific people, who also had lower retesting rates. The authors describe the current opportunistic approach to testing as itself a driver of these gaps.

   How it was done

   retrospective linked cohort analysis, 7,024,858 person-years, 89,067 first H. pylori tests

   Why it matters

   Gastric cancer already carries some of the widest ethnic mortality gaps in the country, and this paper traces part of that gap back to who gets tested for its main modifiable risk factor in the first place.

   What it does not settle

   The authors note undercounting of Māori in the health service user data, no ability to capture private (non-publicly funded) testing, and limited breakdown within ethnic subgroups.

   Full textFull text via PMC mirror (PMC11718595)

4. 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

   Based on the NZMJ abstract as fetched; full text was not read, so detail beyond the stated results and headline odds ratios is not confirmed here.

   Abstract onlyabstract, via the NZMJ journal page

In our library

Nothing in our own library is specific to stomach cancer. What we publish is mostly cross-cutting – annual reports, evaluations and reports that span the whole cancer pathway – and all of it is at Rauemi.