What the research shows

National figures on incidence, stage and survival

Registry and linked-data studies that count what is happening across the whole country – who is diagnosed, at what stage, and who survives – reported separately for Māori and non-Māori.

7 papers, 3 of them summarised from less than the whole paper.

• Blood cancer incidence, mortality and survival for Māori in New Zealand (opens in a new tab)

  Summarised from the whole paperCancer Epidemiology· 2024· doi:10.1016/j.canep.2024.102656

  Clough S, Wheeler M, Stanley J, Signal V, Ruka M, Koea J, Gurney J

  retrospective national registry cohort, 2,653 Māori and 20,458 European blood cancer registrations, NZ Cancer Registry 2007–2019, linked to mortality data to 2018

  Our summary of what it found

  Using national Cancer Registry data from 2007 to 2019 (2,653 Māori and 20,458 European blood cancer registrations), the study found Māori were more likely than Europeans to be diagnosed with, and to die from, leukaemia and myeloma, and had similar rates of Hodgkin and non-Hodgkin lymphoma. Māori had poorer cancer-specific survival across nearly all blood cancer types – age-sex-adjusted hazard ratios were 1.77 for leukaemia, 1.71 for non-Hodgkin lymphoma, 1.40 for myeloma and 1.18 for Hodgkin lymphoma, the last with a wide confidence interval reflecting the small number of cases. Within leukaemia, the survival gap was narrowest under 25 and widest in the 25–64 age bands. The authors call for further research to pinpoint where in the pathway the survival gap arises.

  Why it matters: It gives registry-level numbers, not an estimate, for a group of cancers that gets less attention in Māori cancer commentary than the larger solid-tumour cancers.

  Limits: A registry and mortality-linkage study can show the size of a gap but not explain it. The authors themselves flag the Hodgkin lymphoma estimate as imprecise because of low case numbers. Read from the full published version-of-record PDF (CC BY licence, Otago OUR Archive).

  Read as: full text

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Does diabetes affect breast cancer survival? (opens in a new tab)

  Summarised from the whole paperCancer Reports· 2024· doi:10.1002/cnr2.2040

  Lawrenson R, Lao C, Stanley J, Teng A, Kuper-Hommel M, Campbell I, Krebs J, Sika-Paotonu D, Koea J, Meredith I, Gurney J

  retrospective population-based cohort, 26,968 women with invasive breast cancer, 2005-2020, from Te Rēhita Mate Ūtaetae (the Breast Cancer Foundation National Register) linked to the Virtual Diabetes Register, hospital and mortality data

  Our summary of what it found

  3,137 of the 26,968 women (11.6%) had diabetes at diagnosis. Unadjusted survival was lower with diabetes present (5-year cancer-specific survival 87% versus 89%; 10-year 79% versus 84%), but once the analysis adjusted for age, tumour characteristics and treatment, diabetes was not associated with worse breast-cancer-specific survival (adjusted hazard ratio 0.99, 95% CI 0.89-1.11). Adjusted hazard ratios for Māori and Pacific women with diabetes were 1.01 and 0.88; for Asian women with diabetes, 0.67.

  Why it matters: The raw survival gap by diabetes status looks meaningful but mostly reflects other factors already captured in stage and treatment, which matters for how this comparison gets used in any resource discussing comorbidity and outcomes.

  Limits: The authors note the register does not distinguish diabetes type or give a diagnosis date, and had no data on BMI, smoking, alcohol or diet, so residual confounding is possible. Competing mortality risk in the diabetes group is also flagged. I read the full text via PMC.

  Read as: full text (PMC10953831, open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• The growing cancer burden: Age-period-cohort projections in Aotearoa New Zealand 2020-2044 (opens in a new tab)

  Summarised from the abstractCancer Epidemiology· 2024· doi:10.1016/j.canep.2024.102535

  Teng A, Stanley J, Jackson C, Koea J, Lao C, Lawrenson R, Meredith I, Sika-Paotonu D, Gurney J

  age-period-cohort modelling applied to 25 years of national cancer registry data, with population projections and sub-group breakdowns by age, sex and ethnicity

  Our summary of what it found

  Annual cancer diagnoses are projected to rise from 25,700 a year in 2015-2019 to 45,100 a year by 2040-44, a 76% increase (2.3% a year). Age-standardised incidence rises more modestly, by 9% overall (348 to 378 cases per 100,000 person-years), with a larger increase projected for men (11%) than women (6%). The authors note that trends for individual cancer types vary and some move in the opposite direction to projections published for other countries.

  Why it matters: Most of the projected increase in case numbers comes from population growth and ageing rather than rising risk, which is a distinction worth keeping in any sentence about a 'growing burden' so the figure is not read as a worsening risk per person.

  Limits: I could not get past ScienceDirect's access wall (403 on direct fetch) and found no PMC or other open-access copy; Europe PMC's own record confirms it is not open access. This assessment is built from the abstract only, sourced from Europe PMC's indexed record, not the full paper. I have not seen the paper's stated limitations, ethnicity-specific figures, or per-cancer-type breakdowns.

  Read as: abstract only (Europe PMC indexed record); publisher page returned 403 Forbidden, no open-access full text found

  Written for this website from the paper, not the authors’ abstract.

• Equity of Cancer and Diabetes Co-Occurrence: A National Study With 44 Million Person-Years of Follow-Up (opens in a new tab)

  Summarised from the whole paperJCO Global Oncology· 2023· doi:10.1200/GO.22.00357

  Jason Gurney, James Stanley, Andrea Teng, Bridget Robson, Nina Scott, Dianne Sika-Paotonu, Chunhuan Lao, Ross Lawrenson, Jeremy Krebs, Jonathan Koea

  retrospective national cohort using linked administrative data, close to 5 million people, 44 million person-years, 2008-2018

  Our summary of what it found

  Linking national health records for close to five million people over 44 million person-years, the study found people with diabetes had higher cancer rates than people without it, in every ethnic group, with Māori carrying both the highest age-standardised rate (1,303.6 per 100,000 person-years) and the highest rate ratio (1.37, against 1.23-1.35 for the other groups measured). Uterine, pancreatic, kidney and liver cancers showed the strongest links to diabetes across all groups. It is a descriptive study: it establishes the size of the co-occurring burden by ethnicity, not why the gap exists.

  Why it matters: It gives a population-level size and shape to the diabetes-cancer overlap Māori carry disproportionately, which matters for anyone planning screening or comorbidity care.

  Limits: Descriptive/observational - no causal claim is made or should be drawn. There is a related but distinct 2022 PLOS ONE paper by an overlapping author group with a very similar title ("Cancer and diabetes co-occurrence: A national study with 44 million person-years of follow-up", DOI 10.1371/journal.pone.0276913) - worth not conflating the two. I read the full text via the PMC open-access copy.

  Read as: full text (PMC open-access copy)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• The most commonly diagnosed and most common causes of cancer death for Māori New Zealanders (opens in a new tab)

  Summarised from the whole paperNew 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

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

  Our summary of 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.

  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.

  Limits: Full text read directly on the NZMJ site (confirmed open access, PDF available). 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.

  Read as: full text (nzmj.org.nz, open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Disparities in cancer specific survival between Māori and non-Māori New Zealanders, 2007-2016 (opens in a new tab)

  Summarised from the abstract

  national cohort/data-linkage study

  Our summary of what it found

  Māori had worse cancer-specific survival than non-Māori for 23 of the 24 most common causes of Māori cancer death, with the gap ranging from 12% to 156% depending on the cancer. The size of the gap varied with deprivation, comorbidity and cancer type, and tended to be largest among patients with no other health conditions.

  Why it matters: The gap shows up across nearly every common cancer, which the authors use to argue that no single, generic fix will close it and each cancer needs its own response.

  Limits: The publisher page did not load past its navigation shell, so this summary rests on the PubMed abstract record rather than a direct read of the ASCO page.

  Read as: abstract (via PubMed/search-indexed abstract text; the ASCO landing page itself returned only navigation content, so this was cross-checked against the PubMed record, ID 32511067)

  Written for this website from the paper, not the authors’ abstract.

• Stage at diagnosis for Māori cancer patients, disparities, similarities and data limitations (opens in a new tab)

  Summarised from the abstract

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: abstract, via the NZMJ journal page

  Written for this website from the paper, not the authors’ abstract.

Pūkahukahu – Lung Cancer

Quoted from Hei Āhuru Mōwai's own WICC 2026 programme, Plenary 2: "Pūkahukahu – Lung Cancer".

The largest theme in the collection. It runs from who is diagnosed and how they reach that diagnosis, through screening trials still underway, to the travel and the surgery that follow.

8 papers, 3 of them summarised from less than the whole paper.

• Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context (opens in a new tab)

  Summarised from the abstract· 2024

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

  Our summary of 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.

  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.

  Limits: Read at abstract level via a secondary aggregator, not the publisher page or the full PMC text directly, both of which were blocked. Shares its dataset with the Supportive Care in Cancer travel-equity paper above.

  Read as: abstract, read via a Semantic Scholar record for the paper — the ASCO publisher page redirected to a sign-in wall (PMID 38301179, PMC10846779, also captcha-blocked directly)

  Written for this website from the paper, not the authors’ abstract.

• Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand (opens in a new tab)

  Summarised from the whole paperSupportive Care in Cancer· 2024· doi:10.1007/s00520-024-08375-9

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

  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

  Our summary of 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.

  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.

  Limits: 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. I read the full text via PMC.

  Read as: full text (PMC10879218, open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand (opens in a new tab)

  Summarised from the abstractInternal Medicine Journal· 2024· doi:10.1111/imj.16202

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

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

  Our summary of 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.

  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.

  Limits: I read the PubMed abstract only, via NCBI eutils; the Wiley publisher page sits behind a cookie wall and I found no PMC or open-access copy. The task listed this as a 2023 paper; PubMed's indexed citation gives Intern Med J 2024 Mar;54(3):421-429, so it was likely available online in 2023 ahead of the 2024 print issue.

  Read as: abstract, read via PubMed/NCBI eutils; publisher full text behind a cookie wall, not read

  Written for this website from the paper, not the authors’ abstract.

• Invitation methods for Indigenous New Zealand Māori in lung cancer screening: Protocol for a pragmatic cluster randomized controlled trial (opens in a new tab)

  Summarised from the whole paper· 2023

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: full text (via WebFetch of the PLOS ONE article page)

  Written for this website from the paper, not the authors’ abstract.

• Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities (opens in a new tab)

  Summarised from the whole paperBMC Cancer, Volume 21, Article 121· 2021· doi:10.1186/s12885-021-07862-0

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

  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

  Our summary of 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.

  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.

  Limits: Confined to five rural Midland localities, so the specific barriers found may not generalise to urban Māori communities or other regions; I have not independently checked whether the paper's own limitations section states this or other caveats, since I read a structured summary of the full text rather than transcribing the discussion section myself.

  Read as: full text (read via PMC's open-access copy)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis (opens in a new tab)

  Summarised from the whole paperBMJ Open· 2020· doi:10.1136/bmjopen-2020-037145

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

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: full text (open-access PMC copy, PMC7517554)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Characteristics and outcomes of lung cancer patients presenting through the emergency department: a Waikato District Health Board study (opens in a new tab)

  Summarised from the abstract

  retrospective cohort, 2,397 lung cancer patients

  Our summary of 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.

  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.

  Limits: 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.

  Read as: abstract, read from the article's own page on the NZMJ website (the PDF link given was too large to fetch directly, so the journal's article page was used instead)

  Written for this website from the paper, not the authors’ abstract.

• Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence (opens in a new tab)

  Summarised from the whole paper

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

  Our summary of 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.

  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.

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

  Read as: full text, read via the PMC mirror (PMC11564377)

  Written for this website from the paper, not the authors’ abstract.

Screening participation and design

Cervical, bowel and lung screening: what keeps people away from a screening programme, what changes when the test can be taken at home, and what Indigenous communities have said they want a screening service to be.

9 papers, 2 of them summarised from less than the whole paper.

• Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review (opens in a new tab)

  Summarised from the abstract· 2024

  systematic review (PRISMA), 18 qualitative studies included

  Our summary of what it found

  This systematic review, conducted to PRISMA guidelines and searching MEDLINE, Scopus, PubMed and Google Scholar, identified 18 qualitative studies on what Indigenous communities want from cancer screening services. Four themes recurred across the included studies: culturally appropriate education, community participation in designing screening programmes, trusting relationships with healthcare providers, and respect for individual autonomy in screening decisions. The authors conclude that one-size-fits-all screening programmes are not well suited to reaching Indigenous communities, and argue for local consultation before new screening programmes are introduced.

  Why it matters: It puts a citable evidence base behind community-led screening design rather than one-size-fits-all programmes, which is a useful reference point for arguing that case here.

  Limits: Read at abstract/summary level, not the full text, so it was not possible to confirm which countries or Indigenous groups the 18 included studies covered, or whether any Māori-specific studies were among them.

  Read as: abstract, read via a Semantic Scholar record for the paper — the ASCO publisher page redirected to a sign-in wall, and the PMC page (PMC10881110) was captcha-blocked directly

  Written for this website from the paper, not the authors’ abstract.

• Cervical Screening by HPV Self-Testing: A Game Changer for Māori (opens in a new tab)

  Summarised from the whole paper· 2024

  Bev Lawton, Anna Adcock, Kendall Stevenson, Tania Slater, Francesca Storey

  book chapter drawing on the He Tapu Te Whare Tangata research programme: qualitative interviewing, clinical implementation and randomised controlled trials

  Our summary of what it found

  The chapter sets out why HPV self-testing changes cervical screening for wahine Maori. It reports that 41% of wahine Maori are underscreened or never screened against 21% of European and other women, and that HPV-based screening gives 60 to 70 per cent greater protection than cytology. From the He Tapu Te Whare Tangata studies, underscreened wahine Maori offered an HPV self-test were almost three times more likely to be screened, and those more than ten years from their last screen almost five times as likely. It records that in September 2023 Aotearoa New Zealand became the first high-income country to move straight to HPV self-testing as the primary screening method.

  Why it matters: This is a documented case of Maori-led research changing a national screening programme, and it names the organisations whose advocacy contributed.

  Limits: A chapter summarising a research programme rather than a single study, so the figures quoted rest on the underlying papers it cites, two of which are separately in this collection.

  Read as: full text, supplied by Brooke from the publisher page (open access, CC BY-NC-ND 4.0)

  Written for this website from the paper, not the authors’ abstract.

• Perceived barriers to self-collected HPV testing for cervical cancer screening, and knowledge of HPV: a survey of primary healthcare smear-takers across Aotearoa New Zealand (opens in a new tab)

  Summarised from part of the paper· 2024

  cross-sectional web-based questionnaire, 73 respondents (67 completed in full), 57.8% completion rate

  Our summary of what it found

  The survey measured primary-care smear-takers' knowledge of HPV and their views on the shift to primary HPV testing, including home self-testing. Average knowledge score was 56.5%, with strong understanding of some areas (comparability of self- versus clinician-collected samples) and weak understanding of others, including the new recall guidelines. Respondents mostly rated the anticipated logistical barriers to home self-testing as minor, but 73.3% wanted further education on managing results under the new programme.

  Why it matters: The paper's own introduction notes that 2022 national cervical screening coverage sat at 78% for non-Māori against 62% for Māori, so gaps in provider knowledge about the new HPV self-testing pathway land on a workforce already serving an unequal screening system.

  Limits: This assessment covers only the first five pages of the PDF (abstract through early results); the paper's own stated limitations, further results and full discussion were not read and are not represented here. The study itself is a single-round survey with a 57.8% completion rate, self-reported knowledge, and predominantly NZ European respondents (72.6%), with only 12.3% identifying as Māori.

  Read as: full text (first five pages of the PDF read directly: title, abstract, introduction, methods, and the start of results including demographic tables; the discussion and stated-limitations section further into the PDF was not read)

  Written for this website from the paper, not the authors’ abstract.

• A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial (opens in a new tab)

  Summarised from the whole paperJMIR Research Protocols· 2023· doi:10.2196/51643

  Lawton B, MacDonald EJ, Storey F, Stanton JA, Adcock A, Gibson M, Parag V, Sparkes NK, Kaimoana B, King F, Terry M, Watson H, Bennett M, Lambert CS, Geller S, Paasi I, Hibma M, Sykes P, Hawkes D, Saville M

  trial protocol, cluster randomised crossover design, two rural primary care sites; interim uptake figures only (743 HPV self-tests over the first 15-month period)

  Our summary of what it found

  This is a protocol paper, not a results paper. It sets out a trial comparing two pathways after a positive HPV self-test: one giving a point-of-care result within an hour with immediate referral to colposcopy, run through community-controlled services, against standard laboratory-based testing and referral. The primary measure is the share of women who reach colposcopy within 20 working days. In the first 15-month period, 743 eligible self-tests were done, split roughly evenly between the two pathways, with 7.3% testing positive for high-risk HPV.

  Why it matters: If the community-controlled, point-of-care pathway shortens the wait to colposcopy, it is a concrete model for closing a step in the cervical screening pathway where delay disproportionately affects rural Māori women.

  Limits: Protocol and interim uptake data only; the primary outcome (colposcopy timeliness by pathway) was not yet reported at the point this paper was published.

  Read as: full text, read via PMC (PMC10540018)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Invitation methods for Indigenous New Zealand Māori in lung cancer screening: Protocol for a pragmatic cluster randomized controlled trial (opens in a new tab)

  Summarised from the whole paper· 2023

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: full text (via WebFetch of the PLOS ONE article page)

  Written for this website from the paper, not the authors’ abstract.

• Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand (opens in a new tab)

  Summarised from the whole paper· 2021

  Naomi Brewer, Karen Bartholomew, Jane Grant, Anna Maxwell, Georgina McPherson, Helen Wihongi, Collette Bromhead, Nina Scott, Sue Crengle, Sunia Foliaki, Chris Cunningham, Jeroen Douwes, John D Potter

  open-label three-arm randomised community trial, 3,553 women, with a non-randomised follow-on substudy

  Our summary of what it found

  Never-screened and markedly under-screened Maori, Pacific and Asian women aged 30 to 69 were randomised to take an HPV self-sample at their clinic, to be mailed a kit to use at home, or to usual care by cytology. Participation was highest in the mailed-to-home group: 14.6% of Maori women against 2.0% under usual care. Adjusted for study group, screening history, deprivation and age, Maori women sent a kit were 9.7 times more likely to be screened than those offered usual care (95% CI 3.0 to 31.5), Pacific women 6.0 times and Asian women 5.1 times. Of those who self-sampled, 7.9% tested positive for a high-risk HPV type, and clinically appropriate follow-up was completed for 92% of them, needing a mean of 2.5 hours of nurse time each.

  Why it matters: It shows the route that actually reaches the women the screening programme has never reached, and it puts a number on the follow-up workforce that route requires.

  Limits: The authors note they could not tell whether non-responders ever received the invitation, so participation may be underestimated; recruitment was limited to two Auckland districts, so the findings may not carry to rural areas; and participants and staff could not be blinded.

  Read as: full text, supplied by Brooke from the publisher page (open access)

  Written for this website from the paper, not the authors’ abstract.

• Bowel cancer screening age range for Māori: what is all the fuss about? (opens in a new tab)

  Summarised from the whole paperNew Zealand Medical Journal, Vol 134 No 1535, pp 71-77· 2021

  Melissa McLeod, Ricci Harris, Sarah-Jane Paine, Sue Crengle, Donna Cormack, Nina Scott, Bridget Robson

  viewpoint/opinion article, not primary research, drawing on national bowel cancer incidence-by-age data

  Our summary of what it found

  The authors argue for extending bowel screening down to age 50 for Māori. Their reasoning: 58% of bowel cancers in Māori women and 52% in Māori men occur before age 60, against 27% and 29% in non-Māori respectively - a gap the article attributes to Māori having a younger population age structure, not to a higher age-specific cancer rate (rates were similar by age band in 2017). Even a start age of 50 would still miss roughly 30% of affected Māori women and 25% of affected Māori men.

  Why it matters: Reframes the screening-age debate as a population-structure and equity question rather than a dispute about who gets cancer at what rate.

  Limits: I read this through a page-rendering tool rather than the raw article myself, so treat the specific percentages as the article's own reported figures relayed through that extraction rather than something I visually verified character-by-character. This is the authors' argued position, not a systematic review.

  Read as: full text (article page content, not merely an abstract)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Recommendations for implementing HPV Self-testing in Aotearoa (opens in a new tab)

  Summarised from the whole paper· 2021

  editorial / expert recommendations, not a primary study

  Our summary of what it found

  Written after the 2021 Budget announcement of funding for a national HPV self-testing programme, this editorial by researchers and health board staff who ran New Zealand's HPV self-testing trials sets out recommendations for the Ministry of Health's rollout. These include making Māori health equity the organising principle of implementation rather than an add-on, reviewing the legislation governing the national cervical screening programme to strengthen Māori governance over screening data, building risk-stratified and culturally safe colposcopy and follow-up pathways, and offering an on-request mailed self-test alongside clinic-based testing.

  Why it matters: It put Māori governance over cervical screening data on the table as part of the implementation design, ahead of the 2023 national rollout of HPV self-testing.

  Limits: This is an editorial by the people who ran the underlying self-testing trials; several authors declare Health Research Council funding, pharmaceutical or diagnostics industry fees, or a seat on the National Screening Advisory Committee. It sets out recommendations rather than new data.

  Read as: Full text, read directly from the NZMJ PDF (all pages, including author declarations and references)

  Written for this website from the paper, not the authors’ abstract.

• Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis (opens in a new tab)

  Summarised from the whole paperBMJ Open· 2020· doi:10.1136/bmjopen-2020-037145

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

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: full text (open-access PMC copy, PMC7517554)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

Access to surgery and treatment

What happens once a cancer has been found: whether an operation is offered, how long it takes to happen, how far someone travels for it, and what follows.

10 papers, 3 of them summarised from less than the whole paper.

• Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context (opens in a new tab)

  Summarised from the abstract· 2024

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

  Our summary of 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.

  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.

  Limits: Read at abstract level via a secondary aggregator, not the publisher page or the full PMC text directly, both of which were blocked. Shares its dataset with the Supportive Care in Cancer travel-equity paper above.

  Read as: abstract, read via a Semantic Scholar record for the paper — the ASCO publisher page redirected to a sign-in wall (PMID 38301179, PMC10846779, also captcha-blocked directly)

  Written for this website from the paper, not the authors’ abstract.

• Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand (opens in a new tab)

  Summarised from the whole paperSupportive Care in Cancer· 2024· doi:10.1007/s00520-024-08375-9

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

  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

  Our summary of 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.

  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.

  Limits: 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. I read the full text via PMC.

  Read as: full text (PMC10879218, open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Ethnic differences in time to surgery for women with early stage breast cancer in Aotearoa/New Zealand: a population-based study (opens in a new tab)

  Summarised from the whole paperThe Lancet Regional Health – Western Pacific· 2024· doi:10.1016/j.lanwpc.2024.101091

  Boyle L, Lawrenson R, Ronald M, Campbell I, Nosa V, Tin Tin S

  population-based cohort, 16,365 women, four NZ urban regions, 2000–2020

  Our summary of what it found

  In a cohort of 16,365 women having surgery for early-stage (stage 1–3a) breast cancer across four NZ urban regions between 2000 and 2020, only 58.2% had surgery within the 31-day Faster Cancer Treatment target. Māori women had 18% higher adjusted odds of missing that target than NZ European women (OR 1.18, 95% CI 1.05–1.33), and Pacific women 42% higher odds (OR 1.42, 95% CI 1.22–1.65); there was no significant difference for Asian women. Deprivation and treatment in the public rather than private system explained most of the gap – women treated publicly had close to seven times the odds of a delay past 31 days. The gap did not close after the Faster Cancer Treatment policy was introduced in 2012.

  Why it matters: Time to surgery is a direct, government-tracked equity measure, and this shows Māori and Pacific women are still waiting longer for it despite a policy meant to close that gap.

  Limits: Confined to four urban regions using the Breast Cancer Foundation's clinical register, so may not generalise to rural areas or regions outside the four studied. Read the full open-access text via PubMed Central.

  Read as: full text

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Receipt of mastectomy and adjuvant radiotherapy following breast conserving surgery (BCS) in New Zealand women with BCS-eligible breast cancer, 2010–2015: an observational study focusing on ethnic differences (opens in a new tab)

  Summarised from the whole paperBMC Cancer· 2023· doi:10.1186/s12885-023-11248-9

  Bartholomew K, Ghafel M, Tin Tin S, Aye PS, Elwood JM, Hardie C, Scott N, Kidd J, Ramsaroop R, Campbell I

  retrospective observational study, New Zealand Breast Cancer Registry, 5,520 BCS-eligible women 2010-2015 (4,541 invasive, 979 DCIS)

  Our summary of what it found

  Among women eligible for breast-conserving surgery, 22% had a mastectomy instead and 91% of those who had breast-conserving surgery went on to radiotherapy. Asian women were around twice as likely as the reference group to have a mastectomy for invasive cancer. Pacific women had substantially lower odds of receiving radiotherapy after breast-conserving surgery, for both invasive cancer and DCIS. Māori women's rates did not differ significantly from the reference group on either measure. The most common reason radiotherapy was missed was that a clinician had not referred the woman for it.

  Why it matters: It shows the treatment gap for BCS-eligible women sits mainly with Pacific and Asian ethnicity rather than with Māori in this cohort, which matters for where equity effort in breast cancer treatment pathways is targeted.

  Limits: Registry-based observational study covering 2010-2015 only, so it cannot establish why the differences occurred and may not reflect current practice.

  Read as: full text, read via PMC (PMC10436661)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: A national cohort study (opens in a new tab)

  Summarised from the whole paperBMJ Open· 2022· doi:10.1136/bmjopen-2021-058749

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

  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

  Our summary of 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.

  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.

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

  Read as: full text (via BMJ Open, which is open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand (opens in a new tab)

  Summarised from the whole paperPLOS ONE· 2022· doi:10.1371/journal.pone.0269593

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

  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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: full text (PLOS ONE is open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Disparities in post-operative mortality between Māori and non-Indigenous ethnic groups in New Zealand (opens in a new tab)

  Summarised from part of the paperNew Zealand Medical Journal, Vol 134 No 1542, pp 15-28· 2021

  Jason Gurney, Melissa McLeod, James Stanley, Diana Sarfati, Doug Campbell, Cheryl Davies, Elizabeth Dennett, Peter Himona, Sarah Jackson, Dick Ongley, Bridget Robson, Juliet Rumball-Smith, Virginia Signal, Jeannine Stairmand, Courtney Thomas, Jonathan Koea

  retrospective national cohort, nearly 3.9 million surgical procedures (876,976 acute, 2,990,726 elective/waiting list), Cox proportional hazards regression

  Our summary of what it found

  Māori had higher 30- and 90-day post-operative mortality than other ethnic groups across most procedure categories, with the gap against Europeans strongest for elective/waiting-list procedures (e.g. elective musculoskeletal procedures, 30-day mortality adjusted hazard ratio 1.93, 95% CI 1.56-2.39). This covers surgery generally, not cancer surgery specifically. The authors attribute the pattern to a combination of health-system, process and clinical-team factors rather than patient-level biology.

  Why it matters: Documents a measurable survival gap for Māori after surgery nationally, which bears on how the cancer system should scrutinise its own surgical pathways for the same pattern.

  Limits: I read the abstract and introduction/methods in full but not the discussion or limitations section, so I cannot report what caveats the authors themselves state there. No DOI exists for this article: Crossref shows the New Zealand Medical Journal only began registering DOIs from July 2022 (volume 135 onward); this September 2021 volume-134 article predates that and none has since been assigned.

  Read as: full text (read the published PDF directly: title page, abstract and the opening of the methods section)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence (opens in a new tab)

  Summarised from the whole paper

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

  Our summary of 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.

  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.

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

  Read as: full text, read via the PMC mirror (PMC11564377)

  Written for this website from the paper, not the authors’ abstract.

• Inequalities between Maori and non-Maori men with prostate cancer in Aotearoa New Zealand (opens in a new tab)

  Summarised from the whole paper

  narrative literature review, by Egan, Kidd, Lawrenson, Cassim, Black, Blundell, Bateman and Broughton, funded by the Movember Foundation

  Our summary of what it found

  This review asks why Māori men are less likely than non-Māori men to be diagnosed with prostate cancer, yet significantly more likely to die of it once diagnosed - a mortality rate around 1.5 times higher. Drawing on existing New Zealand studies, the authors found Māori men are screened for prostate cancer roughly half as often as non-Māori men, are more often diagnosed at a later or metastatic stage, and less often receive prostatectomy or low-dose brachytherapy. They link this to institutional racism, weaker continuity of care in general practice, and socioeconomic barriers such as travel and accommodation costs for treatment based in major centres.

  Why it matters: It identifies specific, checkable points along the pathway - screening rates, staging data gaps, treatment choice - where the gap between Māori and non-Māori prostate cancer mortality opens up.

  Limits: As a narrative review it draws together earlier NZ studies of varying size and region (some single-city, some Midland-region only) rather than presenting new data of its own. The authors themselves note that national registry data on prostate cancer stage at diagnosis is about 75% recorded as 'unknown', which limits what any of the underlying studies can show.

  Read as: full text (read directly from the supplied PDF)

  Written for this website from the paper, not the authors’ abstract.

• Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends (opens in a new tab)

  Summarised from the abstract

  retrospective national cohort, 1,836,683 patients, 2005–2017

  Our summary of what it found

  A national cohort of everyone having a procedure under general anaesthetic in New Zealand between 2005 and 2017. Overall 30-day mortality was 0.5 per 100 procedures, far higher after acute admissions (1.6 per 100) than elective ones (0.2 per 100). After adjusting for other factors, Māori patients having an elective procedure were 30% more likely to die within 30 days than European patients. The authors attribute part of this gap to institutionalised racism in the health system.

  Why it matters: This is not a cancer-specific paper, but cancer surgery happens under general anaesthetic, so a gap of this size in the wider surgical system is relevant background for anyone looking at Māori cancer treatment outcomes.

  Limits: Covers all procedures under general anaesthetic, not cancer surgery specifically, and does not report cancer patients as a separate subgroup. Seen via a structured abstract on the journal landing page, not the full text.

  Read as: abstract (structured abstract via landing page; PDF fetch returned only raw PDF code, so HTML landing page was used instead)

  Written for this website from the paper, not the authors’ abstract.

Time to diagnosis, and the route people take to it

How long the path from a first symptom to a diagnosis takes, what sits in the way of it, and how many people arrive at that diagnosis through an emergency department.

5 papers, 2 of them summarised from less than the whole paper.

• Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand (opens in a new tab)

  Summarised from the abstractInternal Medicine Journal· 2024· doi:10.1111/imj.16202

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

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

  Our summary of 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.

  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.

  Limits: I read the PubMed abstract only, via NCBI eutils; the Wiley publisher page sits behind a cookie wall and I found no PMC or open-access copy. The task listed this as a 2023 paper; PubMed's indexed citation gives Intern Med J 2024 Mar;54(3):421-429, so it was likely available online in 2023 ahead of the 2024 print issue.

  Read as: abstract, read via PubMed/NCBI eutils; publisher full text behind a cookie wall, not read

  Written for this website from the paper, not the authors’ abstract.

• Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study (opens in a new tab)

  Summarised from the whole paperFamily Practice· 2022· doi:10.1093/fampra/cmab155

  Tania Blackmore, Lynne Chepulis, Keenan Rawiri, Jacquie Kidd, Tim Stokes, Melissa Firth, Mark Elwood, David Weller, Jon Emery, Ross Lawrenson

  prospective cohort study, structured interviews using the Model of Pathways to Treatment framework; 176 patients analysed of 235 recruited, April 2018 to March 2020

  Our summary of what it found

  Over half of patients (96 of 176, 54.5%) had a total diagnostic interval longer than 120 days; median total interval was 142 days. A third (36.9%) had a GP diagnostic interval over 120 days. Reporting rectal bleeding was linked to a shorter interval (OR 0.34). Longer intervals were linked to being under 60 (OR 3.32 for the appraisal interval), being female (OR 2.19) and being Maaori (OR 3.18, 95% CI 1.04-9.78) for the GP diagnostic interval specifically.

  Why it matters: It locates part of the delay to colorectal cancer diagnosis inside the GP diagnostic interval for Maaori patients specifically, rather than in how long patients themselves take to seek care.

  Limits: Self-reported intervals depend on patient recall; the Maaori OR's confidence interval is wide (1.04-9.78), reflecting a small number of Maaori patients in the 176-patient sample - the paper does not give that subgroup count directly. Read as full text via PMC.

  Read as: full text, read via the PubMed Central open-access copy (PMC9295611) rather than the Oxford Academic page, which shows only the abstract to a non-subscriber

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Hā Ora: secondary care barriers and enablers to early diagnosis of lung cancer for Māori communities (opens in a new tab)

  Summarised from the whole paperBMC Cancer, Volume 21, Article 121· 2021· doi:10.1186/s12885-021-07862-0

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

  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

  Our summary of 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.

  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.

  Limits: Confined to five rural Midland localities, so the specific barriers found may not generalise to urban Māori communities or other regions; I have not independently checked whether the paper's own limitations section states this or other caveats, since I read a structured summary of the full text rather than transcribing the discussion section myself.

  Read as: full text (read via PMC's open-access copy)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination (opens in a new tab)

  Summarised from the whole paper· 2021

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

  Our summary of 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.

  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.

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

  Read as: Full text via PMC (thelancet.com itself returned a 403 error)

  Written for this website from the paper, not the authors’ abstract.

• Characteristics and outcomes of lung cancer patients presenting through the emergency department: a Waikato District Health Board study (opens in a new tab)

  Summarised from the abstract

  retrospective cohort, 2,397 lung cancer patients

  Our summary of 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.

  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.

  Limits: 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.

  Read as: abstract, read from the article's own page on the NZMJ website (the PDF link given was too large to fetch directly, so the journal's article page was used instead)

  Written for this website from the paper, not the authors’ abstract.

Palliative and end-of-life care

Palliative care needs and how services are built, how well organisations communicate across cultures, and where people die.

3 papers, 1 of them summarised from less than the whole paper.

• Palliative care and quality of life needs and outcomes for Māori with cancer: what do we know? (opens in a new tab)

  Summarised from the whole paperAlterNative: An International Journal of Indigenous Peoples· 2023· doi:10.1177/11771801231163919

  Rhiannon Mihi Jones, Virginia Signal, Moira Smith, Jeannine Stairmand, Cheryl Davies, Jason Gurney

  scoping review of 20 New Zealand-based sources (18 articles, 2 book chapters), drawn from 126 candidates found across five databases searched to 30 June 2021, with key-informant input

  Our summary of what it found

  The review searched five databases, found 126 candidate papers, and narrowed to 20 New Zealand sources on palliative care and quality of life for Māori with cancer - only one of which addressed all three together. It concludes that palliative services here are built around a Western model centred on physical symptoms, which sits awkwardly against Māori concepts of wellbeing that include whānau and spiritual dimensions. It reports evidence that Māori access pain relief later in the course of illness than non-Māori, and that services often lack cultural safety. Whānau-led care is identified as working better where it is free of those same assumptions.

  Why it matters: It names how thin the New Zealand evidence base is on this specific overlap - one directly relevant paper out of 126 candidates - which is itself a finding about where research effort is needed.

  Limits: The review's own evidence base is thin by its own account. No PMC or Europe PMC open-access copy was found, so I cannot confirm independent of the publisher whether this article is open access; I read it on the publisher's full-text page, not an abstract.

  Read as: full text (publisher page, journals.sagepub.com)

  Written for this website from the paper, not the authors’ abstract.

• Where Are We Dying? Ethnic Differences in Place of Death Among New Zealanders Dying of Cancer (opens in a new tab)

  Summarised from the whole paperJCO Global Oncology· 2022· doi:10.1200/GO.22.00024

  Jason Kevin Gurney, James Stanley, Jonathan Koea, Jonathan Adler, June Atkinson, Diana Sarfati

  national retrospective cohort, 107,373 cancer deaths, 2007-2018, logistic regression adjusted for age, sex and deprivation

  Our summary of what it found

  Māori dying of cancer were much more likely to die in a private residence than Europeans (46% versus 26%), and correspondingly less likely to die in a hospice inpatient unit (14% versus 27%) or residential care (12% versus 30%); they were somewhat more likely to die in hospital (27% versus 23%). Pacific patients showed a similar pattern to Māori. Asian patients were notably more likely to die in hospital (34%) than Europeans. The authors say it is not possible from this data to tell how much of this reflects genuine preference for place of death versus unequal access to hospice and residential care.

  Why it matters: It puts a number on where the current pattern of end-of-life care access sits for Māori compared with other groups, without asserting a cause - useful for HAM as a factual basis for talking about hospice and residential-care access rather than assuming preference explains the gap.

  Limits: The DOI/link supplied was already correct and reachable; the authors flag that preference and access cannot be separated in this dataset, and call for further research into the difference.

  Read as: full text (PMC open-access copy, PMC9225597) - the link supplied (ascopubs.org, DOI 10.1200/GO.22.00024) is confirmed correct

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Cultural health literacy: the experiences of Māori in palliative care (opens in a new tab)

  Summarised from the abstract· 2018

  qualitative study: 21 patient/whānau interviews, 6 key informant interviews, focus groups with 54 health professionals

  Our summary of what it found

  This qualitative study, based on 2014 fieldwork, looked at health literacy in palliative care for Māori through individual interviews with 21 patients and whānau, six key informants, and focus groups with 54 health professionals. It found that the shock and grief after a life-limiting diagnosis made health information hard for patients and whānau to take in. Health professionals often avoided the harder conversations about moving from active treatment to palliative care, leaving patients and whānau distressed and unclear about their choices and prognosis. The authors conclude that poor cultural health literacy on the part of organisations has likely contributed to Māori accessing palliative care late, or not at all.

  Why it matters: It names organisational cultural health literacy, not just individual communication skill, as a factor in late or avoided access to palliative care for Māori.

  Limits: I read the abstract, not the full text. Findings are reported at the level of themes across participants; the abstract does not state that all participants' underlying illnesses were cancer specifically, though palliative care in this setting commonly involves cancer patients.

  Read as: abstract (verbatim, via Europe PMC; the SAGE Journals page itself only returned site navigation when fetched directly)

  Written for this website from the paper, not the authors’ abstract.

Cancer policy and system design

Crown cancer strategies and plans read against te Tiriti o Waitangi, descriptions of how the cancer system is organised, and arguments about how it should be built instead.

9 papers, 5 of them summarised from less than the whole paper.

• Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context (opens in a new tab)

  Summarised from the whole paper· 2024

  framework development and adaptation: scoping review of existing equity-focused implementation frameworks, interviews with 25 stakeholders and researchers, then iterative refinement with a Māori Advisory Group and a Consumer Advisory Group

  Our summary of what it found

  The authors adapted an existing implementation-science framework (EquIR) for the Aotearoa New Zealand context, producing a framework with Te Tiriti o Waitangi as its foundation, a whānau-centred focus, five core constructs (collaborative design, anti-racism, Māori and priority-population expertise, cultural safety, values-based practice), and a four-step implementation pathway: planning, pathway design, monitoring, and evaluation. It is intended for mainstream health services planning how to implement an intervention equitably.

  Why it matters: A generic implementation framework built for the Aotearoa context, rather than imported unchanged from overseas, gives services a structured way to plan how a cancer intervention or programme is rolled out so it does not simply replicate existing inequities.

  Limits: The paper states the framework has not yet been empirically tested or validated in real-world implementation, and that its evidence base draws mainly on Māori health inequities, which may limit how directly it transfers to other populations or settings.

  Read as: full text (via the open-access PMC mirror, PMC10822165, after the publisher's own page and a Springer login redirect both failed)

  Written for this website from the paper, not the authors’ abstract.

• Supporting implementation of interventions to address ethnicity-related health inequities: frameworks, facilitators and barriers – a scoping review protocol (opens in a new tab)

  Summarised from the whole paperBMJ Open· 2023· doi:10.1136/bmjopen-2022-065721

  Papillon Gustafson, Yasmin Abdul Aziz, Michelle Lambert, Karen Bartholomew, Rachel Brown, Peter Carswell, Adam Fusheini, Mihi Ratima, Patricia Priest, Sue Crengle

  study protocol only, no results; six-stage scoping-review method (Arksey and O'Malley, extended by Levac et al), MEDLINE and CINAHL plus grey literature, 2011 to search date

  Our summary of what it found

  This is a protocol, not a finished review. It sets out how the authors planned to search MEDLINE, CINAHL and grey literature from 2011 onward to map equity-focused implementation frameworks and the facilitators and barriers to using them, using a two-part research question. No results are reported here. The first part of that work - the frameworks themselves - was subsequently published as a completed review by an overlapping author group (Implementation Science, 2023, DOI 10.1186/s13012-023-01304-0), which states the second part, on facilitators and barriers, would be published separately.

  Why it matters: It shows the methodical groundwork behind identifying which implementation approaches actually help close ethnicity-related health gaps, rather than asserting one works.

  Limits: Protocol only - it reports methods, not findings, and results should be sought in the completed review(s) it led to, not in this document. Restricted to English-language sources and weighted toward New Zealand grey literature. I read the full protocol text via the PMC open-access copy.

  Read as: full text (PMC open-access copy) - protocol only, no results reported

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Te Aho o Te Kahu: weaving equity into national-level cancer control (opens in a new tab)

  Summarised from the abstractThe Lancet Oncology· 2022· doi:10.1016/S1470-2045(22)00279-0

  Michelle Mako, Jason Gurney, Moahia Goza, Myra Ruka, Nina Scott, Gary Thompson, Diana Sarfati

  commentary describing an agency's structure and programme, not an empirical study

  Our summary of what it found

  Written by staff of Te Aho o Te Kahu, the paper describes how the agency built equity into its core structure from the outset, rather than adding equity as a separate programme on top of standard operations. It uses Te Tiriti o Waitangi as the organising framework and sets out the equity-focused initiatives taken since the agency's founding, along with the challenges it says remain in reaching equitable cancer outcomes for Māori.

  Why it matters: It is a first-person account from inside the one agency responsible for national cancer control policy, so it shows how equity commitments were meant to be built into the system rather than only how they were experienced by patients.

  Limits: Only the abstract was available; the authors' own account of an agency they work for is not independent, and the abstract itself does not specify what evidence backs the equity claims - that sits in the unread full text.

  Read as: abstract only, via the Europe PMC record. The Lancet Oncology and ScienceDirect both returned 403 to direct fetch; Europe PMC lists this record as not open access and gives no PMC copy; the Otago repository holds only the citation, not the manuscript; ResearchGate offers the abstract with a request-full-text gate. No open-access full text could be found anywhere.

  Written for this website from the paper, not the authors’ abstract.

• Telehealth as a tool for equity, pros, cons and recommendations (opens in a new tab)

  Summarised from the whole paper· 2021

  viewpoint / commentary, no new data collected

  Our summary of what it found

  Written as the COVID-19 lockdown pushed much routine healthcare onto phone and video, this viewpoint sets out the case for and against telehealth as a tool for equity for Māori and Pacific people. It argues telehealth can reduce transport, time and cost barriers to care and widen the pool of clinical expertise available to remote or small communities. It also names the offsetting risk directly: care delivered this way depends on people having a phone, data and digital literacy, so without deliberate attention to equity, telehealth can widen rather than narrow access gaps, and not all care can safely move to phone or video. It recommends collecting connectivity data alongside standard health data, resourcing telehealth roles embedded in Māori and Pacific communities, funding more research led by Māori and Pacific researchers into telehealth experience, and building a telehealth strategy with Te Tiriti o Waitangi and equity as guiding principles.

  Why it matters: It sets out the equity trade-offs of telehealth at a point when many services, cancer follow-up appointments among them, moved quickly to phone and video, and argues telehealth needs an equity-first strategy or it risks widening rather than narrowing the access gap for Māori and Pacific people.

  Limits: This is a viewpoint from health researchers, not a study reporting new data of its own; it draws on modelled and survey evidence cited in its references. The authors declare no competing interests.

  Read as: Full text, read directly from the NZMJ PDF (all pages, including author declarations and references)

  Written for this website from the paper, not the authors’ abstract.

• A critical Tiriti Analysis of the New Zealand Cancer Control Strategy (opens in a new tab)

  Summarised from the whole paper· 2020

  Heather Came, Jacquie Kidd, Teresa Goza

  Critical Tiriti Analysis, a five phase policy analysis method applied against the preamble and articles of the Maori text

  Our summary of what it found

  The authors examined the Cancer Control Strategy against the preamble and the articles of the Maori text of te Tiriti. They found little tangible connection to te Tiriti or to other Maori health strategy documents. The document does not record how Maori were involved in its design, and no Maori individual or group is named in its acknowledgements. Across 23,000 words it uses the word wairua three times and wairuatanga not at all, and mentions rongoa once, listed among complementary and alternative medicines. They note that in 2015/16 only 1.86 per cent of Vote Health was invested with Maori providers. Their recommendation is that future cancer control strategies be built with te Tiriti and tikanga as the central considerations.

  Why it matters: It is a documented, methodical account of how a national cancer strategy failed its own founding obligations, and it was written to inform the strategy that replaced it.

  Limits: The authors state that the fifth phase of the method, a final assessment by Maori following Maori protocols, is to be presented in a later paper.

  Read as: full text, supplied by Brooke from the publisher page (complimentary access)

  Written for this website from the paper, not the authors’ abstract.

• A critical te Tiriti analysis of the New Zealand cancer action plan 2019–2029 (opens in a new tab)

  Summarised from the abstractJournal of Cancer Policy, vol 26, article 100252 (published December 2020)· 2020· doi:10.1016/j.jcpo.2020.100252

  Heather Came, Jacquie Kidd

  Critical te Tiriti Analysis - a five-phase qualitative policy-assessment framework - applied to one Crown policy document

  Our summary of what it found

  Applies the Critical te Tiriti Analysis framework to the New Zealand Cancer Action Plan 2019-2029. The authors score the Plan 'fair' - level 2 of 4 - on te Tiriti compliance, an improvement on the 2003 Cancer Control Strategy but still lacking detail on mātauranga Māori, kaupapa Māori approaches and Māori public health. They argue that lack of specificity makes it hard to hold the Crown to account for delivery against the Plan.

  Why it matters: Gives Hei Āhuru Mōwai a citable, methodical, independent assessment of the Crown's ten-year cancer plan to draw on when pressing for more specific te Tiriti commitments.

  Limits: Read the published abstract only, via Semantic Scholar's indexed record of the publisher's abstract - not the full article. The full text, including the detailed five-phase scoring and reference list, was not reached: ScienceDirect returns a 403, and no open-access copy was found at Europe PMC, AUT's institutional repository, or Community Research's own tracking page for Critical Tiriti Analysis outputs (which lists this one as paywalled).

  Read as: abstract (indexed via Semantic Scholar's API record of the publisher's listed abstract); full text not reached

  Written for this website from the paper, not the authors’ abstract.

• Addressing cancer inequities for indigenous populations. The New Zealand story (opens in a new tab)

  Summarised from the abstract· 2020

  Jason K. Gurney, Shelley Campbell, Stephanie Turner, Nina Scott

  commentary written by four Maori researchers, cancer care providers and patient advocates

  Our summary of what it found

  Maori have higher cancer incidence, higher mortality and poorer survival than non-Maori. On 2002 to 2006 figures the age and sex standardised incidence rate was 220 per 100,000 for Maori against 185 for non-Maori, and mortality 112 against 63, so Maori were around 20 per cent more likely to get cancer and around 80 per cent more likely to die of it. The authors trace the drivers to poorer access to timely diagnosis, less timely treatment and differences in the quality of care received, and upstream of those to colonisation and institutional racism. They also name parts of the system that are working: sustained effort to lift Maori participation in screening has produced survival gains, and child cancer services are achieving survival parity for Maori children.

  Why it matters: It is the reference statement of the problem, written by Maori practitioners rather than about them, and it is unusual in naming what is already working as well as what is not.

  Limits: A commentary rather than a new analysis, and the headline incidence and mortality figures come from a 2002 to 2006 study, so they describe that period rather than the present.

  Read as: abstract, highlights and section openings, supplied by Brooke from the publisher page; the full text is behind a paywall

  Written for this website from the paper, not the authors’ abstract.

• Health service provider responses to indigenous peoples with cancer: An integrative review (opens in a new tab)

  Summarised from the abstract· 2018

  integrative review of 9 studies

  Our summary of what it found

  This integrative review searched for published studies on how health services respond to indigenous people with cancer. It found only nine such studies, most from the United States. Where services built culturally appropriate activities, resources and environments around the indigenous population they served, the review found increases in cancer knowledge, fewer treatment interruptions, better access to cancer care and clinical trial enrolment, and higher satisfaction with care. The authors flag the small number of published studies as itself worth asking about.

  Why it matters: It is evidence that culturally focused service delivery changes measurable outcomes for indigenous cancer patients, and a reminder that this evidence base is thin worldwide.

  Limits: I read the abstract, not the full text, so I cannot confirm whether any of the nine included studies were set in Aotearoa or involved Māori. The authors themselves note how few eligible studies they found.

  Read as: abstract (verbatim, via Europe PMC; Wiley Online Library itself blocked automated access with a cookie-consent page)

  Written for this website from the paper, not the authors’ abstract.

• Viewpoint. Equity by 2030. Achieving equity in survival for Māori cancer patients (opens in a new tab)

  Summarised from the abstract

  viewpoint/commentary, no original dataset

  Our summary of what it found

  A viewpoint proposing a goal of equal cancer survival between Māori and non-Māori by 2030, put forward after a panel of Māori cancer leaders reviewed the history of cancer control and its effect on Māori. It states Māori are around twice as likely to die of their cancer as non-Māori, and argues this gap comes mainly from failures in the health system rather than from differences in the disease itself. It calls for better stage-at-diagnosis data, improved primary care access, wider screening, more consistent treatment, and resourcing weighted toward closing the gap.

  Why it matters: It set a named target and timeframe that the later survival and stage-at-diagnosis papers on this list can be read against.

  Limits: A viewpoint piece rather than original research. The authors themselves note no single intervention will be enough, and that prevention measures will not shift survival for people already diagnosed.

  Read as: abstract/summary, via the NZMJ journal page

  Written for this website from the paper, not the authors’ abstract.

Data, research governance and workforce

Ethnicity data quality, the governance of genomic and biobank research with Māori, and the training and research capacity of the people the cancer system runs on.

8 papers, 5 of them summarised from less than the whole paper.

• What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Māori public health competencies (opens in a new tab)

  Summarised from the abstractAustralian and New Zealand Journal of Public Health· 2024· doi:10.1016/j.anzjph.2024.100132

  Veenstra N, Kewene F, Morgaine K, Crengle S

  kaupapa Māori competency-development study, four stages including consultation hui and respondent validation; participant/hui numbers not stated in the abstract

  Our summary of what it found

  This is not a clinical outcomes study but an account of developing a set of Māori public health competencies through a four-stage kaupapa Māori process, including consultation hui and respondent validation. Key themes from participants were the importance of te reo Māori proficiency, strength-based approaches, self-determination, and individual practitioner responsibility for addressing structural racism, with reflective practice identified as a competency running across all the others. Participants also wanted planetary health and political context added as social determinants of health. The resulting competency document has been published under a Creative Commons licence for use in universities and workplaces.

  Why it matters: It is a workforce-training resource rather than a cancer-outcomes study, of most use to Hei Āhuru Mōwai if it is assessing or building training for people working with Māori across the cancer system, not only clinicians.

  Limits: Seen only as an abstract, via Europe PMC and PubMed. Europe PMC lists it as subscription-required with no open-access copy, and none was found on the University of Otago repository either. The abstract does not give hui or participant numbers, so none are reported here.

  Read as: abstract only – confirmed subscription-required at publisher via Europe PMC; no open-access copy found on Europe PMC, PubMed Central or the University of Otago OUR Archive

  Written for this website from the paper, not the authors’ abstract.

• Challenging structural racism through the development of equity-driven core Māori hauora ā iwi/public health competencies for university hauora ā iwi/public health teaching (opens in a new tab)

  Summarised from the abstractHigher Education Research & Development· 2023· doi:10.1080/07294360.2023.2246404

  Kewene F, Morgaine K, Colhoun S, Crengle S

  development paper, kaupapa Māori four-stage process (literature scoping, drafting, consultation hui, respondent validation); not a quantitative study

  Our summary of what it found

  The paper reports how a set of core Māori hauora ā iwi/public health competencies was developed for use in university teaching, built through a kaupapa Māori process of literature review, drafting and consultation hui, intended to give both Māori and non-Māori academics a shared framework for anti-racist, equity-focused curricula. It does not report cancer-specific data; its subject is public health workforce education generally.

  Why it matters: It bears on the pipeline of people trained to work in hauora ā iwi/public health, including cancer-related roles, rather than on cancer outcomes directly.

  Limits: I read the abstract only, via Crossref and Semantic Scholar metadata; the Taylor & Francis publisher page returned a 403 and I found no PubMed, PMC, Europe PMC, or institutional-repository copy of the full text.

  Read as: abstract, read via Semantic Scholar/Crossref metadata; publisher page returned 403; no PMC, Europe PMC, PubMed indexing, or repository copy found

  Written for this website from the paper, not the authors’ abstract.

• Creating an environment to inform, build, and sustain a Māori health research workforce (opens in a new tab)

  Summarised from the whole paperJournal of the Royal Society of New Zealand· 2023· doi:10.1080/03036758.2023.2235303

  Nikki M. Barrett, Reigna Morgan, Jade Tamatea, Amy Jones, Polly Atatoa Carr, Ross Lawrenson, Nina Scott

  Kaupapa Māori mixed-methods study: survey of Māori staff at Waikato District Health Board (168 of 842 invited, a 17% response rate) plus 10 follow-up interviews

  Our summary of what it found

  A survey of Māori staff at Waikato District Health Board found only 14% had ever taken part in research, though 40% of those with no prior involvement wanted to, and three-quarters wanted training in Māori health research skills. Ten follow-up interviews traced the gap to a lack of information about how to start a project, unclear institutional processes, and no dedicated time or funding. Staff framed research as mattering because it served whānau and community, not career advancement. The authors call for a named Māori research support team, training, and clearer internal pathways.

  Why it matters: It sets out, with numbers from one DHB, the concrete barriers - process, time, funding - that stand between Māori health staff and the research capacity a cancer-equity system depends on.

  Limits: Self-selected sample with a 17% response rate at a single DHB; cross-sectional and not specific to cancer research. I read the full text via the PMC open-access copy.

  Read as: full text (PMC open-access copy)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Mapping a route to Indigenous engagement in cancer genomic research (opens in a new tab)

  Summarised from the abstract· 2019

  Personal View / roadmap paper, not an empirical study with results

  Our summary of what it found

  This Personal View sets out a roadmap for properly involving Māori in cancer genomic research, built around a neuroendocrine tumour genomics research programme in Aotearoa New Zealand. It proposes ongoing dialogue, Māori leadership in the research, reciprocity, agreed kawa and tikanga, and honest monitoring of what the roadmap does and does not achieve. The authors ask cancer researchers elsewhere to build their own locally appropriate roadmaps rather than adopt this one directly.

  Why it matters: It is a documented, named example of what Māori involvement in a cancer genomics research programme has looked like, which other genomic cancer studies could be measured against.

  Limits: I read the abstract, not the full text. It is a position and process paper rather than a study reporting outcomes, so there are no measured results to report beyond the roadmap itself.

  Read as: abstract (verbatim, via a Europe PMC record matched to the article's DOI; the Lancet Oncology page itself returned a 403 error when I tried to fetch it directly)

  Written for this website from the paper, not the authors’ abstract.

• New Zealand's revised Ethnicity Data Protocols must not become a shelved document: a challenge from Hei Āhuru Mōwai (opens in a new tab)

  Summarised from the whole paperNew Zealand Medical Journal· 2018

  Hei Āhuru Mōwai – National Māori Cancer Leadership Group (corresponding author Jason K Gurney; co-authors Nina Scott, Gary Thompson, Stephanie Turner, Jo Anson, Melissa Cragg, Joanne Doherty, Madeleine Wall, George Laking, Terina Moke, Rawiri Blundell, Pania Coote)

  opinion/position letter, not empirical research

  Our summary of what it found

  Published under Hei Āhuru Mōwai's own name, the letter sets out what changed when the Ministry of Health revised its Ethnicity Data Protocols in September 2017: ethnicity must be self-identified rather than inferred, there is to be no forced single 'principal' ethnicity, at least six affiliations must be stored, an 'Other' option sits alongside the 2013 Census categories, classification must reach the most detailed (Level 4) standard, and ethnicity data must be re-collected at least every three years. It states that Māori are 20% more likely than non-Māori to get cancer but 80% more likely to die of it, citing this as the reason good ethnicity data matters for measuring and closing cancer inequities. It closes with two challenges: to the Ministry, to see the protocols actually implemented across DHBs rather than left on a shelf, and to the wider health sector, to commit to collecting ethnicity data accurately and often.

  Why it matters: A citable primary source for Hei Āhuru Mōwai's own published advocacy on ethnicity-data quality, now correctly pointed at its live host rather than the dead nzma.org.nz domain or an inaccessible personal drive link.

  Limits: An opinion/position letter with no new study data of its own — its statistics on Māori cancer incidence and mortality are drawn from two cited Ministry of Health/University of Otago reports (Robson et al 2010; Soeberg et al 2012), which this assessment has not separately verified.

  Read as: full text (PDF served from nzmj.org.nz, the journal's current host — confirmed the old nzma.org.nz host is dead and that URL was never used). No DOI is assigned to this letter; none is shown on the publisher page or in the PDF.

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Te Mata Ira: Guidelines for Genomic Research with Māori (opens in a new tab)

  Summarised from part of the paper· 2016

  Guidelines document built from a 2012-2015 Health Research Council-funded project (grant 12/470) that gathered views from whānau, hapū, iwi, Māori health workers, Māori and non-Māori researchers, social and biomedical scientists, and biobank managers.

  Our summary of what it found

  This is a guidelines and framework document, not a study report. It builds on the earlier Te Ara Tika guidelines and sets out four ethical principles for genomic and biobank research with Māori: whakapapa, mana, tika and manaakitanga (the document's own glosses in parentheses: 'genealogy', 'power, control', 'right, correct', and 'to look after, care for'). It maps these onto three research stages -- Consultation, Research, Transformation -- and describes a cultural foundation covering whakapapa, taonga (the document glosses this as 'something precious or significant'), tapu and tākoha as they apply to human tissue, DNA and genomic data. A key-themes table records separate concerns raised by Māori generally (protection of rights and interests, control over samples and data, expectations of consultation and consent) and by iwi specifically (loss of control over tissue over time, expectation of iwi governance over projects, and the importance of ongoing communication about progress and outcomes). Input came from several named iwi: Ngāti Hine, Ngāti Porou, Ngāti Rakaipaaka, Southern Runaka o Ngāi Tahu, and Ngāti Whātua ki Ōrākei.

  Why it matters: For a research overview on the Hei Āhuru Mōwai site, this is the standing framework for how genomic and biobank research involving Māori participants -- including any cancer genomics -- is expected to be governed and consented in Aotearoa, rather than a finding about cancer itself.

  Limits: I read only the first fifth or so of the document. Sections 2 (full framework detail), 3 (guidance tables on engagement, methods and benefit-sharing) and 4 (incidental findings, data rights, data linkage) were not read, so this entry does not cover their content. The document itself states it should be read alongside the earlier Te Ara Tika guidelines, which I have not reviewed.

  Read as: Full text, partial. The OneDrive link redirected to a Microsoft share page WebFetch could not render, so I located the same document via the publisher (University of Waikato) and read it directly: cover, contents, introduction, purpose, background, and the opening of Section 1 'Cultural Foundation' (roughly pages 1-9 of about 48). I did not read Sections 2-4 in full (framework detail, guidance tables, special ethical considerations) or the glossaries.

  Written for this website from the paper, not the authors’ abstract.

• Indigenous Cancer Research: Reflections on Roles and Responsibilities (opens in a new tab)

  Summarised from the whole paper

  commentary/viewpoint, not original research

  Our summary of what it found

  A reflective commentary on what non-Indigenous researchers owe Indigenous communities when doing cancer research. It argues most health researchers are non-Indigenous while most health research affects Indigenous peoples, and that research done without Indigenous governance, partnership and cultural safety can cause real harm. It sets out principles including shared decision-making, redistributing power to Indigenous researchers, and approaching the work with humility rather than as an outside expert. The authors state directly that the piece is a reflection, not a comprehensive best-practice guide.

  Why it matters: It speaks to how HĀMō and any partner researchers structure a study relationship, rather than to any clinical or survival finding.

  Limits: The authors state the piece does not attempt an in-depth analysis or a comprehensive best-practice summary; it is offered to prompt further discussion, not as settled guidance.

  Read as: full text, via the PMC copy (PMC6998022)

  Written for this website from the paper, not the authors’ abstract.

• Stage at diagnosis for Māori cancer patients, disparities, similarities and data limitations (opens in a new tab)

  Summarised from the abstract

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: abstract, via the NZMJ journal page

  Written for this website from the paper, not the authors’ abstract.

Prevention and co-occurring conditions

Smoking cessation, the infections behind liver and stomach cancer, and what it means when diabetes and cancer occur in the same person.

5 papers.

• Does diabetes affect breast cancer survival? (opens in a new tab)

  Summarised from the whole paperCancer Reports· 2024· doi:10.1002/cnr2.2040

  Lawrenson R, Lao C, Stanley J, Teng A, Kuper-Hommel M, Campbell I, Krebs J, Sika-Paotonu D, Koea J, Meredith I, Gurney J

  retrospective population-based cohort, 26,968 women with invasive breast cancer, 2005-2020, from Te Rēhita Mate Ūtaetae (the Breast Cancer Foundation National Register) linked to the Virtual Diabetes Register, hospital and mortality data

  Our summary of what it found

  3,137 of the 26,968 women (11.6%) had diabetes at diagnosis. Unadjusted survival was lower with diabetes present (5-year cancer-specific survival 87% versus 89%; 10-year 79% versus 84%), but once the analysis adjusted for age, tumour characteristics and treatment, diabetes was not associated with worse breast-cancer-specific survival (adjusted hazard ratio 0.99, 95% CI 0.89-1.11). Adjusted hazard ratios for Māori and Pacific women with diabetes were 1.01 and 0.88; for Asian women with diabetes, 0.67.

  Why it matters: The raw survival gap by diabetes status looks meaningful but mostly reflects other factors already captured in stage and treatment, which matters for how this comparison gets used in any resource discussing comorbidity and outcomes.

  Limits: The authors note the register does not distinguish diabetes type or give a diagnosis date, and had no data on BMI, smoking, alcohol or diet, so residual confounding is possible. Competing mortality risk in the diabetes group is also flagged. I read the full text via PMC.

  Read as: full text (PMC10953831, open access)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Effectiveness of nicotine salt vapes, cytisine, and a combination of these products, for smoking cessation in New Zealand: protocol for a three-arm, pragmatic, community-based randomised controlled trial (opens in a new tab)

  Summarised from the whole paper· 2023

  protocol for a single-blind, pragmatic, three-arm randomised controlled trial, target N=800, allocated 3:3:2

  Our summary of what it found

  This is a trial protocol, not yet a results paper. It sets out a plan to compare nicotine-salt vapes plus cytisine against either product alone for smoking cessation, in daily smokers aged 18 and over who want to quit within two weeks. All three arms also get six months of text-message-based behavioural support. The primary outcome will be continuous abstinence at six months, verified by carbon monoxide testing.

  Why it matters: Smoking is the largest single driver of preventable cancer, and the protocol specifically targets Māori and Pacific participants through stratified randomisation and targeted promotion, citing prior New Zealand cytisine research that showed benefit specifically for Māori smokers.

  Limits: As a protocol, there are no effectiveness results yet to report. The authors themselves note budget constraints meant no 12-month follow-up for all participants, no text-only control arm, no cluster-randomised design, and no ecological momentary assessment.

  Read as: full text (via the open-access PMC mirror, PMC10494376, after the publisher's own page and a Springer login redirect both failed)

  Written for this website from the paper, not the authors’ abstract.

• Equity of Cancer and Diabetes Co-Occurrence: A National Study With 44 Million Person-Years of Follow-Up (opens in a new tab)

  Summarised from the whole paperJCO Global Oncology· 2023· doi:10.1200/GO.22.00357

  Jason Gurney, James Stanley, Andrea Teng, Bridget Robson, Nina Scott, Dianne Sika-Paotonu, Chunhuan Lao, Ross Lawrenson, Jeremy Krebs, Jonathan Koea

  retrospective national cohort using linked administrative data, close to 5 million people, 44 million person-years, 2008-2018

  Our summary of what it found

  Linking national health records for close to five million people over 44 million person-years, the study found people with diabetes had higher cancer rates than people without it, in every ethnic group, with Māori carrying both the highest age-standardised rate (1,303.6 per 100,000 person-years) and the highest rate ratio (1.37, against 1.23-1.35 for the other groups measured). Uterine, pancreatic, kidney and liver cancers showed the strongest links to diabetes across all groups. It is a descriptive study: it establishes the size of the co-occurring burden by ethnicity, not why the gap exists.

  Why it matters: It gives a population-level size and shape to the diabetes-cancer overlap Māori carry disproportionately, which matters for anyone planning screening or comorbidity care.

  Limits: Descriptive/observational - no causal claim is made or should be drawn. There is a related but distinct 2022 PLOS ONE paper by an overlapping author group with a very similar title ("Cancer and diabetes co-occurrence: A national study with 44 million person-years of follow-up", DOI 10.1371/journal.pone.0276913) - worth not conflating the two. I read the full text via the PMC open-access copy.

  Read as: full text (PMC open-access copy)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• The past, present and future of liver cancer control for Māori (opens in a new tab)

  Summarised from the whole paperNew Zealand Medical Journal· 2022· doi:10.26635/6965.5852

  Sydney Clough, Tara Cleverley, Clarence Kerrison, Matire Harwood, Jonathan Koea, Jason K Gurney

  narrative literature review (viewpoint), no new primary data

  Our summary of what it found

  The paper reviews why liver cancer hits Māori harder: it is one of the top five causes of Māori cancer death, and incidence keeps rising for Māori while staying flat for non-Māori. It traces this to hepatitis B and C, which drive about 80% of hepatocellular carcinoma, and to gaps in New Zealand's response - as of 2018 an estimated 333,906 Māori over 30 remained unvaccinated for hepatitis B, and only 19% of people with hepatitis B nationally were enrolled in monitoring by late 2019. The authors call for a nationally coordinated primary-care programme to detect and treat hepatitis B and C and screen high-risk patients, run with Māori-led vaccination and engagement rather than a one-size-fits-all approach.

  Why it matters: It sets out a specific, actionable gap - the absence of coordinated national hepatitis screening and surveillance - as the main lever behind Māori liver cancer outcomes, rather than treating the disparity as unexplained.

  Limits: A narrative rather than systematic review, so it summarises prior published figures (some, like the 2018 vaccination count, are now several years old) rather than presenting new analysis; full text read in full.

  Read as: full text (PDF read in full, via nzmj.org.nz)

  Written for this website from the paper, not the authors’ abstract.

  A copy that can be read free (opens in a new tab)

• Ethnic Inequity in the Current Approach to H. pylori Testing and Treatment: Linked Data Cohort Analysis (opens in a new tab)

  Summarised from the whole paper

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: Full text via PMC mirror (PMC11718595)

  Written for this website from the paper, not the authors’ abstract.

Services through COVID-19

What happened to diagnosis and treatment volumes through 2020, and the shift to phone and video appointments that came with it.

3 papers.

• Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience (opens in a new tab)

  Summarised from the whole paper· 2021

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

  Our summary of 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.

  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.

  Limits: 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.

  Read as: Full text via PMC (thelancet.com itself returned a 403 error)

  Written for this website from the paper, not the authors’ abstract.

• The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination (opens in a new tab)

  Summarised from the whole paper· 2021

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

  Our summary of 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.

  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.

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

  Read as: Full text via PMC (thelancet.com itself returned a 403 error)

  Written for this website from the paper, not the authors’ abstract.

• Telehealth as a tool for equity, pros, cons and recommendations (opens in a new tab)

  Summarised from the whole paper· 2021

  viewpoint / commentary, no new data collected

  Our summary of what it found

  Written as the COVID-19 lockdown pushed much routine healthcare onto phone and video, this viewpoint sets out the case for and against telehealth as a tool for equity for Māori and Pacific people. It argues telehealth can reduce transport, time and cost barriers to care and widen the pool of clinical expertise available to remote or small communities. It also names the offsetting risk directly: care delivered this way depends on people having a phone, data and digital literacy, so without deliberate attention to equity, telehealth can widen rather than narrow access gaps, and not all care can safely move to phone or video. It recommends collecting connectivity data alongside standard health data, resourcing telehealth roles embedded in Māori and Pacific communities, funding more research led by Māori and Pacific researchers into telehealth experience, and building a telehealth strategy with Te Tiriti o Waitangi and equity as guiding principles.

  Why it matters: It sets out the equity trade-offs of telehealth at a point when many services, cancer follow-up appointments among them, moved quickly to phone and video, and argues telehealth needs an equity-first strategy or it risks widening rather than narrowing the access gap for Māori and Pacific people.

  Limits: This is a viewpoint from health researchers, not a study reporting new data of its own; it draws on modelled and survey evidence cited in its references. The authors declare no competing interests.

  Read as: Full text, read directly from the NZMJ PDF (all pages, including author declarations and references)

  Written for this website from the paper, not the authors’ abstract.