Systemic anti-cancer treatment for Māori with stage III and IV non-small cell lung cancer in Aotearoa New Zealand.

Abstract

Aims: We aimed to assess the frequency of systemic anti-cancer therapy (SACT) use in patients with advanced non-small cell lung cancer (NSCLC), comparing Māori and non-Māori. Secondary aims were to assess predictive factors for patients managed with SACT, SACT agent regimens and lung cancer-specific mortality.

Methods: A retrospective cohort study of patients with incident advanced NSCLC in the Aotearoa New Zealand Midland Region between 1 January 2011 to 31 December 2021 was undertaken. Data were primarily derived from the Midland Lung Cancer Registry.

Results: The study cohort comprised 2,549 patients with incident advanced NSCLC. A total of 775 patients were Māori (30%). SACT was received by 942 patients (37%). There was no difference in overall SACT rate between Māori and non-Māori: adjusted odds ratio (OR) 0.88 (95% confidence interval [CI] 0.71-1.09), p-value >0.05. For patients who received SACT, Māori were less likely to receive targeted therapy first-line (8.5% vs 16.1%, p-value <0.01). Māori had higher cancer-specific mortality: adjusted OR 1.19 (95% CI 1.08-1.32), p-value <0.001.

Conclusion: In this pre-funded immunotherapy era, no difference was observed in overall SACT rate for Māori patients with advanced NSCLC. Māori were less likely to receive targeted therapy first-line, for which the underlying reasons require investigation. Our data suggest other factors, beyond overall SACT use rate, influence the higher cancer-specific mortality in Māori.