One of the challenges facing the New Zealand health system is how to maintain equitable access to a high-performing health system and eliminate existing health inequalities. The C3 project aimed to address the role of comorbidity and possible unequal treatment in secondary/tertiary care services among Māori with cancer.
Our approach was highly collaborative (actively involving Māori and non-Māori, clinicians, community workers, central and regional health policy and health service delivery professionals) and multidisciplinary. Our focus was on research that informs action with the view to improve equity and quality of care in secondary/tertiary services for Māori cancer patients.
Aims of the C3 Quantitative study
- Optimise the measurement of comorbidity in the context of Māori patients with cancer;
- Describe the epidemiology of comorbidity among Māori and non-Māori cancer patients in New Zealand including patterns by cancer site, deprivation and region/ rurality;
- Establish the associations of each of ethnicity and comorbidity, with completeness and timing of cancer treatments and survival, adjusted for confounding socio-demographics, and stratified by cancer type;
- Determine how ethnicity and comorbidity interact in their association with cancer treatment and survival;
- Determine how much of the association of ethnicity with cancer survival is mediated by comorbidities, and explore the extent to which this mediation is due to the impact of comorbidity on the timing and completeness of treatment;
- Attempt to model what impact there might be upon survival, if all patients received 'best practice' treatment given comorbidities; and
- Develop and consider feasibility of interventions based on the findings of the two C3 studies, and on review of relevant sources aimed at improving the adequacy and effectiveness of services for Māori cancer patients with comorbidity.
Presentations
C3 (Quantitative) Study Symposium
In April 2014, the Cancer Control and Screening Research Group convened a final symposium for the C3 (Quantitative) study. The purpose of this symposium was to share the findings of the C3 (Quantitative) study, update progress on the C3 (Qualitative) study, and engage with stakeholders in a discussion about interventions that could result from our work. The presentations and PDF of the slides are outlined below.
Cancer, Care and Comorbidity
Associate Professor Diana Sarfati presents background information about the intersection between cancer and comorbidity, and summarises the purpose and methods of the 'C3' group of studies. She then discusses the measurement of comorbidity in cancer populations.
Presentation - Cancer, Care and Comorbidity (PDF)
C3 (Quantitative) study: Key Findings from the Routinely-Collected Data
Dr Jason Gurney presents the key findings from the routinely-collected data component of the C3 (Quantitative) study.
Presentation - What were the key findings from the routinely-collected data? (PDF)
C3 (Quantitative) study: Key Findings from the Notes Review Data
Associate Professor Diana Sarfati, Dr Ruth Cunningham and Virginia Signal present the key findings from the rectal, liver and stomach cancer notes review data respectively.
Presentation - Ethnic inequities in rectal, liver and stomach cancer patient pathways (PDF)
C3 (Qualitative) study: Update on Progress
Associate Professor Louise Signal updates progress on the C3 (Qualitative) study.
Presentation - Update on Progress (PDF)
Self-Management Support in the Secondary Care Setting
Inga O'Brien discusses the usefulness of self-management support in the cancer setting, and presents some of her current PhD work in this area.
Presentation - Self-Management Support in the Secondary Care Setting (PDF)
C3 studies: Where to from here?
Associate Professor Diana Sarfati sums-up the symposium with a summary of the day's presentations, plus a brief discussion about future directions.