Maori are more likely to be diagnosed with cancer, and once diagnosed are more likely to die from cancer. One of the challenges facing clinicians and health services is how to identify, reduce or even eliminate such inequities in cancer-related outcomes. Our work in this area was the first to identify reasons for stark and consistent disparities in cancer survival between Māori and non-Māori. It has had a substantial impact on policy and practice in NZ. Continuing work in this area focuses on specific cancer types including stomach, rectal and liver cancers.
Kei te nui ake te tinga tērā ka kitea te mate pukupuku i te tangata Māori, ā, ina kitea, kei te nui ake te tinga ka mate rātau i te mate pukupuku. Ko tētahi o ngā wero mō ngā kaimahi haumanu me ngā ratonga hauora, ko te rapu me pēhea e tautohu ai, e whakaiti ai, e aukati atu ai i ngā ōritenga kore i ngā tatauranga nei mō te mate pukupuku. Ko tā mātau mahi te kaupapa tuatahi i tautohu i ngā pūtake o ngā tino ōritenga kore e mau roa nei, arā mō te ora i te mate pukupuku ki waenga i a Ngāi Māori me tauiwi. Kua tino whai take tēnei mahi ki ngā kaupapahere me ngā mahi haumaru i Aotearoa. Kei te haere tonu ngā mahi e hāngai ana ki ngā momo mate pukupuku, arā mō te puku, mō te kumu, mō te ate hoki.
Key activities
- We are conducting (and have conducted) multiple research projects focussing on describing poor cancer outcomes for Māori, understanding their drivers, and then advocating for change. Our projects are detailed further below.
- Members of our C3 team are members of multiple boards and working groups who are directly involved in driving policy change, including:
- Hei Āhuru Mōwai (National Māori Cancer Leadership Group)
- Multiple Te Aho o Te Kahu – Cancer Control Agency committees and working groups
- Cancer Society of New Zealand (both Auckland/Northland and Wellington boards)
- We continue to publish extensively in the area of cancer outcomes for Māori (see Key publications below).
Projects
- Improving the quantity and quality of life for Māori with cancer
- C3 Qualitative Study: Cancer care journeys and clinical decision-making
- C3 Quantitative Study: Effect of comorbidity on care and cancer survival inequalities
- Stomach cancer inequalities and interventions (Virginia Signal)
- The contribution of Helicobacter pylori, smoking, salt and low fruit and vegetable intake to stomach cancer and inequality in New Zealand (Andrea Teng)
- Colon cancer survival in New Zealand
- Trends and inequalities in cancer survival in New Zealand (Matt Soeberg)
Related projects
Key publications
Book chapters
Dew, K., Cunningham, C., Davies, C., Tavite, H., Stairmand, J., Sarfati, D. & Signal, L. (2017) Maori centred research and ethnomethodology: Cancer inequities and research by and for indigenous peoples. SAGE Research Methods Cases. Sage: London.
Journal articles
Gurney, J., Stanley, J, Adler, J., McLeod, H., Atkinson, J., Sarfati, D. (2021). National study of pain medicine access among Māori and non-Māori lung cancer patients in New Zealand. JCO Global Oncology, 7, p1276–1285.
Davies, A., Diaz, A., Garvey, G., Gurney, J., Segelov, E. (2021). Cancer care disparities among Australian and New Zealand First Nations Peoples. Current Opinion in Supportive and Palliative Care, 15(3), p162-168.
Gurney, J., Robson, B., Scott, N., Fraser, L., Ikihele, A., Manderson, J. (2021). Telehealth as a tool for equity: pros, cons and recommendations. New Zealand Medical Journal, 134(1530).
Gurney, J., Robson, B., Koea, J., Scott, N., Stanley, J., Sarfati, D. (2020). The most commonly-diagnosed and most common causes of cancer death for Māori New Zealanders. New Zealand Medical Journal, 133, p77-96.
Gurney, J., Stanley, J., McLeod, M., Koea, J., Jackson, C., Sarfati, D. (2020). Disparities in cancer-specific survival between Māori and non-Māori New Zealanders, 2007-2016. JCO Global Oncology, 6, p 6:766-774.
Gurney, J., Stanley, J., Jackson, C., Sarfati, D. (2020). Stage at diagnosis for Māori cancer patients: disparities, similarities and data limitations. New Zealand Medical Journal, 133(1508), p43-64.
Gurney, J., Campbell, S., Turner, S., Scott, N. (2020). Addressing cancer inequities for indigenous populations: the New Zealand story. Journal of Cancer Policy, 23 (100204), p1-6.
Dew K, Barton J, Stairmand J, Sarfati D, Signal L. Ascertaining patients' understandings: Dealing with contradictory norms in cancer specialist consultations. Health Sociology Review, 15(3), p162–168.
Lawrenson R, Lao C, Jacobson G, Seneviratne S, Scott N, Sarfati D, Elwood M, Campbell. Outcomes in different ethnic groups of New Zealand patients with screen detected vs. non-screen-detected breast cancer. J Med Screening 2019 DOI: 10.1177/0969141319844801.
Sharples K, Firth M, Hinder V, Hill A, Jeffery M, Sarfati D, Brown C, Atmore C, Lawrenson R, Reid P, Derrett S, Macapagel J, Keating J, Secker A, De Groot C, Jackson C, Findlay M. The New Zealand PIPER Project: Colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation – results from a retrospective cohort study. NZ Medical Journal 2018;131(1476):24-39.
McLeod M, Kvizhinadze G, Boyd M, Barendregt J, Sarfati D, Wilson N, Blakely T. Colorectal cancer screening: Variation in health gain and cost-effectiveness by ethnic group, and the optimal age-range to screen. Cancer Epidemiology, Biomarkers & Prevention 2017;pii:cebp.0150.2017
Lawrenson R, Lao C, Campbell I, Harvey V, Seneviratne S, Elwood M, Sarfati D, Kuper-Hommel M. Treatment and survival disparities by ethnicity in New Zealand women with stage I-III breast cancer tumour subtypes. Cancer Causes Control 2017; DOI 10.1007/s10552-017-0969-9
Tin Tin S; Elwood JM; Brown C; Sarfati D; Campbell I; Scott N; Ramsaroop R; Seneviratne S; Harvey V; Lawrenson R. Ethnic disparities in breast cancer survival in New Zealand: Which factors contribute? BMC Cancer 2018 doi: 10.1186/s12885-017-3797-0
Teng A, Blakely T, Baker M, Sarfati D. The contribution of Helicobacter pylori to excess gastric cancer in Indigenous and Pacific men: a birth cohort estimate. Gastric Cancer 2016; DOI 10.1007/s10120-016-0671-8.
Teng AM, Atkinson J, Disney G, Wilson N, Sarfati D, McLeod M, Blakely T. Ethnic Inequalities in Cancer Incidence and Mortality: Census-Linked Cohort Studies with 87 Million Years of Person-Time Follow-Up. BMC Cancer 2016;16:755. DOI: 10.1186/s12885-016-2781-4.
Gurney J, Stanley J, Shaw C, Sarfati D. Ethnic patterns of hypospadias in New Zealand do not resemble those observed for cryptorchidism and testicular cancer: evidence of differential aetiology? Andrology 2016; 4: 82-86.
Soeberg M, Blakely T, Sarfati D. Trends in ethnic and socioeconomic inequalities in cancer survival, New Zealand, 1991-2004. Cancer Epidemiology 39.6 (2015): 860-862.
Sarfati D, Robson B. Equitable cancer control requires better data on indigenous peoples (invited commentary). Lancet Oncology 2015; 16:1442-4.
Dew K, Signal L, Davies C,Tavite H, Hooper C, Sarfati D, Stairmand J, Cunningham C. Dissonant roles: The experience of Māori in cancer care. Social Science and Medicine 2015; 138: 144-51.
Gurney J, Sarfati D, Stanley J. Obscure aetiology, unusual disparity: the epidemiology of testicular cancer in New Zealand. Cancer Causes Control 2015; 26(4) 561-69.
McDonald A, Sarfati D, Baker M, Blakely T. Trends in Helicobacter pylori infection among Māori, Pacific and European birth cohorts in New Zealand. Helicobacter 2015; 20(2): 139-45.
Signal V, Sarfati D, Cunningham R, Gurney J, Koea J, Ellison-Loschmann L. Indigenous inequities in the presentation and management of stomach cancer in New Zealand: a country with universal health care coverage. Gastric Cancer 2014; DOI: 10.1007/s10120-014-0410-y (advanced access)
Sarfati D, Gurney J, Stanley J, Koea J. A retrospective cohort study of patients with stomach and liver cancers: the impact of comorbidity and ethnicity on cancer care and outcomes. BMC Cancer 2014, 14:821 DOI: 10.1186/1471-2407-14-821
Gurney JK, Sarfati D, Stanley J, Studd R. Do ethnic differences in cryptorchidism reflect those found in testicular cancer? Journal of Urology 2013; 190(5): 1852-1857.
Chamberlain J, Sarfati D, Cunningham R, Koea J, Gurney J, Blakely T. Incidence and management of hepatocellular carcinoma among Māori and non-Māori New Zealanders. Australian & New Zealand Journal of Public Health 2013; 37 (6): 520-526.
Swart E, Sarfati S, Cunningham R, Dennett E, Signal V, Gurney J, Stanley J. Ethnicity and rectal cancer management in New Zealand. NZ Med J 2013; 126(1384): 42-52.
Hill S, Sarfati D, Robson B, Blakely T. Indigenous inequalities in cancer – what role for health care? Australian and NZ Journal of Surgery 2012; 83 (1-2), 36-41.
Shah A, Sarfati D, Blakely T, Atkinson J, Dennett L. Trends in Colorectal Cancer Incidence Rates in New Zealand, 1981–2004. Australian and New Zealand Journal of Surgery. 2012; 82 (4), 258-264.
Blakely T, Shaw C, Atkinson J, Cunningham R, Sarfati D. Social inequalities or inequities in cancer incidence? Repeated census-cancer cohort studies, New Zealand 1981-86 to 2001-04. Cancer Causes and Control 2011; 22 (9), 1307-1318.
Sarfati D, Shaw C, Blakely T, Atkinson J, Stanley J. Ethnic and Socioeconomic trends in testicular cancer incidence in New Zealand. International Journal of Cancer 2011; 128 (7): 1683-91.
Cunningham R, Shaw C, Blakely T, Atkinson J, Sarfati D. Ethnic and socioeconomic trends in breast cancer incidence in New Zealand. BMC Cancer 2010: 10: 674.
Hill S, Sarfati D, Blakely T, Robson B, Purdie G, Chen J, Dennett E, Cormack D, Cunningham R, Dew K, McCreanor T, Kawachi I. Ethnic disparities in treatment of Māori and non-Māori New Zealanders with colon cancer. Cancer 2010; 116: 3205-14.
Sarfati D, Hill S, Blakely T, Robson B. Is bowel cancer screening important for Māori? (Invited editorial). New Zealand Medical Journal 2010; 123 (1320): (online).
Sarfati D, Shaw C, Simmonds S. Commentary: Inequalities in cancer screening programmes. Int J Epidemiol 2010; 39: 766-8.
Hill S, Sarfati D, Blakely T, Robson B, Purdie G, Chen J, Dennett E, Cormack D, Cunningham R, Dew K, McCreanor T, Kawachi I. Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors. J Epidemiol Community Health 2010; 64: 117-123
Hill S, Sarfati D, Blakely T, Robson B. Ethnicity and cancer treatment in New Zealand: do Maori patients get a worse deal? J Epidemiol Community Health 2009; 63: 13
Cunningham R, Sarfati D, Hill S, Dennett E, O'Donnell A. Colon cancer management in New Zealand: 1996-2003. New Zealand Medical Journal 2009; 122 (1294): 51-60
Sarfati D, Blakely T, Shaw C, Cormack D, Atkinson J. Patterns of disparity: ethnic and socio-economic trends in breast cancer mortality in New Zealand. Cancer Causes and Control 2006; 17 (5): 671-8.
Shaw C, Blakely T, Sarfati D, Fawcett J, Peace J. Trends in colorectal cancer mortality by ethnicity and socioeconomic position in New Zealand 1981-1999: One country, many stories. Australian and New Zealand Journal of Public Health 2006; 30 (1): 64-70.
Shaw C, Blakely T, Sarfati D, Fawcett J, Hill S. Varying evolution of the New Zealand lung cancer epidemic by ethnicity and socioeconomic position (1981–1999). New Zealand Medical Journal 2005; 118: 1213
Presentations
Associate Professor Diana Sarfati: Ethnic Inequalities in Cancer Outcomes in New Zealand