背景:世界各地的土著人民经历不公平的癌症结局,目前尚不清楚这是否是由内分泌治疗(ET)的差异或不充分使用引起的,经常与其他癌症治疗结合使用。以前对土著人民使用ET的研究主要集中在国家以下一级,通常导致样本量小,统计能力有限。本系统综述旨在整理有关土著癌症患者ET使用的文章的发现,并描述可能影响ET使用的相关因素。
方法:我们对全球土著人群使用ET治疗癌症的研究进行了系统评价和荟萃分析。PubMed,Scopus,CINAHL,WebofScience,和Embase进行了相关文章的搜索。随机效应荟萃分析用于汇集ET使用比例。我们还进行了亚组分析(如样本量)和荟萃回归,以探索异质性的潜在来源。使用社会生态模型来介绍可能影响ET使用的相关因素。
结果:13篇文章报道了土著居民的ET利用率,得出67%的汇总估计值(95%CI:54-80),这与土著人口的67%相当(95%CI:53-81)。然而,在具有足够大小的研究样本/队列(≥500)的研究中,土著人口的ET利用率比非土著人口低14%(62%;95%CI:43-82)(76%;95%CI:60-92)。美国土著人民的ET率(例如,美洲印第安人)和新西兰(例如,毛利人)分别为72%(95%CI:56-88)和60%(95%CI:49-71),分别。与非土著居民相比,更高比例的土著居民被诊断出患有晚期癌症,在年轻的时候,获得医疗服务的机会有限,社会经济地位较低,和更高的合并症患病率。
结论:土著癌症患者的ET利用率低于非土著癌症患者,尽管诊断时晚期癌症的发病率较高。虽然这些差异的原因尚不清楚,他们可能会反映,至少在某种程度上,获得癌症治疗服务的机会不公平。加强提供和获得文化上适当的癌症护理和治疗服务可能会提高土著人口的ET利用率。该研究方案在Prospero(CRD42023403562)上注册。
BACKGROUND: Indigenous peoples worldwide experience inequitable cancer outcomes, and it is unclear if this is underpinned by differences in or inadequate use of endocrine treatment (ET), often used in conjunction with other cancer treatments. Previous studies examining ET use in Indigenous peoples have predominately focused on the sub-national level, often resulting in small sample sizes with limited statistical power. This systematic review aimed to collate the findings ofarticles on ET utilisation for Indigenous cancer patients and describe relevant factors that may influence ET use.
METHODS: We conducted a systematic review and meta-analysis of studies reporting ET use for cancer among Indigenous populations worldwide. PubMed, Scopus, CINAHL, Web of Science, and Embase were searched for relevant articles. A random-effect meta-analysis was used to pool proportions of ET use. We also performed a subgroup analysis (such as with sample sizes) and a meta-regression to explore the potential sources of heterogeneity. A socio-ecological model was used to present relevant factors that could impact ET use.
RESULTS: Thirteen articles reported ET utilisation among Indigenous populations, yielding a pooled estimate of 67% (95% CI:54 - 80), which is comparable to that of Indigenous populations 67% (95% CI: 53 - 81). However, among studies with sufficiently sized study sample/cohorts (≥ 500), Indigenous populations had a 14% (62%; 95% CI:43 - 82) lower ET utilisation than non-Indigenous populations (76%; 95% CI: 60 - 92). The ET rate in Indigenous peoples of the USA (e.g., American Indian) and New Zealand (e.g., Māori) was 72% (95% CI:56-88) and 60% (95% CI:49-71), respectively. Compared to non-Indigenous populations, a higher proportion of Indigenous populations were diagnosed with advanced cancer, at younger age, had limited access to health services, lower socio-economic status, and a higher prevalence of comorbidities.
CONCLUSIONS: Indigenous cancer patients have lower ET utilisation than non-Indigenous cancer patients, despite the higher rate of advanced cancer at diagnosis. While reasons for these disparities are unclear, they are likely reflecting, at least to some degree, inequitable access to cancer treatment services. Strengthening the provision of and access to culturally appropriate cancer care and treatment services may enhance ET utilisation in Indigenous population. This study protocol was registered on Prospero (CRD42023403562).