Analysis reveals geographic and ethnic inequities in cancer radiotherapy access across New Zealand

A new nationwide study conducted by the University of Otago – Ōtākou Whakaihu Waka has uncovered significant geographic and ethnic inequities in cancer radiotherapy access across New Zealand. The research, published in the Journal of Medical Imaging and Radiation Oncology, compared radiotherapy rates among rural and urban New Zealanders for breast, prostate, and lung cancers.

Dr. Stephen Withington, the lead author, emphasizes that cancer is a leading cause of death in New Zealand, but accessing radiation therapy can be challenging for rural patients due to the need to travel away from whānau and access treatment centers in major urban centers.

The study, which utilized the national database for radiotherapy linked with the Geographical Classification for Health, found that rural populations, particularly older women and Māori, face lower rates of radiotherapy treatment. For instance, women with breast cancer older than 75 living in small towns and rural non-Māori women aged 45 to 64 received radiotherapy at significantly lower rates compared to their urban counterparts.

Rural Māori aged 75 and older with lung cancer experienced a 66% lower rate of curative radiotherapy. Conversely, some rural groups, including rural men with prostate cancer and rural men and women with lung cancer, received radiotherapy at rates 47% and 90% higher than their urban peers, respectively.

Another concerning finding was the marked differences in radiotherapy receipt between Māori and non-Māori within the same geographic zones. For lung cancer, Māori rates were consistently higher than non-Māori across all age groups and regions, although it remains uncertain whether these higher rates fully match the actual need. In contrast, Māori women younger than 45 with breast cancer had lower radiotherapy rates compared to their non-Māori counterparts, particularly in remote areas where rates were 50% lower.

This disparity correlates with higher rates of total mastectomy instead of breast-conserving surgery, which typically involves radiotherapy.

To address these inequities, the authors propose practical measures such as improved transport and accommodation services, better communication with local teams, and engagement with communities to understand patient social and cultural needs. Technical initiatives like the use of hypofractionation and simulation-free radiation therapy could also improve access for those living far from main radiation oncology centers.

Ultimately, targeted strategies are needed to reduce inequities between ethnicities, including policies to identify and mitigate access gaps for Māori and other disadvantaged groups, cultural safety programs to address potential biases, and efforts to increase the Māori workforce in radiation therapy and other cancer services.