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dc.contributor.authorDiaz Aen_US
dc.contributor.authorBaade PDen_US
dc.contributor.authorValery PCen_US
dc.contributor.authorWhop LJen_US
dc.contributor.authorMoore SPen_US
dc.contributor.authorCunningham Jen_US
dc.contributor.authorGarvey Gen_US
dc.contributor.authorBrotherton JMLen_US
dc.contributor.authorO'Connell DLen_US
dc.contributor.authorCanfell Ken_US
dc.contributor.authorSarfati Den_US
dc.contributor.authorRoder Den_US
dc.contributor.authorBuckley Een_US
dc.contributor.authorCondon JRen_US
dc.description.abstractBackground Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women’s higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. Methods Data for cervical cancers diagnosed in 2003–2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. Results Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9–3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. Conclusions Survival was lowest for women with comorbidity. However, there wasn’t a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. Impact The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).en_US
dc.subject.otherCancer Control, Survivorship, and Outcomes Research - Resources and Infrastructureen_US
dc.subject.otherCancer Type - Cervical Canceren_US
dc.titleComorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)en_US
dc.typePeer Reviewed Journal Articleen_US
dc.identifier.journaltitlePLOS Oneen_US
dc.identifier.divisionCancer Research Divisionen_US
dc.identifier.fundingbodyThe National Indigenous Cervical Screening Project (NICSP) was funded by a National Health and Medical Research Council (NHMRC; Project Grant (#1045591). This project was conducted under the auspice of the Centre of Research Excellence in Discovering Indigenous Strategies to improve Cancer Outcomes via Engagement, Research Translation & Training (DISCOVER-TT CRE) funded by NHMRC (#1041111) & the Strategic Research Partnership to Improve Cancer Control for Indigenous Australians (STREP Ca-CIndA), funded by Cancer Council NSW (#SRP 13-01; with supplementary funding from Cancer Council WA ( We also acknowledge the ongoing support of the Lowitja Institute (, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. A Diaz was supported by a National Health and Medical Research Council (NHMRC) Training Scholarship for Indigenous Australian Health Research (#1055587) and a Menzies Enhanced Living Top-up scholarship ( funded by the DISCOVER-TT CRE. PCV was supported by the NHMRC (Career Development Fellowship #1083090). LJW was supported by a Sidney Myer Health Scholarship (, Menzies Enhanced Living Top-up Scholarship and a student scholarship funded by the Lowitja Institute. GG was supported by an NHMRC Early Career Fellowship (#1105399). JC was supported by an NHMRC Research Fellowship (#1058244). KC receives salary support from NHMRC (Career Development Fellowship #1082989).en_US
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