Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 300
  • Home
  • Print this page
  • Email this page

 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 316-323

Global perspectives on cancer health disparities: Impact, utility, and implications for cancer nursing


1 Asian Oncology Nursing Society; The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
2 Cancer Nurses Society of Australia; Royal Brisbane and Women's Hospital, Queensland University of Technology, Brisbane, Australia
3 Canadian Association of Nurses in Oncology
4 European Oncology Nursing Society
5 International Society of Nurses in Cancer Care; School of Nursing, University of California, San Francisco, CA, USA
6 Oncology Nursing Society; Memorial Sloan Kettering Cancer Center, New York, NY; College of Nursing, University of Missouri, St. Louis, MO, USA

Date of Submission25-Jul-2016
Date of Acceptance29-Oct-2016
Date of Web Publication22-Dec-2016

Correspondence Address:
Margaret Barton-Burke
Immediate Past President, Oncology Nursing Society; Director of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY; Professor Emeritus, University of Missouri, St. Louis, MO; 205 East 64th Street, New York, NY, Concourse Level (Rm 251)
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-5625.195885

Rights and Permissions
  Abstract 

This paper examines cancer health disparities and contributing factors at national, regional, and international levels. The authors all live in different countries and regions with different health-care systems and practices. Despite the shared cancer nursing perspective, each country or global region approaches cancer disparities differently. With globalization the world is becoming smaller, and in turn becoming interconnected and interdependent. This article focuses on cancer health disparities and global cancer nursing, exemplifying these concepts about the impact and implications of person-centered care.

Keywords: Cancer health disparities, cancer nursing, impact, implications, utility


How to cite this article:
So WK, Chan RJ, Truant T, Trevatt P, Bialous SA, Barton-Burke M. Global perspectives on cancer health disparities: Impact, utility, and implications for cancer nursing. Asia Pac J Oncol Nurs 2016;3:316-23

How to cite this URL:
So WK, Chan RJ, Truant T, Trevatt P, Bialous SA, Barton-Burke M. Global perspectives on cancer health disparities: Impact, utility, and implications for cancer nursing. Asia Pac J Oncol Nurs [serial online] 2016 [cited 2021 Oct 21];3:316-23. Available from: https://www.apjon.org/text.asp?2016/3/4/316/195885


  Introduction Top


Over the past 40 years, cancer nursing care has changed immensely and radically from a gross understanding of the disease to a refined knowledge of molecular and genetic changes occurring at, in, or on the cell. Parallel to this expanding biological knowledge comes growth in other areas of oncology nursing knowledge, as well. This growth in understanding of disease, treatment, and clinical nursing care has allowed a focus on other, albeit different, topics.

Over the past few years, health disparities, social determinants of health (SDH), and person-centered care have emerged as areas where nurses can have an impact. Cancer care around the globe is changing at a rapid pace. Yet, these topics have been addressed from a primarily Eurocentric perspective. At the 2016 Oncology Nursing Society, the authors, leaders of global oncology nursing societies, were invited to be on a panel to discuss health disparities from their respective society's perspectives.

Each Oncology Nurses Association is constituted in a different way and for a different purpose. These differences make us similar but not the same, especially when asked to discuss health disparities, SDH, and person-centered care. There were representatives from the Asian Oncology Nursing Society (AONS), the Cancer Nurses Society of Australia (CNSA), the Canadian Association of Nurses in Oncology (CANO), the International Society of Nurses in Cancer Care (ISNCC), and the Oncology Nursing Society (ONS). The various societies work with nurses who are different from each other as well. The differences arise from the level of education, the oncology nurse role, the geopolitical situation, as well as the health-care and cancer-care systems. This paper outlines health disparities, SDH, and person-centered care through the lens of global cancer nurse leaders of oncology and cancer nursing organizations. We examine cancer health disparities and contributing factors at national, regional, and international levels. We offer possible solutions, like navigation, from an international perspective, focusing on the impact and implications of health disparities and SDH.

The authors all live in different countries and regions with different health-care systems and different clinical practices; yet we all share a cancer and oncology nursing paradigm. With globalization, the world has become smaller, more interconnected, and interdependent. [1] This article illustrates our interconnectedness, interdependence, and differences from the perspective of cancer health disparities and global cancer nursing.


  Canadian Perspectives on Cancer Health Disparities Top


The CANO is a national organization established in 1985 with a mission to advance oncology nursing excellence through practice, education, research and leadership for the benefit of all Canadians, and a vision of being an influencing force internationally in cancer control. The association is member-led and takes direction from its membership in formulating activities and initiatives. [2]

One of these initiatives is working with the Canadian Partnership Against Cancer on a pan-Canadian strategy with the goal of all Canadians having access to equitable, person-centered, safe, and high-quality cancer care. [3],[4] Increasingly, however, health disparities are being documented among cancer survivors who live in rural and remote settings, those with lower socioeconomic status, or who are older, with advanced disease at diagnosis, and in Indigenous and ethnic minority groups, as well as immigrants. [3],[4],[5],[6],[7],[8],[9],[10],[11]

Factors and contexts contributing to health disparities in cancer survivors include (1) personal attributes (biological/genetic endowment); (2) health-care accessibility; (3) acquired health behaviors; and (4) the social, economic, and cultural resources and environments (ie., SDH) of where people live. [5],[12],[13] Efforts to address cancer disparities in Canada largely have been aimed at improving access to care, such as through the introduction of nurse navigator roles.

In response to a fragmented system of care that marginalizes vulnerable individuals and populations, an evidence-informed Canadian cancer patient navigation agenda has been articulated. [14] Navigation is considered a part of an integrated cancer service delivery program, where navigators, usually oncology nurses, work with patients and families to assess needs, provide supportive care, answer questions, identify and address any barriers to quality care, and facilitate access to needed resources and services. Competencies for nurse navigators align with the CANO Standards and Competencies for Specialized Oncology Nurses [15] and can be found in [Box 1 [Additional file 1]]. [15]

Various navigation models and programs exist across Canada, contextualized to the unique needs of populations and designed to fit within existing cancer care services. Nurse navigators are placed at different points along the cancer trajectory (from diagnosis, through treatment, and transitions to survivorship), in various care settings (rural, urban, community, and hospital), and to serve diverse populations (grouped by type of cancer, vulnerable groups, or complex health needs). Evaluation of navigation roles and programs is in the nascent stage in Canada with little published evidence related to the impact on reducing disparities. Most studies focus on demonstrating system efficiencies through improved care coordination and timely access to care. [2],[15],[16] Impacts on patient outcomes have been reported, such as decreased anxiety, improved self-reports of feeling prepared for consultations, and patient satisfaction. [3],[16]

Furthermore, even with improved access to care, it is anticipated that navigation will not be the single answer to addressing cancer care equity. A broader approach to addressing root causes that contribute to the development of inequities is needed. [4],[5],[6],[8] Understanding the SDH [Box 2 [Additional file 2]], [17] including the factors, contexts, and structures that influence opportunities for health, is an essential foundation for moving the health equity agenda forward in Canadian cancer care.


  Australian Perspectives on Cancer Health Disparities Top


The CNSA was founded in 1998. Its beginnings were in the Nurses Group of the Clinical Oncological Society of Australia. Today, CNSA is an independent member-based organization of cancer nurses with over 1000 members throughout Australia. The CNSA is committed to achieving and promoting excellence in cancer care through the professional contributions of nurses. The society acts as a resource for cancer nurses around Australia, whatever the geographical location or area of practice and works with other Australian cancer agencies to address health disparities as a key priority.

The CNSA is very cognisant of outcome disparities in Australia and it's role in addressing these through the contribution of cancer nurses. Cancer Australia is the lead national government agency that makes evidence-based recommendations to the Australian Government about cancer policy and priorities, and Cancer Australia identified key outcome disparity issues in their 2014-2019 strategic plan. [19] Such key issues include people living in remote or very remote areas, those living in low socioeconomic status areas, Aboriginal and Torres Strait Islander peoples, and those with certain cancer diagnoses. Key evidence highlighted by Cancer Australia is summarized in [Box 3 [Additional file 3]]. [19],[20],[21],[22]

The data listed in Box 3 highlights the privileged position that Australia has regarding available data and evidence to inform care and cancer service planning. However, it is important to acknowledge the lack of data concerning survivorship and supportive care outcomes due to a lack of relevant routine reporting mechanisms. Until such data are available, a challenge remains to identify and address survivorship and supportive care outcome disparities at the population level.

An evidence-based whole-of-system approach to address outcome disparities is critical. Researchers, policy-makers and clinicians are required to work together to ensure that multi-level strategies are informed by data and best practice standards. It is imperative that we understand the experience of outcome disparities from the patients' and caregivers' perspectives. We need a deeper understanding of the potential causes or modifiable factors associated with outcome disparities. This will enable us to formulate appropriate strategies that are likely to make an impact. Moreover, we must continue to evaluate the effectiveness including the costs, of strategies using a range of robust research designs.

In Australia, navigation is known as care coordination - an intervention that may alleviate some problems associated with outcome disparities. However, given the limited evidence available, it is difficult to determine the extent of the impact that care coordination has on health outcome disparities. [23] Therefore, care coordination alone is not the solution. It is critical to acknowledge that addressing outcome disparities requires a systems approach that requires collaborative efforts of government agencies, not-for-profit organizations, professional organizations, advocacy groups, local health-care executives/leaders, and health professionals.


  Cancer Health Disparities across Europe Top


EONS is a pan-European organization dedicated to the support and development of cancer nurses and cancer nursing across its member countries. The membership of EONS consists of individual members, as well as multiple national societies like the Irish Association for Nurses in Oncology and Verpleegkundigen & Verzorgenden Nederland Oncologie (V&VN). Its strength comes from its partnership not just with cancer nursing organisations but with European multidisciplinary organisations with which it collaborates to optimise the nursing contribution of cancer care in Europe. Through individual membership and national societies EONS engages in large scale projects to empower nurses to better develop their skills, share best practice, network and raise the profile of cancer nursing across Europe. [24] Therefore, EONS looks at health disparities, SDH, and person-centered care through a different lens than CANO and CNSA. It must do so since, as an organization, EONS works at both the member level but more specifically at the organizational level.

Across Europe, cancer is the second most common cause of death after cardiovascular disease. [25] In the year 2012, 3.75 million new cases were diagnosed with 1.75 million deaths. [26] More worryingly, a European analysis shows a considerable disparity among the different countries. Data from EUROCARE 5, a European collaborative project monitoring population-based cancer survival, demonstrate the different survival rates between countries. For example, in cancers with a mostly good prognosis, the European average 5-year relative survival for breast cancer was 82% while in Eastern Europe it was 10%-15% lower. For prostate cancer, the European 5-year survival rate of 83% is to be compared with 72% in Eastern Europe. Similarly, colon cancer and skin melanoma have lower survival rate in Eastern Europe than the European average 5-year survival. [27]

For cancers with a poorer prognosis, there appears to be less variation. The 5-year relative survival European average for lung cancer was 13%, with 11% in Eastern Europe, 10% in Denmark, and 9% in the UK and Ireland. For stomach cancer, the 5-year survival rate was 25%, with 19% in Eastern Europe, 17% in the UK and Ireland, and 16% in Denmark. The 5-year European ovarian cancer survival rate was 38%, with 35% in Denmark, and 31% in the UK and Ireland. [27]

Reviewing the data from 7.5 million cancer cases across 29 European countries illustrates that Denmark, the UK, and Eastern Europe have lower survival rate than other parts of Europe. [27] Of particular, concern is the parts of Eastern Europe where mortality rates for many cancers are above the national average. For example, Poland has a lung cancer mortality rate of 83% versus the European Union (EU) average of 56.4%; Romania has a cervical cancer mortality rate of 14.2% versus the EU average of 3.7%. [27] The best survival rates for most cancers are in the Nordic countries except Denmark, Central Europe, and some countries in the Southern Europe, particularly Italy, Portugal, and Spain [Table 1]. [27]
Table 1: Examples of cancer survival across European countries

Click here to view


The evidence for cancer health disparities between different European countries appears to be influenced by SDH (see Box 2). In Europe, they include lifestyle factors, socioeconomic, and health status, as well as age. While it is tempting to link health care spending as a proxy measure with poor outcomes, such as in Eastern Europe with a shortage of public cancer funding, this does not seem to correlate with the low survival of the UK and Danish cancer patients. [28] Extensive analysis would appear to suggest delayed diagnosis possibly linked to advanced stage at presentation and unequal access to treatment. [29] In Eastern Europe, cancer health care may be further compromised by poor infrastructure - no national cancer strategy, poorly implemented screening programs, and fragmented service delivery - less developed cancer clinical pathways and inequitable access to care. [30]

Closing the cancer disparity gap across Europe will remain extremely challenging. Strategies will need to be developed internally and targeted at the micro, meso, and macro environments within each country (recognizing that cancer will not be a priority health care issue for all). Workforce and clinical pathways remain fragile in some places and will require strengthening. While health-care resources may need to be increased in some localities, it is possible that best practice sharing and collaborative projects between differently resourced countries may lead to improved outcomes.


  Cancer Health Disparities in Asia Top


AONS, was founded in 2013 which is a regional organization with a vision to support cancer nurses in providing high-quality and scientifically-based care to cancer patients in Asia. AONS is committed to advancing cancer nursing in the Asia region through collaborative exchange of clinical practice, education and research among AONS members, developing and disseminating the latest evidence-based nursing practice, and preparing future nurse leaders for cancer care in Asia. Similar to EONS, AONS works more specifically at the organizational level across countries in the Asia region. [31]

Asia bears a significant cancer burden compared with other world regions, with 48% of new cancer cases and 55% of cancer-related deaths reported in Asian countries. [32] This cancer burden may be fueled by a more pressing problem that of cancer health disparities.

In Asia, cancer survival rates in high-income countries (HICs) were found to be considerably higher than those in low- and middle-income countries (LMICs). Indeed, HICs appear to have a smaller mortality-to-incidence ratio, one indicator of cancer survival, [33] than do LMICs. [32] Moreover, ethnic and rural-urban disparities in cancer survival were reported in Asian countries. For example, Uyghurs, an ethnic minority group in China, appears to have a higher cervical cancer incidence than other ethnic groups in the Xinjiang region. [34] Meanwhile, in India cancer survival, rates of rural residents are lower than those of their urban counterparts [35] providing evidence of health disparities across and within countries in Asia.

Several factors may contribute to cancer health disparities in Asia. There is a lack of governmental health-care funding, a prominent phenomenon in LMICs, and ultimately leading to out-of-pocket health-care expenditure among individuals in LMICs. [36] It may be difficult for individuals to pay for services such as cancer screening. Moreover, there is a lack of access to health information for ethnic minorities and rural residents in certain Asian countries. Individuals generally possess limited knowledge about cancer and prevention strategies. [34],[37] Individuals in different countries may not appreciate the importance of adopting a healthy lifestyle and may not use cancer screening and prevention practices. Most health-care professionals prefer to work in urban areas, [38] and advanced medical facilities are located in metro areas. [39] This lack of health-care access becomes a barrier for rural residents, who may be reluctant to utilize health-care services including cancer screening, due to lengthy travel.

Strategies to reduce cancer health disparities include government involvement in screening programs, registries, treatment, survivorship, and palliative care. Asian LMICs should allocate resources to health care despite the costs, enabling individuals to use cancer screening programs. Cancers found through screening programs should be registered. The Cancer Atlas 2016 reported that in Asia only 6% of countries (or regions) have a high-quality cancer registry, compared with 95% of North America and 75% of Oceania. Increasing the number and quality of cancer registries in Asia would provide evidence (data) about the scope of the cancer incidence.

As mentioned earlier in this paper, various factors contribute to cancer health disparities and one size does not fit all when considering person-centered care, which should be rooted in the needs of the disadvantaged. Stakeholders should be engaged from nongovernment organizations, ethnic minority associations, government, and health professionals. Navigators may provide low health-literate individuals with information on effective cancer prevention in such a way that they understand cancer. Navigators could facilitate access to health-care services such as cancer screening leading to increased utilization of screening services and effective early detection of cancer. This is especially true of individuals in disadvantaged groups, including ethnic minorities. However, cancer navigation is underdeveloped in Asia when compared with Western countries.


  Cancer Health Disparities - The Worldview Top


The ISNCC is an international membership organization dedicated to improving the health and well-being of people at risk of, or already living with, cancer. It is composed of nursing associations and individual members, and associate members and corporate partners. Through its strategic partnerships and members' related initiatives, the society influences and participates in setting directions for cancer nursing, health policy, and cancer control initiatives that are intended to improve the health and well-being of people around the world. By promoting the nurse's role in cancer care, ISNCC leads a global community of cancer nurses to share, discuss, and debate strategies and innovations that advance clinical practice, education, research, management, and leadership. [40]

The issue of global disparities in cancer care goes beyond disparities to the need for a serious conversation about health justice. Data from the World Health Organization GloboCan for the year 2012 demonstrate that a significant proportion of new cancer cases is found in HICs. The highest proportion of cancer mortality is found in LMIC demonstrating, once again, that in LMIC a combination of late stage diagnosis, low access to treatment, and a myriad of challenges to the health-care system indicates that where you live when you receive a diagnosis of cancer will determine your chances of treatment and survival.

This difference was perfectly illustrated by the International Atomic Energy Agency as displayed in [Table 2]. [41] Furthermore, the Council on Foreign Relations estimates that from 1990 to 2010, there was a higher than 100% change in disability-adjusted life years, i.e., years of healthy life lost, due to leukemia, breast cancer, and lung cancer in several of the poorest countries in the world. [42] Despite evidence of the devastating impact of cancer in LMIC, the vast majority of international aid programs for LMIC remains focused on communicable diseases. In addition to the existing lack of equity between countries, there are huge disparities within countries, regardless of level of income.
Table 2: Examples of cancer survival based on country of residence, International Atomic Energy Agency Programme of Action for Cancer Therapy

Click here to view


An example of the global disparities in cancer is lung cancer, which is the leading cause of cancer death globally, and among the top 5 cancer diagnoses in men and women. Tobacco control decreases the incidence and improves the survival of people already diagnosed. Thus, conceptually, a care coordination and integration, or navigation, program could address lung cancer prevention, screening, diagnosis, treatment, recovery, or palliative care. The reality, however, is that prevention is seldom integrated into a navigation program and tobacco dependence treatment, when available, is seldom integrated in the continuum of care.

An opportunity for this integrated and coordinated, evidence-based approach to care therefore exists, but a few challenges need to be addressed. First, the nursing shortage, which is severe in several parts of the world where there is a desperate need for nurses at the bedside carrying heavy patient loads. Second, nurses themselves, who may not see their role as navigators in some countries. Third, nurses in many countries may see the care coordination activities of a navigator as beyond the scope of standard nursing practice. Last but not least, nurses' basic and postbasic education varies globally, and not all may feel prepared to embrace a navigator role.

The cancer health disparities seen in cancer care globally in many ways mirror and are intrinsically related to the disparities we see in the availability of professional nursing globally, particularly nurses that can assist patients throughout the cancer care continuum. Nevertheless, opportunities exist to accelerate the professionalization and implementation of diverse roles for cancer nurses. We have professional organizations that can support each other in building leadership. We have new ways to share expertise through the internet, mobile health, and other innovations that could help nurses, particularly those in LMIC and in deprived areas within HIC to make huge strides toward the implementation of excellence in cancer care.


  Conclusion Top


This paper examined cancer health disparities and SDH at national, regional, and international levels. Possible solutions were suggested to address these disparities and improve access to cancer care. Although one size does not fit all, strategies should be focused in the needs of the disadvantaged. The oncology nurses associations are joining hands to support global cancer nurses strive for excellence in cancer care, and to work with all stakeholders together to reduce the global cancer burden.

Acknowledgments

The authors would like to thank Oncology Nursing Society for providing a platform to discuss global cancer health disparities and cancer navigation at 41 st ONS Congress, San Antonio, USA, on April 28, 2016. Dr. Barton-Burke acknowledges funding support from MSK Cancer Center Support Grant/Core Grant (P30 CA008748).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Beaglehole R, Yach D. Globalisation and the prevention and control of non-communicable disease: The neglected chronic diseases of adults. Lancet 2003;362:903-8.  Back to cited text no. 1
    
2.
The Canadian Association of Nurses in Oncology/Association Canadienne des Infirmières en Oncologie (CANO/ACIO). Available from: http://www.cano-acio.ca/about_us. [Last accessed on 2016 Oct 29].  Back to cited text no. 2
    
3.
Canadian Partnership Against Cancer. Sustaining Action Toward a Shared Vision; 2012. Available from: http://www.partnershipagainstcancer.ca/wp-content/uploads/sites/5/2015/03/Sustaining-Action-Toward-a-Shared-Vision_accessible.pdf. [Last accessed on 2016 May 27].  Back to cited text no. 3
    
4.
Palaty C. Cancer care for all Canadians: Improving access and minimizing disparities for vulnerable populations in Canada. Vancouver, BC; BC Cancer Agency, Canadian Partnership Against Cancer; 2008.  Back to cited text no. 4
    
5.
Ahmed S, Shahid RK. Disparity in cancer care: A Canadian perspective. Curr Oncol 2012;19:e376-82.  Back to cited text no. 5
    
6.
Ahmed S, Shahid RK, Episkenew JA. Disparity in cancer prevention and screening in aboriginal populations: Recommendations for action. Curr Oncol 2015;22:417-26.  Back to cited text no. 6
    
7.
Canadian Cancer Society′s Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society′s Steering Committee on Cancer Statistics; 2015.  Back to cited text no. 7
    
8.
Canadian Partnership Against Cancer. Examining Disparities in Cancer Control: A System Performance Special Focus Report; 2014. Available from: http://www.cancerview.ca/systemperformancereport">http://www.cancerview.ca/systemperformancereport. [Last accessed on 2016 May 26].  Back to cited text no. 8
    
9.
Maddison AR, Asada Y, Urquhart R. Inequity in access to cancer care: A review of the Canadian literature. Cancer Causes Control 2011;22:359-66.  Back to cited text no. 9
    
10.
Sheppard AJ, Chiarelli AM, Marrett LD, Mirea L, Nishri ED, Trudeau ME; Aboriginal Breast Cancer Study Group. Detection of later stage breast cancer in First Nations women in Ontario, Canada. Can J Public Health 2010;101:101-5.  Back to cited text no. 10
    
11.
Withrow D, Marrett LD, Tjepkema M, Nishri D, Pole J. Disparities in cancer survival between indigenous and non-indigenous adults in Canada: Results from a linkage of the Canadian long form census to the Canadian cancer registry. Ann Epidemiol 2015;25:705.  Back to cited text no. 11
    
12.
Lalonde M. A New Perspective on the Health of Canadians. A Working Document. Ottawa: Health and Welfare Canada; 1974.  Back to cited text no. 12
    
13.
Raphael D. Health equity in Canada. Soc Altern 2010;29:41-9.  Back to cited text no. 13
    
14.
Cancer Journey Portfolio. Navigation: A Guide to Implementing Best Practices in Person-centred Care; Canadian Partnership Against Cancer; 2012. Available from: http://www.cancerview.ca. [Last accessed on 2016 May 26].  Back to cited text no. 14
    
15.
Canadian Association of Nurses in Oncology (CANO/ACIO). Standards and Competencies for the Specialized Oncology Nurse; 2006. Available from: http://www.cano-acio.ca/practice-standards. [Last accessed on 2016 May 26].  Back to cited text no. 15
    
16.
Fillion L, Cook S, Veillette AM, Aubin M, de Serres M, Rainville F, et al. Professional navigation framework: Elaboration and validation in a Canadian context. Oncol Nurs Forum 2012;39:E58-69.  Back to cited text no. 16
    
17.
Bryant T, Raphael D, Schrecker T, Labonte R. Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy 2011;101:44-58.  Back to cited text no. 17
    
18.
The Cancer Nurses Society of Australia (CNSA). Avaiable from: https://www.cnsa.org.au/about-us/cnsa-history. [Last accessed on 2016 Oct 30].  Back to cited text no. 18
    
19.
Cancer Australia. Cancer Australia Strategic Plan 2014-2019. Surry Hills: NSW; 2014.  Back to cited text no. 19
    
20.
Australian Institute of Health and Welfare and Australasian Association of Cancer Registries. Cancer in Australia: An Overview, Cancer Series No. 74. Cat. no. CAN 70. Canberra; 2012.  Back to cited text no. 20
    
21.
Australian Institute of Health and Welfare and Cancer Australia. Cancer in Aboriginal and Torres Strait Islander Peoples of Australia: An Overview. Cancer Series No. 78. Cat. No. CAN 75. Canberra; 2013.  Back to cited text no. 21
    
22.
Australian Institute of Health and Welfare. Cancer Survival and Prevalence in Australia: Period Estimates from 1982 to 2010.Cancer Series no. 69. Cat. no. CAN 65. Canberra; 2012.  Back to cited text no. 22
    
23.
Clinical Oncology Society of Australia. Cancer Care Coordinator Position Statement. Sydney; 2015.  Back to cited text no. 23
    
24.
The European Oncology Nursing Society. Avaiable from: http://www.cancernurse.eu/. [Last accessed on 2016 Oct 30].  Back to cited text no. 24
    
25.
World Health Organization. European Health Report 2012: Charting the Way to Well-being; 2013. Available from: http://www.euro.who.int/_data/assets/pdf_file/0004/197113/EHR2012-Eng.pdf. [Last accessed on 2016 Jun 14].  Back to cited text no. 25
    
26.
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374-403.  Back to cited text no. 26
    
27.
De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007 by country and age: Results of EUROCARE-5 - A population-based study. Lancet Oncol 2014;15:23-34.  Back to cited text no. 27
    
28.
Molassiotis A. The UK and Denmark are still the countries with low all-cancer survival in Europe. Eur J Oncol Nurs 2007;11:383-4.  Back to cited text no. 28
    
29.
Mackillop WJ. Killing time: The consequences of delays in radiotherapy. Radiother Oncol 2007;84:1-4.  Back to cited text no. 29
    
30.
Malicki J, Golusinski W. Challenges in organizing effective oncology service: Inter-European variability in the example of head and neck cancers. Eur Arch Otorhinolaryngol 2014;271:2343-7.  Back to cited text no. 30
    
31.
Aisan Oncology Nursing Society. Avaiable from: http://www.aons.asia/01_sub/1c_sub02.php. [Last accessed on 2016 Oct 29].  Back to cited text no. 31
    
32.
IARC. Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012; 2012. Available from: http://www.globocan.iarc.fr/Default.aspx. [Last accessed on 2016 May 19].  Back to cited text no. 32
    
33.
Wagner SE, Hurley DM, Hébert JR, McNamara C, Bayakly AR, Vena JE. Cancer mortality-to-incidence ratios in Georgia: Describing racial cancer disparities and potential geographic determinants. Cancer 2012;118:4032-45.  Back to cited text no. 33
    
34.
Abudukadeer A, Azam S, Mutailipu AZ, Qun L, Guilin G, Mijiti S. Knowledge and attitude of Uyghur women in Xinjiang province of China related to the prevention and early detection of cervical cancer. World J Surg Oncol 2015;13:110.  Back to cited text no. 34
    
35.
Swaminathan R, Selvakumaran R, Esmy PO, Sampath P, Ferlay J, Jissa V, et al. Cancer pattern and survival in a rural district in South India. Cancer Epidemiol 2009;33:325-31.  Back to cited text no. 35
    
36.
World Health Organization. Out-of-pocket Expenditure on Health as a Percentage of Private Expenditure on Health; 2015. Available from: http://www.who.int/gho/health_financing/out_pocket_expenditure/en. [Last accessed on 2016 Jun 14].  Back to cited text no. 36
    
37.
Tripathi N, Kadam YR, Dhobale RV, Gore AD. Barriers for early detection of cancer amongst Indian rural women. South Asian J Cancer 2014;3:122-7.  Back to cited text no. 37
[PUBMED]  Medknow Journal  
38.
Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98.  Back to cited text no. 38
    
39.
Choi KM. Investigation of cancer mortality inequalities between rural and urban areas in South Korea. Aust J Rural Health 2016;24:61-6.  Back to cited text no. 39
    
40.
International Society of Nurses in Cancer Care (ISNCC). Avaiable from: http://www.c.ymcdn.com/sites/www.isncc.org/resource/resmgr/About_ISNCC/ISNCC_Bylaws_Final_Designed_.pdf. [Last accessed on 2016 Oct 29].  Back to cited text no. 40
    
41.
The International Atomic Energy Agency (IAEA). Investing in Cancer Care Saveslives and Strengthens Economies in Developing World. Available from: https://www.iaea.org/newscenter/news/investing-in-cancer-care-saves-lives-and strengthens-economies-in-developing-world. [Last accessed on 2016 Oct 29].  Back to cited text no. 41
    
42.
Council on Foreign Relations. The Emerging Crisis: Noncommunicable Diseases; 2014. Available from: http://www.cfr.org/diseases-noncommunicable/NCDs-interactive/p33802?cid=otr-marketing_use-NCDs_interactive/#!/. [Last accessed on 2016 Jun 14].  Back to cited text no. 42
    

 
  Authors Top


Margaret Barton-Burke



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 A scoping review documenting cancer outcomes and inequities for adults living with intellectual and/or developmental disabilities
Morgan Stirling,Alexandrea Anderson,Helene Ouellette-Kuntz,Julie Hallet,Shahin Shooshtari,Christine Kelly,David E. Dawe,Mark Kristjanson,Kathleen Decker,Alyson L. Mahar
European Journal of Oncology Nursing. 2021; : 102011
[Pubmed] | [DOI]
2 Essential oncology nursing care along the cancer continuum
Annie M Young,Andreas Charalambous,Ray I Owen,Bernard Njodzeka,Wendy H Oldenmenger,Mohammad R Alqudimat,Winnie K W So
The Lancet Oncology. 2020;
[Pubmed] | [DOI]
3 Scoping review protocol documenting cancer outcomes and inequalities for adults living with intellectual and/or developmental disabilities
Morgan Stirling,Janice Linton,Hélène Ouellette-Kuntz,Shahin Shooshtari,Julie Hallet,Christine Kelly,David Dawe,Mark Kristjanson,Kathleen Decker,Alyson Mahar
BMJ Open. 2019; 9(11): e032772
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Canadian Perspec...
Australian Persp...
Cancer Health Di...
Cancer Health Di...
Cancer Health Di...
Conclusion
References
Authors
Article Tables

 Article Access Statistics
    Viewed3035    
    Printed59    
    Emailed0    
    PDF Downloaded588    
    Comments [Add]    
    Cited by others 3    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]