Patterns of primary health care service use of Indigenous Australians diagnosed with cancer

  • Patricia C. ValeryEmail author
  • Christina M. Bernardes
  • Audra de Witt
  • Jennifer Martin
  • Euan Walpole
  • Gail Garvey
  • Daniel Williamson
  • Judith Meiklejohn
  • Gunter Hartel
  • Isanka U. Ratnasekera
  • Ross Bailie
Original Article



The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians.


A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010–2016 were abstracted from patient’s medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator.


A total of 138 patients’ records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61–2.17; IRR = 1.79, 95%CI 1.45–2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts.


The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Cancer care Primary care General practitioners (GPs) Indigenous Australians 



The authors would like to thank Aboriginal Community Controlled Health Organizations and primary health care staff at participating centers for their support for this study.

Authors contributions

PCV, RB, GG, and AdW contributed to the conception and design of the study. PCV performed the data analysis and takes responsibility for the integrity and the accuracy of the data. PCV drafted the report. All authors contributed the interpretation of data, revising draft critically for important intellectual content, and approved the final version.

Funding information

This work was supported by the National Health and Medical Research Council (no. 1044433). PCV was supported by the National Health and Medical Research Council (Career Development Fellowship no. 1083090). ADW was sup-ported by an Australian Postgraduate Award Scholarship from Charles Darwin University and a top up scholarship from Menzies School of Health Research. GG was supported by a National Health and Medical Research Council Early Career Research Fellowship (no. 1105399). This study was undertaken under the auspices of the Centre of Research Excellence in Discovering Indigenous Strategies to Improve Cancer Outcomes Via Engagement, Research Translation and Training (DISCOVER-TT CRE, funded by the National Health and Medical Research Council no. 1041111) and the Strategic Research Partnership to improve Cancer control for Indigenous Australians (STREP Ca-CIndA, funded through Cancer Council NSW (SRP 13-01) with supplementary funding from Cancer Council WA). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest. Authors have no financial relationship with the organizations that sponsored the research. PCV had full control of all primary data and agree to allow the journal to review our data if requested.

Ethical approval

Ethics approvals for the study were obtained from the Human Research Ethics Committees of the Darling Downs Hospital and Health Service, Menzies School of Research, and QIMR Berghofer Medical Research Institute.

Supplementary material

520_2019_4821_MOESM1_ESM.docx (40 kb)
ESM 1 (DOCX 39 kb)


  1. 1.
    Cancer Research UK. Cancer survival statistics 2011. Available from: Accessed 1 Sept 2018
  2. 2.
    Australian Institute of Health and Wellfare (2017) Cancer in Australia. In: Australian Bureau of Statistics (ed) Cancer series no. 101. Cat. no. CAN 100. AIHW, CanberraGoogle Scholar
  3. 3.
    Kish JK, Yu M, Percy-Laurry A, Altekruse SF (2014) Racial and ethnic disparities in cancer survival by neighborhood socioeconomic status in surveillance, epidemiology, and end results (SEER) registries. J Natl Cancer Inst Monogr 2014(49):236–243CrossRefGoogle Scholar
  4. 4.
    Cramb SM, Moraga P, Mengersen KL, Baade PD (2017) Spatial variation in cancer incidence and survival over time across Queensland, Australia. Spat Spatiotemporal Epidemiol 23:59–67CrossRefGoogle Scholar
  5. 5.
    McGahan CE, Linn K, Guno P, Johnson H, Coldman AJ, Spinelli JJ, Caron NR (2017) Cancer in first nations people living in British Columbia, Canada: an analysis of incidence and survival from 1993 to 2010. Cancer Causes Control 28(10):1105–1116CrossRefGoogle Scholar
  6. 6.
    Moore SP, Green AC, Bray F, Garvey G, Coory M, Martin J, Valery PC (2014) Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients. BMC Cancer 14:517CrossRefGoogle Scholar
  7. 7.
    Valery PC, Coory M, Stirling J, Green AC (2006) Cancer diagnosis, treatment, and survival in indigenous and non-indigenous Australians: a matched cohort study. Lancet 367(9525):1842–1848CrossRefGoogle Scholar
  8. 8.
    Meiklejohn JA, Mimery A, Martin JH, Bailie R, Garvey G, Walpole ET, Adams J, Williamson D, Valery PC (2016) The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv 10(6):990–1011CrossRefGoogle Scholar
  9. 9.
    Adam R, Watson E (2018) The role of primary care in supporting patients living with and beyond cancer. Curr Opin Support Palliat Care 12(3):261–267Google Scholar
  10. 10.
    Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C (2015) The expanding role of primary care in cancer control. Lancet Oncol 16(12):1231–1272CrossRefGoogle Scholar
  11. 11.
    Holtedahl K, Scheel BI, Johansen ML (2018) General practitioners' participation in cancer treatment in Norway. Rural Remote Health 18(2):4276CrossRefGoogle Scholar
  12. 12.
    DeMario MD, Ratain MJ (1998) Oral chemotherapy: rationale and future directions. J Clin Oncol 16(7):2557–2567CrossRefGoogle Scholar
  13. 13.
    Whop LJ et al (2012) Cancer support services--are they appropriate and accessible for indigenous cancer patients in Queensland, Australia? Rural Remote Health 12:2018Google Scholar
  14. 14.
    National Rural Health Alliance (2016) The health of people living in remote Australia. [25 Jun 2018]; Available from:
  15. 15.
    Adams D, Marx G (2010) Daily life as an Australian medical oncologist. J Oncol Pract 6(3):146–148CrossRefGoogle Scholar
  16. 16.
    Baade PD, Dasgupta P, Aitken JF, Turrell G (2013) Geographic remoteness, area-level socioeconomic disadvantage and inequalities in colorectal cancer survival in Queensland: a multilevel analysis. BMC Cancer 13:493CrossRefGoogle Scholar
  17. 17.
    Zucca A, Boyes A, Newling G, Hall A, Girgis A (2011) Travelling all over the countryside: travel-related burden and financial difficulties reported by cancer patients in New South Wales and Victoria. Aust J Rural Health 19(6):298–305CrossRefGoogle Scholar
  18. 18.
    Butow PN et al (2012) Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer 20(1):1–22CrossRefGoogle Scholar
  19. 19.
    Johnson CE, Lizama N, Garg N, Ghosh M, Emery J, Saunders C (2014) Australian general practitioners' preferences for managing the care of people diagnosed with cancer. Asia Pac J Clin Oncol 10(2):e90–e98CrossRefGoogle Scholar
  20. 20.
    Gracey M (2014) Why closing the aboriginal health gap is so elusive. Intern Med J 44(11):1141–1143CrossRefGoogle Scholar
  21. 21.
    Australian Institute of Health and Welfare (AIHW) and Cancer Australia (2018) Cancer in Aboriginal & Torres Strait Islander people of Australia. AIHW, CanberraGoogle Scholar
  22. 22.
    Australian Institute of Health and Welfare (AIHW) (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. AIHW, CanberraGoogle Scholar
  23. 23.
    Chong A, Roder D (2010) Exploring differences in survival from cancer among indigenous and non-indigenous Australians: implications for health service delivery and research. Asian Pac J Cancer Prev 11(4):953–961Google Scholar
  24. 24.
    Condon JR et al (2004) Long-term trends in cancer mortality for indigenous Australians in the Northern Territory. Med J Aust 180(10):504–507Google Scholar
  25. 25.
    Garvey G, Cunningham J, Janda M, Yf He V, Valery PC (2018) Psychological distress among indigenous Australian cancer survivors. Support Care Cancer 26(6):1737–1746CrossRefGoogle Scholar
  26. 26.
    Shahid S, Finn L, Bessarab D, Thompson SC (2011) Nowhere to room ... Nobody told them': logistical and cultural impediments to aboriginal peoples' participation in cancer treatment. Aust Health Rev 35(2):235–241CrossRefGoogle Scholar
  27. 27.
    Valery PC, Bernardes CM, Beesley V, Hawkes AL, Baade P, Garvey G (2017) Unmet supportive care needs of Australian aboriginal and Torres Strait islanders with cancer: a prospective, longitudinal study. Support Care Cancer 25(3):869–877CrossRefGoogle Scholar
  28. 28.
    Australian Bureau of Statistics (ABS) (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians. ABS, CanberraGoogle Scholar
  29. 29.
    Panaretto KS, Gardner KL, Button S, Carson A, Schibasaki R, Wason G, Baker D, Mein J, Dellit A, Lewis D, Wenitong M, Ring I (2013) Prevention and management of chronic disease in aboriginal and islander community controlled health Services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services. BMJ Open 3(4):e002083CrossRefGoogle Scholar
  30. 30.
    Gomersall JS, Gibson O, Dwyer J, O'Donnell K, Stephenson M, Carter D, Canuto K, Munn Z, Aromataris E, Brown A (2017) What indigenous Australian clients value about primary health care: a systematic review of qualitative evidence. Aust N Z J Public Health 41(4):417–423CrossRefGoogle Scholar
  31. 31.
    de Witt A, Cunningham FC, Bailie R, Bernardes CM, Matthews V, Arley B, Meiklejohn JA, Garvey G, Adams J, Martin JH, Walpole ET, Williamson D, Valery PC (2017) Identification of Australian aboriginal and Torres Strait islander Cancer patients in the primary health care setting. Front Public Health 5:199CrossRefGoogle Scholar
  32. 32.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefGoogle Scholar
  33. 33.
    Young JL et al (2001) Summary Staging Manual 2000: Codes and Coding Instructions. National Cancer Institute, BethesdaGoogle Scholar
  34. 34.
    Garvey G, Beesley VL, Janda M, O'Rourke PK, He VYF, Hawkes AL, Elston JK, Green AC, Cunningham J, Valery PC (2015) Psychometric properties of an Australian supportive care needs assessment tool for indigenous patients with cancer. Cancer 121(17):3018–3026CrossRefGoogle Scholar
  35. 35.
    Holmberg L (2005) The role of the primary-care physician in oncology care. Primary healthcare and specialist cancer services. Lancet Oncol 6(2):121–122Google Scholar
  36. 36.
    Deeble J (2009) Assessing the health service use of aboriginal and Torres Strait islander peoples. Department of Health and Ageing, Australian Government Canberra. Available from: Accessed 1 Sept 2018
  37. 37.
    Australian Institute of Health and Welfare (AIHW) (2018) Mental health services in Australia [7 Jul 2018]. Available from: Accessed 1 Sept 2018
  38. 38.
    Brennan M et al (2011) Follow up after breast cancer -- views of Australian women. Aust Fam Physician 40(5):311–316Google Scholar
  39. 39.
    Wind J, Duineveld LA, van der Heijden RP, van Asselt KM, Bemelman WA, van Weert HC (2013) Follow-up after colon cancer treatment in the Netherlands; a survey of patients, GPs, and colorectal surgeons. Eur J Surg Oncol 39(8):837–843CrossRefGoogle Scholar
  40. 40.
    Jacobsen PB, Wagner LI (2012) A new quality standard: the integration of psychosocial care into routine cancer care. J Clin Oncol 30(11):1154–1159CrossRefGoogle Scholar
  41. 41.
    Matthews V et al (2018) Submission to the Senate Inquiry, “Accessibility and quality of mental health services in rural and remote Australia” On behalf of the Centre for Research Excellence in integrated quality improvementGoogle Scholar
  42. 42.
    Handley TE, Lewin TJ, Perkins D, Kelly B (2018) Self-recognition of mental health problems in a rural Australian sample. Aust J Rural Health 26(3):173–180CrossRefGoogle Scholar
  43. 43.
    Garvey G et al (2016) Indigenous cancer patient and staff attitudes towards unmet needs screening using the SCNAT-IP. Support Care Cancer 24(1):215–223CrossRefGoogle Scholar
  44. 44.
    Tzelepis F, Paul CL, Sanson-Fisher RW, Campbell HS, Bradstock K, Carey ML, Williamson A (2018) Unmet supportive care needs of haematological cancer survivors: rural versus urban residents. Ann Hematol 97(7):1283–1292CrossRefGoogle Scholar
  45. 45.
    Campbell MA et al (2017) Contribution of aboriginal community-controlled health services to improving aboriginal health: an evidence review. Aust Health Rev 42(2):218–226Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Patricia C. Valery
    • 1
    Email author
  • Christina M. Bernardes
    • 1
  • Audra de Witt
    • 2
    • 3
  • Jennifer Martin
    • 4
  • Euan Walpole
    • 5
  • Gail Garvey
    • 2
  • Daniel Williamson
    • 6
  • Judith Meiklejohn
    • 1
    • 7
  • Gunter Hartel
    • 1
  • Isanka U. Ratnasekera
    • 1
    • 8
  • Ross Bailie
    • 9
  1. 1.Population HealthQIMR Berghofer Medical Research InstituteBrisbaneAustralia
  2. 2.Menzies School of Health ResearchCharles Darwin UniversityDarwinAustralia
  3. 3.Queensland University of Technology, Faculty of Health, Translational Research InstituteBrisbaneAustralia
  4. 4.School of Medicine and Public HealthThe University of NewcastleCallaghanAustralia
  5. 5.Princess Alexandra HospitalWoolloongabbaAustralia
  6. 6.Aboriginal and Torres Strait Islander Health UnitQueensland HealthBrisbaneAustralia
  7. 7.Orange Sky AustraliaBrisbaneAustralia
  8. 8.School of MedicineThe University of QueenslandBrisbaneAustralia
  9. 9.University Centre for Rural HealthThe University of SydneyLismoreAustralia

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