Strengthening cancer education evidence to achieve equity in outcomes for First Nations Australians

Cancer is the leading cause of mortality for Aboriginal and Torres Strait Islander people who experience lower levels of cancer survival rates than non-Indigenous Australians. As cancer incidence and mortality has decreased for non-Indigenous Australians, they have increased for Indigenous Australians.¹ Disadvantage across a range of socio-economic and health indicators, poorer access to health services, systemic discrimination, communication barriers, lower health literacy, and a lack of culturally appropriate care all contribute to this widening gap.^1,2

In the Lancet Regional Health—Western Pacific, Crook and colleagues’ narrative review explores how education programs work to improve First Nations Australians understanding of cancer with a focus on prevention, screening and treatment. Through the assessment of 14 evaluated initiatives the authors have identified important factors that contribute to the effectiveness of cancer education initiatives targeting First Nations Australians. These include the importance of co-design and consultation, local ownership and empowerment.

To strengthen this limited evidence base we support the authors recommendation that more emphasis needs to be placed on evaluation of education activities for First Nations Australians, with a focus on priorities identified and led by Aboriginal and Torres Strait Islander communities.

In 2023 Cancer Australia led the development of the Australian Cancer Plan (ACP)³ that provides a ten-year future focused plan to accelerate world-class cancer outcomes and improve the lives of all Australians affected by cancer. Achieving equity for Aboriginal and Torres Strait Islander people is the most significant ambition for the future of cancer care in Australia and at the center of the ACP.

Underpinning the ACP are six Strategic Objectives which identify where national focus and effort are best directed to deliver better outcomes for the next decade and beyond. This includes the priority action to strengthen health literacy for Aboriginal and Torres Strait Islander people through co-designed health and lifestyle strategies for cancer prevention. All components of the ACP relevant to Aboriginal and Torres Strait Islander people were developed through a co-design approach with Aboriginal and Torres Strait Islander leaders. Implementation of the ACP and associated priority actions is a shared responsibility requiring coordinated action across the cancer control sector.

The reviews key findings support the ACPs acknowledgement that Aboriginal and Torres Strait Islander health belongs in Aboriginal and Torres Strait Islander hands, and to improve First Nations cancer outcomes leadership and significant involvement of Aboriginal and Torres Strait Islander people in developing, implementing and evaluating priority actions identified in the ACP is required.

To support implementation of the ACP Cancer Australia partnered with Indigenous researchers to develop Key Principles and Best Practice approaches to co-design.⁴ A practical guide has also been developed to support co-design for people who work in health policy, service and program design. The guide supports users to develop initiatives using best practice approaches to uphold Aboriginal and Torres Strait Islander leadership, partnership and shared decision making. The key findings of the review offer valuable insight into the acceptability, impact and viability of cancer education initiatives, and provide further evidence to support the Key Principles to co-design.

Cancer Australia is undertaking a range of priority actions of the ACP to improve First Nations cancer outcomes. This includes the Partnerships for culturally safe cancer care grant program that supports cancer services and Aboriginal and Torres Strait Islander community-controlled health organisations to deliver culturally safe cancer care across all health sectors. The program will strengthen health sector alignment to the ACP and the National Aboriginal Community Controlled Health Organisation (NACCHO) Cancer Plan (2023).⁵

All grant activities are underpinned by the Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer.⁶ Where appropriate, activities will be evaluated adopting Indigenous research methodologies that will further strengthen the evidence to support development of cancer education programs for First Nations Australians.

Cancer Australia in partnership with relevant Indigenous led organisations is also building the capacity and capability of Aboriginal and Torres Strait Islander researchers by supporting development of academic scholars and their access to research opportunities including research in priority areas that include prevention and early detection.

Cancer Australia agrees with the review that overcoming the social, economic, and cultural determinants of health which affect the education and understanding of First Nations people requires knowledge dissemination, trust-building, and sustained engagement at both the community and healthcare system levels.

As noted by the authors Cancer Australia has several health promotion initiatives designed to strengthen health literacy and destigmatise cancer, this includes the Our Mob and Cancer website and Yarn for Life national health promotion campaign. We agree with the authors on the importance of evaluating health education programs, and the upcoming two-year evaluation of the ACP provides an opportunity to assess how these and other initiatives contribute to achieving the goals of the ACP and how health literacy can be strengthened through robust Indigenous led approaches to evaluation.

We acknowledge the identified need for long-term commitment to removing systemic barriers rather than short-term and project-based funding. Cancer Australia encourages the cancer care system to join with us to implement the ACP, particularly its imperative to see optimal culturally safe cancer care provided across the county embedding Aboriginal and Torres Strait Islander voice, culture, strength, and knowledge. Essential to this is the need to strengthen the evidence base to achieve Indigenous led partnerships that develop, implement and evaluate health education programs to achieve equity in cancer outcomes for Aboriginal and Torres Strait Islander people.

Contributors

Jacinta Elston–Conceptualization, Writing–review and editing.

Caroline Nehill–Conceptualization, Writing–original draft.

Dorothy Keefe–Conceptualization, Writing–review and editing.

Declaration of interests

The authors have no conflicts of interest to declare.