Treatment and outcomes for indigenous and non-indigenous lung cancer patients in the Top End of the Northern Territory.

BACKGROUND: Lung cancer is the most common cause of cancer-related mortality for both Indigenous and non-Indigenous Australians, and the death rate of lung cancer in Indigenous Australians is increasing. AIMS: To provide a comprehensive description of patterns of lung cancer presentation, diagnosis, treatment and outcomes in Indigenous and non-Indigenous Australians in the Top End of the Northern Territory. METHODS: Retrospective cohort study of adult patients with a new diagnosis of lung cancer in the Top End between January 2010 and December 2014. Unadjusted survival probabilities by indigenous status were calculated. The primary end-point was all-cause mortality. RESULTS: Despite receiving similar diagnostic procedures and treatment, Indigenous Australians with lung cancer have poorer 1- and 5-year survival (25.0% and 9.4% respectively), when compared to non-Indigenous Australians included in the study (42.0% and 16.2% respectively). Indigenous lung cancer patients were more likely to be female (51.6% of indigenous patients were female, compared to 30.5% non-indigenous), be current smokers (61.3% vs 36.9%), have more comorbidities (73.6% vs 52.7%, 24.2% vs 5.3% and 30.8% vs 14.2% for respiratory disease, renal insufficiency and diabetes mellitus respectively), and live in more socio-economically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1% vs 6.8%). They were also more likely to die at home, compared to their non-indigenous counterparts (64.3% vs 26.7%). CONCLUSIONS: Indigenous patients from the Top End diagnosed with lung cancer were more likely to have poorer survival outcomes when compared to non-indigenous people. Potential reasons for the discrepancy in survival need to be addressed urgently.

Pulmonary cryptococcal infection presenting with multiple lung nodules.

Pulmonary infections from the environmental fungus Cryptococcus gattii (C. gattii) are notable for cryptococcomas, which are usually solitary and can be very large. As with infections with Cryptococcus neoformans (C. neoformans) patients can have concomitant cryptococcal meningitis; however, unlike for C. neoformans, infections with C. gattii often occur in immunocompetent patients. The highest published incidence of C. gattii infection has been in the Indigenous Australian population of Arnhem Land in the tropical north of the country. More recently C. gattii has been responsible for outbreaks of cryptococcosis in the Pacific Northwest of Canada and the United States of America (USA). A previously healthy Indigenous male from Arnhem Land presented with pulmonary cryptococcosis with chest imaging showing >50 bilateral lung nodules. This unusual occurrence was attributed to probable inhalation of fungal elements from prior use of a high-pressure leaf blower to clear eucalyptus and other debris in a remote bush camp.

The global burden of respiratory infections in indigenous children and adults: A review.

This review article focuses on common lower respiratory infections (LRIs) in indigenous populations in both developed and developing countries, where data is available. Indigenous populations across the world share some commonalities including poorer health and socio-economic disadvantage compared with their non-indigenous counterparts. Generally, acute and chronic respiratory infections are more frequent and more severe in both indigenous children and adults, often resulting in substantial consequences including higher rates of bronchiectasis and poorer outcomes for patients with chronic obstructive pulmonary disease (COPD). Risk factors for the development of respiratory infections require recognition and action. These risk factors include but are not limited to socio-economic factors (e.g. education, household crowding and nutrition), environmental factors (e.g. smoke exposure and poor access to health care) and biological factors. Risk mitigation strategies should be delivered in a culturally appropriate manner and targeted to educate both individuals and communities at risk. Improving the morbidity and mortality of respiratory infections in indigenous people requires provision of best practice care and awareness of the scope of the problem by healthcare practitioners, governing bodies and policy makers.

Rapid diagnostic tests for defining the cause of community-acquired pneumonia.

PURPOSE OF REVIEW: We review the potential new diagnostic tools for determining the cause of pneumonia in the setting of community-acquired infection after outlining the limitation of currently available tests. RECENT FINDINGS: A number of new tools are on the horizon with the potential to overcome the problems of existing tests. These tools include new nucleic acid amplification platforms, real-time computer-assisted microscopy, next-generation sequencing and high-throughput mass spectrometry. All of these tests still face significant barriers before they can enter general clinical practice including cost, reliability and physician acceptance. SUMMARY: Although new platforms are exciting and do offer the promise of finally moving beyond our current very limited scope of microbiological tests, empiric therapy based on knowledge of local epidemiological data is likely to remain the standard of care until the hurdles of proven accuracy, physician acceptance and cost-effectiveness are successfully negotiated.