Aims: To describe the gaps in outcomes for the four most common cancer types for Australian Indigenous people and to identify future research and health service priorities activities to reduce any disparities.

Methods: The Aboriginal Patterns of Cancer Care Project (APOCC) used mixed methods including analysis of linked data, a medical records audit, qualitative interviews and a telephone survey to investigate the magnitudes and possible causes of disparities in cancer outcomes between Indigenous and non-Indigenous people in New South Wales, Australia.

Results: Survival was lower for Indigenous people each of the four most common cancers: lung (adjusted Sub-Hazard Ratio 1.32, 95% Confidence interval (CI) 1.14-1.52), breast (adjusted Hazard Ratio (aHR)1.30, 95% CI 0.94-1.75), colorectal (aHR 1.68, 95% CI 1.32-2.09) and prostate (aHR 1.49, 95% CI 1.07-1.99). Indigenous people, compared to a non-Indigenous person, were less likely to receive surgery for cancers of the lung (adjusted OR (aOR) 0.65 95% CI 0.45-0.94), breast (aOR 0.60 95% CI 0.39-0.95) and prostate (aOR 0.60, 95% CI 0.40–0.91) but not for colorectal. For Indigenous people the observed rates of adjuvant chemotherapy and radiotherapy for all four cancers were less than recommended but were similar to that in previous population-based studies. Interviews identified that disparities in care may be due to cultural as well as practical barriers. Finally we measured participant’s perceived Aboriginal community engagement (ACE) to understand how this influenced their access to health services and our ACE scale had good internal consistency reliability (Cronbach’s alpha 0.82) and promising construct validity for Indigenous people with cancer.

Conclusions: Demographic, disease and treatment differences do not fully explain the differences observed in survival for Indigenous people with cancer compared with non-Indigenous people. Closing the gap in cancer outcomes for Indigenous people will require measuring and reducing cultural and practical barriers to care.