Culturally safe cancer survivorship care in general practice - clinical fact sheet and MCQ

Overview

Cancer outcomes in Australia vary significantly across population groups. Aboriginal and Torres Strait Islander people, those in rural and remote areas, LGBTIQA+ people, and people from culturally and linguistically diverse (CALD) backgrounds all experience poorer cancer outcomes and greater barriers to survivorship care than the general population¹.

'Cultural safety' is considered care that is safe as defined by the recipient, free from racism, discrimination and assumption, rather than care that simply avoids overt offence². This implies that responsibility for safety is on the health system and clinician, not the patient.

Current disparities in cancer outcomes

• Aboriginal and Torres Strait Islander people are about 40% more likely to die from cancer than non-Indigenous Australians, and the gap is widening³

• people in rural and remote areas are 1.3 times more likely to die from cancer, with poorer 5-year survival than those in major cities¹

• LGBTIQA+ people affected by cancer face disproportionate psychosocial burdens, with higher levels of distress and ongoing concerns about discrimination that can negatively impact engagement with care and patient experience⁴, and

• people from CALD backgrounds face communication barriers and lower health literacy in navigating the health system, which can affect engagement with ongoing survivorship care⁵

Many people experience more than one source of disadvantage. For example, an Aboriginal person living in a remote area or an LGBTIQA+ person from a culturally and linguistically diverse background may face multiple, compounding barriers to accessing and engaging with care. As a result, people who belong to more than one priority population often experience greater challenges than would be expected from any single factor alone.

Practical considerations for culturally safe and inclusive post treatment cancer care

Aboriginal and Torres Strait Islander patients

• build relationships with local Aboriginal community-controlled health services and Aboriginal health workers/practitioners; refer to these services and co-manage where possible

• recognise health as holistic and connected to land, culture, family, and community

• avoid assuming a single 'Aboriginal experience'; communities and individuals are diverse in language, kinship, and needs

• be aware that systemic and interpersonal racism remains a documented barrier to engagement – actively signal safety rather than assuming its absence, and

• support follow-up and surveillance care as close to home as possible or consider telehealth where necessary; travel for ongoing appointments can place a substantial burden on patients, families and carers, particularly those living in rural and remote communities

Rural and remote patients

• anticipate isolation and disconnection after patients return home from treatment received in distant urban centres – proactively check in rather than waiting for the patient to raise concerns

• use telehealth with the patient's existing specialist team to reduce travel burden while preserving continuity with a trusted clinician

• be conscious that access to allied health and psycho-oncology support for ongoing survivorship needs is lower outside major cities – actively offer referral rather than assuming access, and

• factor in the financial and logistical cost of travel when planning follow-up intensity, and coordinate visits to minimise trips where clinically reasonable

LGBTIQA+ patients

• create routine opportunity to disclose gender identity, sexuality, and chosen family/partners rather than placing the burden of disclosure entirely on the patient

• use the person's stated pronouns and language for their body and relationships

• actively welcome and include partners and chosen family in consultations and decision-making about follow up care, treatment effects and future planning where appropriate

• ask about the impact of cancer and its treatment on relationships, intimacy, sexuality and quality of life, avoiding assumptions about a patient's goals, relationships or support needs

• recognise that previous experiences of discrimination may affect engagement with healthcare

• create visible signs of inclusion within the practice environment (eg intake forms with non-binary options, inclusive language), and

• take additional care when supporting transgender, gender-diverse and intersex patients, who report lower confidence that healthcare services will provide affirming and respectful care

CALD patients

• use accredited professional interpreters rather than family members for clinical discussions, even when a patient's English seems adequate for everyday conversation

• check understanding actively (eg teach-back) rather than assuming comprehension from nodding or brief affirmation

• explore individual information and communication preferences, including preferred language, health literacy needs and preferred modes of receiving information

• provide or direct patients to translated, culturally appropriate cancer information rather than relying on English-only resources

• recognise that language barriers and differing levels of health literacy may affect engagement with post-treatment care

• be aware that CALD survivors may experience unmet needs beyond language barriers, including psychological support, health system navigation and ongoing survivorship planning⁵, and

• recognise that cultural beliefs and stigma surrounding cancer may influence disclosure, help-seeking behaviours, and engagement with ongoing care

Practical principles for all groups

• cultural safety is defined by the patient, not the clinician – check in on what feels safe and appropriate for this person

• proactively signal inclusivity (forms, language, visible cues) rather than waiting for patients to identify their own needs

• do not assume – ask about identity, family structure, and support needs as a routine part of consultation, not an exception

• consider intersecting identities and barriers rather than treating each population group in isolation, and

• cultural safety requires both inclusive clinician behaviour and supportive practice systems. This includes appropriate documentation, interpreter access, staff training and strong referral pathways with community organisations 

References 

1. Cancer Australia. Australian Cancer Plan. 2023. Available at: https://www.australiancancerplan.gov.au/welcome (last accessed Aug 2026).

2. Australian Institute of Health and Welfare. Cultural safety in health care for Indigenous Australians: monitoring framework. Module 2: patient experience of health care (Cat. no. IHW 222). Canberra: AIHW, 2023. https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/module-2-patient-experience-of-health-care (viewed Aug 2026).

3. National Aboriginal Community Controlled Health Organisation (NACCHO). Aboriginal and Torres Strait Islander Cancer Plan. Canberra: NACCHO; 2023. Available: https://www.naccho.org.au/app/uploads/2024/02/NACCHO_CancerPlan_Oct2023_FA_online.pdf (last accessed Aug 2026).

4. Ussher JM, Power R, Allison K, Perz J, Ryan S, Sperring S, Hawkey A, and the Out with Cancer Study Team. Out with Cancer: LGBTIQ+ experiences of cancer survivorship and care. Overview of findings. Sydney: Translational Health Research Institute, Western Sydney University; 2025.

5. Li J, Tan JY, Wang H, et al. Unmet needs of culturally and linguistically diverse cancer survivors in Australia: a systematic review. Eur J Oncol Nurs 2025; 78: 102976.
   

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