Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables

Ming Sze¹, Phyllis Butow², Melanie Bell¹, Lisa Vaccaro¹, Skye Dong¹, Maurice Eisenbruch¹, Michael Jefford¹, Afaf Girgis¹, Madeleine King¹, Joshua McGrane¹, Weng Ng¹, Ray Asghari¹, Phillip Parente¹, Winston Liauw¹, David Goldstein¹; Psycho-oncology Co-operative Research Group Culturally and Linguistically Diverse (CALD) TEAM

Affiliations

¹ Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
² Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia phyllis.butow@sydney.edu.au.

PMID: 25802406
PMCID: PMC4425378
DOI: 10.1634/theoncologist.2014-0274

Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables

Ming Sze et al. Oncologist. 2015 May.

. 2015 May;20(5):523-31.

doi: 10.1634/theoncologist.2014-0274. Epub 2015 Mar 23.

Authors

Affiliations

¹ Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
² Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia phyllis.butow@sydney.edu.au.

PMID: 25802406
PMCID: PMC4425378
DOI: 10.1634/theoncologist.2014-0274

Abstract

Background: Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based sample of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables.

Methods: Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously.

Results: In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL; 3.6-7.3 points on FACT-G, p < .0001), higher depression and anxiety (both p < .0001), and higher incidence of clinical depression (p < .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p < .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes.

Conclusion: Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.

Keywords: Anxiety; Cancer; Depression; Health disparities; Health-related quality of life; Migrants.

©AlphaMed Press.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

See this image and copyright information in PMC

References

1. Cultural competency in health: A guide for policy, partnerships and participation. Canberra, Australia: National Health and Medical Research Council; 2005.
1. U.S. Department of Health . Human Services, Office of Minority Health: National standards for culturally and linguistically appropriate services in health care. Rockville, MD: IQ Solutions; 2001.
1. Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: Burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–2765. - PubMed
1. Luckett T, Goldstein D, Butow PN, et al. Psychological morbidity and quality of life of ethnic minority patients with cancer: A systematic review and meta-analysis. Lancet Oncol. 2011;12:1240–1248. - PubMed
1. World Health Organization . How health systems can address health inequities linked to migration and ethnicity. Copenhagen, Denmark: WHO Regional Office for Europe; 2010. p. 1.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables

Affiliations

Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical