Quality of cancer care among foreign-born and US-born patients with lung or colorectal cancer.
BACKGROUND
Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended care differed between US-born and foreign-born cancer patients.


METHODS
The authors collected surveys and medical records for a population-based cohort including white, Hispanic, and Asian adults (2205 US-born and 890 foreign-born individuals) with lung or colorectal cancer diagnosed in California from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer, and curative surgery for stage I/II nonsmall cell lung cancer). The authors also assessed whether language explained any differences in care by nativity.


RESULTS
Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality of care (adjusted odds ratio [AOR], 0.80; 95% confidence interval [95% CI], 0.65-1.00), a difference partly explained by the language of the survey, an indicator of English proficiency. Rates of recommended therapies ranged from 64% to 85%; foreign-born patients were less likely to receive chemotherapy and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12-0.99). Rates of other treatments did not differ significantly by nativity.


CONCLUSIONS
Foreign-born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States. Better coordination of care and communication regarding cancer treatments and expanded use of interpreters may lessen these disparities.
Nielsen
Signe Smith
SS
Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
He
Yulei
Y
Ayanian
John Z
JZ
Gomez
Scarlett Lin
SL
Kahn
Katherine L
KL
West
Dee W
DW
Keating
Nancy L
NL
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000628:therapy*; D003131:Combined Modality Therapy; D054242:Emigrants and Immigrants; D004645:Empathy; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States