Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors.
BACKGROUND
Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients.


METHODS
This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated.


RESULTS
Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors.


CONCLUSIONS
This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
Department of Medical Oncology, Prince of Wales Hospital, Sydney.
D
D
Goldstein
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney.
M L
ML
Bell
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney phyllis.butow@sydney.edu.au.
P
P
Butow
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney.
M
M
Sze
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney.
L
L
Vaccaro
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney.
S
S
Dong
Cancer Care Centre, St George Hospital, Sydney.
W
W
Liauw
Department of Medical Oncology, Westmead Hospital and Blacktown Oncology Unit, Blacktown Hospital Sydney, Sydney.
R
R
Hui
Department of Cancer Medicine, University of Sydney, Sydney Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney.
M
M
Tattersall
Department of Medical Oncology, Liverpool Hospital, Sydney.
W
W
Ng
Bankstown Cancer Care Centre, Bankstown Lidcombe Hospital, Sydney.
R
R
Asghari
Border Medical Oncology, Wodonga.
C
C
Steer
Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney.
J
J
Vardy
Department of Clinical Haematology and Medical Oncology, Box Hill Hospital, Victoria.
P
P
Parente
Department of Medical Oncology, Monash Medical Centre, Victoria.
M
M
Harris
Department of Medical Oncology, Royal Darwin Hospital, Northern Territory.
N V
NV
Karanth
Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney.
M
M
King
Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, and University of NSW, Sydney.
A
A
Girgis
School of Psych, Psychiatry and Psych Medicine, Monash University, Victoria.
M
M
Eisenbruch
Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria Division of Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
M
M
Jefford
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D010465:Perception; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
cancer outcomes; care co-ordination; health services; immigrant health