title: Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables.
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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Ming
authors: M
authors: Sze
authors: 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.
authors: Phyllis
authors: P
authors: Butow
authors: 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.
authors: Melanie
authors: M
authors: Bell
authors: 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.
authors: Lisa
authors: L
authors: Vaccaro
authors: 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.
authors: Skye
authors: S
authors: Dong
authors: 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.
authors: Maurice
authors: M
authors: Eisenbruch
authors: 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.
authors: Michael
authors: M
authors: Jefford
authors: 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.
authors: Afaf
authors: A
authors: Girgis
authors: 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.
authors: Madeleine
authors: M
authors: King
authors: 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.
authors: Joshua
authors: J
authors: McGrane
authors: 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.
authors: Weng
authors: W
authors: Ng
authors: 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.
authors: Ray
authors: R
authors: Asghari
authors: 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.
authors: Phillip
authors: P
authors: Parente
authors: 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.
authors: Winston
authors: W
authors: Liauw
authors: 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.
authors: David
authors: D
authors: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001315:Australia; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D011379:Prognosis; D011788:Quality of Life; D014171:Transients and Migrants / Q000523:psychology
keywords: Anxiety; Cancer; Depression; Health disparities; Health-related quality of life; Migrants