Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Inferior quality of life and psychological well-being in immigrant cancer survivors (#245)

Phyllis N Butow 1 , Lynley Aldridge 2 , Melanie Bell 2 , Ming Sze 2 , Maurice Eisenbruch 3 , Michael Jefford 4 , Penelope Schofield 5 , Afaf Girgis 6 , Madeleine King 2 , Priya Dugal-Beri 2 , David Goldstein 7
  1. CeMPED/ PoCoG, The University of Sydney, NSW, Australia
  2. PoCoG, Sydney, NSW, Australia
  3. Monash University, School of Psychology and Psychiatry, Melbourne, VIC, Australia
  4. Dept of Medical Oncology, Peter McCallum Cancer Centre, Melbourne, VIC, Australia
  5. Peter McCallum Cancer Centre, Department of Nursing and Supportive Care Research, Melbourne, VIC, Australia
  6. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
  7. Dept of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia

Background: Social suffering, language difficulties and cultural factors may contribute to poorer outcomes for immigrants with cancer. We compared quality of life (QoL) and psychological morbidity in a population-based sample of first generation immigrants and Anglo-Australians cancer survivors.

Methods: Eligible cancer survivors, recruited via 3 Australian Cancer Registries, were newly diagnosed with one of 12 most incident cancers (all stages) 1–6 years earlier, aged 18-80 years at diagnosis and had a treating doctor who approved approach.  Eligible immigrant participants and both parents were born in a country where Chinese, Arabic, or Greek is the primary language and spoke one of these languages. A random sample of English-speaking Anglo-Australian controls frequency matched for cancer diagnosis was recruited.  QoL and psychological morbidity were assessed with the Functional Assessment of Cancer Therapy – General (FACT-G) and Hospital Anxiety and Depression Scale (HADS). Multiple linear regression adjusted for sociodemgraphic variables.

Results: 596 patients (including 277 immigrants) participated. As 20% of cancer stage data was missing, stage was excluded from analyses (but estimates for impact of immigrancy were unaffected when stage was included in sensitivity analyses). After adjusting for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QoL (5.4-8.5 FACT-G points, p<0.0001) and higher depression (p<0.0001) than Anglo-Australians. Understanding the health system partially mediated the relationship between immigrant status and depression (p = 0.0004) and QoL (p=0.001), accounting for 55% of the total effect for depression, and 25% for QoL. Participants with higher confidence understanding English had higher QoL by 5.0 points (p = 0.06).

Conclusions: Immigrant cancer survivors have worse psychological and QoL outcomes compared with Anglo Australians. Interventions to reduce disparities could include assistance in navigating the health system, translated information and cultural competency training for health professionals.