Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

Psychosocial outcomes in first-generation immigrant cancer patients in Australia (#249)

Ming Sze 1 , Phyllis Butow 1 , Melanie Bell 1 , David Goldstein 2 , Madeleine King 1 , Michael Jefford 3 , Afaf Girgis 4 , Maurice Eisenbruch 5 , Lisa Vaccaro 1 , Skye Dong 1
  1. Psycho-Oncology Co-operative Research Group (PoCoG) , The University of Sydney, NSW, Australia
  2. Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
  3. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
  4. Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, UNSW, Sydney, NSW, Australia
  5. School of Psychology, Psychiatry, and Psychological Medicine, Monash University, Clayton, VIC, Australia

Aims
With immigration rising, a common challenge faced by multicultural countries is to optimally manage immigrants’ health-care needs to reduce disparity in outcomes and patient experience. This study compared the level of psychological morbidity and quality of life (OoL) in immigrant and Australian-born, English speaking cancer patients.


Methods
A cross-sectional study was conducted with cancer patients recruited through 16 oncology clinics across three states in Australia. Participants were born in a country where Chinese, Greek or Arabic is spoken, and a control group of Australian-born English-speaking patients. All were diagnosed and treated with cancer within the last 12 months. Questionnaires (completed in preferred language) assessed anxiety and depression (HADS, range 0-14) and QoL (FACT-G, range 0-100). Clinical data were collected from hospital records.

Results
856 of 1409 eligible patients (572 immigrants and 284 Anglo-Australians) participated (response rate=61%). After adjusting for age, gender, education, socio-economic status, marital status, cancer type, staging and treatment, immigrants had clinically significant higher anxiety (OR 2.07, 95%CI: 1.29, 3.31) and depression (OR 3.69, 95%CI: 2.15, 6.34), and poorer QoL (mean difference 5.71, 95%CI: 3.22, 8.20) than their Anglo-Australian counterparts. Many immigrants reported difficulties understanding English (45%); understanding the health system (38%) and communicating with their doctor (73%). Problems understanding the health system predicted anxiety (1.2, 95%CI: 0.3,2.0; P=0.007), depression (0.9, 95%CI: 0.04,1.8; p=0.04) and QoL (1.3, 95%CI: 1.3,7.6; p=0.006); difficulties understanding English predicted anxiety (1.5, 95%CI: 0.5,2.4; p=0.003) and depression (1.1, 95%CI: 0.1,2.1; p=0.03); difficulties communicating with doctors predicted QoL (-3.6, 95%CI: -7.0, -0.1; p=0.04).

Conclusions
These documented disparities in immigrant outcomes warrant psychosocial intervention. Results highlighted areas of immigrant-specific need (support in navigating the health system and communication of information) that may be best addressed at a system level. While the study was conducted with immigrants in Australia, immigrants may face the same challenges globally.