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Supportive Care in Cancer

, Volume 21, Issue 9, pp 2509–2520 | Cite as

Unmet needs in immigrant cancer survivors: a cross-sectional population-based study

  • P. N. ButowEmail author
  • M. L. Bell
  • L. J. Aldridge
  • M. Sze
  • M. Eisenbruch
  • M. Jefford
  • P. Schofield
  • A. Girgis
  • M. King
  • P. S. Duggal
  • J. McGrane
  • D. Goldstein
  • on behalf of the Psycho-Oncology Co-operative Research Group (PoCoG) CALD team
Original Article

Abstract

Purpose

Social suffering, language difficulties, and cultural factors may all make the cancer experience more difficult for immigrants. This study aimed to document unmet needs, and variables associated with these, in a population-based sample of first-generation immigrants and Anglo-Australians who had survived cancer.

Methods

Participants were recruited via Australian cancer registries. Eligible cancer survivors had a new diagnosis 1–6 years earlier and were aged between 18 and 80 years at diagnosis. Eligible immigrant participants and parents were born in a country where Arabic, Chinese (Mandarin, Cantonese, and other dialects), or Greek is spoken, and they spoke one of these languages. A random sample of English-speaking Anglo-Australian-born controls was recruited.

Results

Five hundred ninety-six patients (277 immigrants) were recruited to the study (response rate, 26 %). Compared to Anglo-Australians, the adjusted odds ratio of Chinese immigrants for at least one unmet information/support need was 5.1 (95 % CI 3.1, 8.3) and for any unmet physical need was 3.1 (95 % CI 1.9, 5.1). For Greek, these were 2.0 (95 % CI 1.1, 4.0) and 2.7 (95 % CI 1.4, 5.2). Arabic patients had elevated, but not statistically significant, odds ratios compared to Anglo-Australians. Written information and having a specialist, support services, and other health professionals who spoke their language were in the top ten unmet needs amongst immigrants.

Conclusion

Immigrant cancer survivors, several years after initial diagnosis, are more likely to have an unmet need for information or for help with a physical problem than Anglo-Australians. They strongly desire information and support in their own language.

Keywords

Unmet needs Immigrants Cancer CALD Multi-culturalism Cultural competence 

Notes

Acknowledgments

We are grateful to the organizations which assisted with access to and recruitment of research participants: New South Wales, Victorian and Queensland cancer registries. In particular, we would like to thank Narelle Grayson and Serina Faraji from the NSW Central Cancer Registry, Helen Farrugia and Sue Douglas from the Victorian Cancer Registry, Kerrie Dennison and Carly Scott from the Queensland Cancer Registry, and Shirley Connell from the Queensland University of Technology for their contribution to methods of identifying participants and recruitment. We are most grateful to members of our community advisory boards who provided invaluable advice on community engagement, interpretation of data, and study procedures. Respectively, they are (1) Arabic Advisory Board: Fr Antonios Kaldas, Mona Saleh, Seham Gerges, Katya Nicholl; (2) Chinese Advisory Board: Wendy Wang, Theresa Chow, Daniel Chan, Viola Yeung, Dr. Agnes Li, Hudson Chen, Dr. Ven Tan, Nancy Tam, Soo See Yeo, Prof. Richard Chye; (3) Greek Advisory Board: Nicole Komninou, Fr Sophronios Konidaris, Maria Petrohilos, Bill Gonopoulos, Dr. Peter Calligeros, Elfa Moraitakis. We would also like to thank our bilingual research assistants who assisted with patient recruitment and all our participants. Professor Butow and A/Prof Schofield hold NHMRC fellowships. Professor King is supported by the Australian Government through Cancer Australia.

Funding

This study was funded by a grant from the Australian National Health and Medical Research Council (#457432), beyondblue: the national depression initiative, and the Victorian Community Foundation—James & Vera Lawson Trust (managed by ANZ trustees). Professor Butow holds a NHMRC Senior Principal research fellowship, and A/Prof Schofield holds a NHMRC career development fellowship (CDA level 2).

Conflict of interest

The authors have no financial relationships with any of the organizations that sponsored the research. We have full control of all primary data and agree to allow the journal to review the data if requested.

References

  1. 1.
    Luckett T, Goldstein D, Butow P, Gebski V, Aldridge LJ, McGrane J, Ng W, King MT (2011) Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis. Lancet Oncol 12:1240–1248CrossRefGoogle Scholar
  2. 2.
    Butow P, Aldridge LJ, Bell ML, Sze M, Eisenbruch M, Jefford M, Schofield P, Girgis A, King MT, Duggal-Beri P, McGrane J, Goldstein D (2013) Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: a population based study. Eur J Cancer. doi: 10.1016/j.ejca.2013.01.011 CrossRefGoogle Scholar
  3. 3.
    Foot G (1996) Needs assessment in tertiary and secondary oncology practice: a conceptual and methodological exposition. PhD University of Newcastle, NewcastleGoogle Scholar
  4. 4.
    Foot G, Sanson-Fisher R (1995) Measuring the unmet needs of people living with cancer. Cancer Forum 19:131–135Google Scholar
  5. 5.
    Harrison J, Young JM, Price MA, Butow PN, Solomon M (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17:1117–28CrossRefGoogle Scholar
  6. 6.
    Butow PN, Sze M et al (2010) From inside the bubble: migrant’s perceptions of communication with the cancer team. Support Care Cancer 19:281–290CrossRefGoogle Scholar
  7. 7.
    Ngui EM, Flores G (2007) Unmet needs for specialty, dental, mental, and allied health care among children with special health care needs: are there racial/ethnic disparities? J Health Care Poor Underserved 18:931–949CrossRefGoogle Scholar
  8. 8.
    Moadel AB, Morgan C, Dutcher J (2007) Psychosocial needs assessment among an underserved, ethnically diverse cancer patient population. Cancer 15:446–454CrossRefGoogle Scholar
  9. 9.
    Schuman H (1996) The random probe: a technique for evaluating the validity of closed questions. Am Sociol Rev 31:218–222CrossRefGoogle Scholar
  10. 10.
    Bonevski B, Sanson-Fisher RW, Girgis A, Burton L, Cook BA (2000) Evaluation of an instrument to assess the needs of patients with cancer. Cancer 88:217–225CrossRefGoogle Scholar
  11. 11.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Cancer 88:226–237CrossRefGoogle Scholar
  12. 12.
    Boyes AW, Girgis A, D’Este C, Zucca AC (2012) Prevalence and correlates of cancer survivors’ supportive care needs 6 months after diagnosis: a population-based cross-sectional study. BMC Cancer 12:150CrossRefGoogle Scholar
  13. 13.
    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, Wain G (2007) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors’ Unmet Needs measure). Psycho-Oncology 16:796–804CrossRefGoogle Scholar
  14. 14.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefGoogle Scholar
  15. 15.
    Mystakidou K, Tsilika E, Parpa E, Katsouda E, Galanos A, Vlahos L (2004) The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability. Support Care Cancer 12:821–825CrossRefGoogle Scholar
  16. 16.
    Leung CM, Ho S, Kan CS, Hung CH, Chen CN (1993) Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom 40:29–34PubMedGoogle Scholar
  17. 17.
    Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy (FACT) scale: development and validation of the general measure. J Clin Oncol 11:570–579CrossRefGoogle Scholar
  18. 18.
    Cheung YB, Goh C, Wee J, Khoo KS, Thumboo J (2009) Measurement properties of the Chinese language version of the functional assessment of cancer therapy-general in a Singaporean population. Ann Acad Med Singap 38:225–229PubMedGoogle Scholar
  19. 19.
    Bonomi AE, Cella DF, Hahn EA, Bjordal K, Sperner-Unterweger B, Gangeri L, Bergman B, Willems-Groot J, Hanquet P, Zittoun R (1996) Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system. Qual Life Res 5:309–320CrossRefGoogle Scholar
  20. 20.
    McElduff P, Boyes A, Zucca A, Girgis A (2004) The Supportive Care Needs Survey: a guide to administration, scoring and analysis. Centre for Health Research & Psycho-Oncology, NewcastleGoogle Scholar
  21. 21.
    Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 13:290–312CrossRefGoogle Scholar
  22. 22.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research. Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182CrossRefGoogle Scholar
  23. 23.
    Shavers V (2007) Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 99:1013–1023PubMedPubMedCentralGoogle Scholar
  24. 24.
    Dysart-Gale D (2007) Clinicians and medical interpreters. Negotiating culturally appropriate care for patients with limited English ability. Fam Community Health 30:237–246CrossRefGoogle Scholar
  25. 25.
    Flores G (2005) The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev 62:255–299CrossRefGoogle Scholar
  26. 26.
    Butow PN, Goldstein D, Bell ML, Sze M, Aldridge LJ, Abdo S, Mikhail M, Dong S, Iedema R, Vardy J, Ashgari R, Hui R, Eisenbruch M (2011) Interpretation in consultations with immigrant cancer patients; how accurate is it? J Clin Oncol 29:2801–2807CrossRefGoogle Scholar
  27. 27.
    Kaufert JM, Koolage WW (1984) Role conflict among ‘culture brokers’: the experience of Native Canadian medical interpreters. Soc Sci Med 18:283–286CrossRefGoogle Scholar
  28. 28.
    Ashing-Giwa KT, Tejero JS, Kim J et al (2009) Cervical cancer survivorship in a population based sample. Gynecol Oncol 112:358–364CrossRefGoogle Scholar
  29. 29.
    Giedzinska AS, Meyerowitz BE, Ganz PA, Rowland JH (2004) Health-related quality of life in a multiethnic sample of breast cancer survivors. Ann Behav Med 28:39–51CrossRefGoogle Scholar
  30. 30.
    Dohan D, Schrag D (2005) Using navigators to improve care of underserved patients: current practices and approaches. Cancer 104:848–855CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • P. N. Butow
    • 1
    • 2
    Email author
  • M. L. Bell
    • 1
    • 2
  • L. J. Aldridge
    • 1
    • 2
  • M. Sze
    • 1
    • 2
  • M. Eisenbruch
    • 3
  • M. Jefford
    • 4
    • 5
    • 6
  • P. Schofield
    • 4
    • 5
    • 6
  • A. Girgis
    • 7
  • M. King
    • 1
    • 2
  • P. S. Duggal
    • 1
    • 2
  • J. McGrane
    • 8
  • D. Goldstein
    • 9
    • 10
  • on behalf of the Psycho-Oncology Co-operative Research Group (PoCoG) CALD team
  1. 1.Psycho-Oncology Co-operative Research Group (PoCoG)University of SydneySydneyAustralia
  2. 2.School of PsychologyUniversity of SydneySydneyAustralia
  3. 3.School of Psychology and PsychiatryMonash UniversityMelbourneAustralia
  4. 4.Department of Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneAustralia
  5. 5.Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneAustralia
  6. 6.Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneAustralia
  7. 7.Ingham Institute for Applied Medical Research, South Western Sydney Clinical SchoolUniversity of New South WalesSydneyAustralia
  8. 8.Pearson Psychometric Laboratory, Faculty of EducationUniversity of Western AustraliaPerthAustralia
  9. 9.Faculty of MedicineUniversity of NSWSydneyAustralia
  10. 10.Dept of Medical OncologyPrince of Wales HospitalSydneyAustralia

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