Do ethnic patients report longer lung cancer intervals than Anglo-Australian patients?: Findings from a prospective, observational cohort study.

OBJECTIVE Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo-Australian patients to identify ethnic disparities. METHODS This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo-Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo-Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo-Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted. RESULTS CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26-34] than Anglo-Australian patients (median 17, 95% CI 14-20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09-1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03-1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant. CONCLUSION Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval.

[1]  A. Gavin,et al.  Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP) , 2019, BMJ Open.

[2]  D M Parkin,et al.  Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods , 2018, International journal of cancer.

[3]  Y. Paradies,et al.  Tobacco smoking between immigrants and non‐immigrants in Australia: A longitudinal investigation of the effect of nativity, duration of residence and age at arrival , 2018, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[4]  Jane M. Young,et al.  The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds , 2018, BMC Cancer.

[5]  J. Flickinger,et al.  Population‐based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease , 2018, Cancer medicine.

[6]  S. J. Henley,et al.  Lung cancer survival in the United States by race and stage (2001‐2009): Findings from the CONCORD‐2 study , 2017, Cancer.

[7]  J. Benneyan,et al.  Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review. , 2017, Lung cancer.

[8]  D. Overgaard,et al.  Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis , 2016, Health and Quality of Life Outcomes.

[9]  C. la Vecchia,et al.  Risk factors for lung cancer worldwide , 2016, European Respiratory Journal.

[10]  A. Earnest,et al.  Timeliness of lung cancer care in Victoria: a retrospective cohort study , 2016, The Medical journal of Australia.

[11]  N. Pavlidis,et al.  Lung cancer during pregnancy: A narrative review , 2015, Journal of advanced research.

[12]  P. Butow,et al.  Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables. , 2015, The Oncologist.

[13]  S. Pit,et al.  The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review , 2014, BMC Medical Research Methodology.

[14]  J. Emery,et al.  Diagnosing cancer in the bush: a mixed methods study of GP and specialist diagnostic intervals in rural Western Australia. , 2013, Family practice.

[15]  Rachelle Buchbinder,et al.  The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ) , 2013, BMC Public Health.

[16]  M. Frydenberg,et al.  Evidence of increasing mortality with longer diagnostic intervals for five common cancers: a cohort study in primary care. , 2013, European journal of cancer.

[17]  Bernard Rachet,et al.  Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007 , 2013, Thorax.

[18]  J. Emery,et al.  The model of pathways to treatment: conceptualization and integration with existing theory. , 2013, British journal of health psychology.

[19]  Ali O. Farooqi,et al.  Lung cancers diagnosed at annual CT screening: volume doubling times. , 2012, Radiology.

[20]  A. Bezjak,et al.  Understanding the needs of lung cancer patients during the pre-diagnosis phase , 2012, Journal of Cancer Education.

[21]  J. Emery,et al.  The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis , 2012, Journal of health services research & policy.

[22]  J. Emery,et al.  The Aarhus statement: improving design and reporting of studies on early cancer diagnosis , 2012, British Journal of Cancer.

[23]  J. Prins,et al.  The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways , 2012, Psycho-oncology.

[24]  G. Pison.  The number and proportion of immigrants in the population: international comparisons , 2010 .

[25]  C. Weldon,et al.  Primary lung tumors in children and adolescents: a 90-year experience. , 2010, Journal of pediatric surgery.

[26]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[27]  V. Allgar,et al.  Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer , 2005, British Journal of Cancer.

[28]  J. Emery,et al.  Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies. , 2017, European journal of cancer care.