Quality of cancer care among foreign-born and US-born patients with lung or colorectal cancer

Authors

  • Signe Smith Nielsen MSc,

    1. Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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  • Yulei He PhD,

    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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  • John Z. Ayanian MD, MPP,

    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
    2. Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Scarlett Lin Gomez PhD,

    1. Northern California CancerCenter, Fremont, California
    2. Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford, California
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  • Katherine L. Kahn MD,

    1. Rand Health, RAND Corporation, Santa Monica, California
    2. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California
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  • Dee W. West PhD,

    1. Northern California CancerCenter, Fremont, California
    2. Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford, California
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  • Nancy L. Keating MD, MPH

    Corresponding author
    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
    2. Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    • Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
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    • Fax: (617) 432-0173


Abstract

BACKGROUND:

Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended care differed between US-born and foreign-born cancer patients.

METHODS:

The authors collected surveys and medical records for a population-based cohort including white, Hispanic, and Asian adults (2205 US-born and 890 foreign-born individuals) with lung or colorectal cancer diagnosed in California from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer, and curative surgery for stage I/II nonsmall cell lung cancer). The authors also assessed whether language explained any differences in care by nativity.

RESULTS:

Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality of care (adjusted odds ratio [AOR], 0.80; 95% confidence interval [95% CI], 0.65-1.00), a difference partly explained by the language of the survey, an indicator of English proficiency. Rates of recommended therapies ranged from 64% to 85%; foreign-born patients were less likely to receive chemotherapy and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12-0.99). Rates of other treatments did not differ significantly by nativity.

CONCLUSIONS:

Foreign-born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States. Better coordination of care and communication regarding cancer treatments and expanded use of interpreters may lessen these disparities. Cancer 2010. © 2010 American Cancer Society.

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