癌症中的移民健康：结局差异及特定移民变量的决定作用
Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables.
作者信息
Sze Ming, Butow Phyllis, Bell Melanie, Vaccaro Lisa, Dong Skye, Eisenbruch Maurice, Jefford Michael, Girgis Afaf, King Madeleine, McGrane Joshua, Ng Weng, Asghari Ray, Parente Phillip, Liauw Winston, Goldstein David
机构信息
Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia; School of Psychology and Psychiatry, Monash University, Victoria, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre and Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia; Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia; Bankstown-Lidcombe Hospital Cancer Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia; Department Medical Oncology, Eastern Health and Monash University, Box Hill, Victoria, Australia; St. George and Sutherland Cancer Care Centre, St. George Hospital, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
出版信息
Oncologist. 2015 May;20(5):523-31. doi: 10.1634/theoncologist.2014-0274. Epub 2015 Mar 23.
BACKGROUND
Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based sample of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables.
METHODS
Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously.
RESULTS
In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL; 3.6-7.3 points on FACT-G, p < .0001), higher depression and anxiety (both p < .0001), and higher incidence of clinical depression (p < .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p < .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes.
CONCLUSION
Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.
背景
多民族社会在提供基于证据且具备文化胜任力的医疗保健方面面临挑战。本研究比较了以医院为基础的第一代移民样本与澳大利亚出生的盎格鲁癌症患者的健康相关生活质量和心理疾病情况，同时控制了与移民身份相关的潜在混杂因素。此外，还探讨了种族与移民相关变量的相对贡献。
方法
通过澳大利亚的16家肿瘤诊所招募符合条件的参与者，包括年龄在18岁以上、在过去12个月内被诊断患有癌症（任何类型或阶段）且至少在1个月前开始治疗的患者。
结果
共有571名移民患者（包括145名阿拉伯人、248名中国人和178名希腊人）以及274名盎格鲁 - 澳大利亚患者组成的对照组参与研究。在调整了年龄、性别、教育程度、婚姻状况、社会经济地位、确诊时间和癌症类型的多元线性回归模型中，与盎格鲁 - 澳大利亚人相比，移民的健康相关生活质量（HRQL；FACT - G量表上低3.6 - 7.3分，p <.0001）、抑郁和焦虑程度更高（均p <.0001），临床抑郁症（p <.0001）和焦虑症（p =.003）的发病率也更高。对医疗系统的了解（每个结果的p <.0001）以及与医生沟通困难（p =.04至.0001）部分介导了移民身份的影响。在仅针对移民的分析中，预测结果的是与移民相关的变量（语言困难和对医疗系统的理解不足），而非种族。
结论
患癌症的移民在心理和健康相关生活质量方面的结果比盎格鲁 - 澳大利亚人更差。潜在的干预目标包括帮助患者熟悉医疗系统、提供翻译信息以及对医疗专业人员进行文化胜任力培训。
Zotero 插件