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患者报告了接受乳腺癌手术的移民和加拿大长期居民女性的症状负担。

Patient reported symptom burden amongst immigrant and Canadian long-term resident women undergoing breast cancer surgery.

机构信息

Department of Surgery, McMaster University, Hamilton, ON, Canada.

Hamilton Health Sciences, Juravinski Hospital and Cancer Center, Hamilton, ON, Canada.

出版信息

Breast Cancer Res Treat. 2023 Jun;199(3):553-563. doi: 10.1007/s10549-023-06938-8. Epub 2023 Apr 21.

Abstract

PURPOSE

Immigrants are susceptible to marginalization due to social isolation, economic disadvantage and systemic bias. Our goal was to compare symptom burden between immigrant and long-term resident women undergoing breast cancer surgery in Ontario, Canada.

METHODS

A population-level retrospective cohort-study using administrative databases was conducted. Women who underwent surgery for newly diagnosed breast cancer and were treated at regional cancer centers between 2010 and 2016 were included. The primary outcome was a moderate or severe (≥ 4) symptom score on the Edmonton Symptom Assessment System Scale (ESAS).

RESULTS

There were 12,250 (87.2%) long-term Canadian residents and 1,806(12.8%) immigrants. Immigrants were younger (mean age 53 vs. 61 years); had a higher proportion residing in a lowest income quintile neighbourhood (22.2% vs 15.4%); were less often on a primary-care physician roster (83.7% vs. 90.4%); and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p < 0.01). The proportion of women with scores ≥ 4 was significantly higher amongst immigrant women for 7/9 symptom categories; with the largest differences for depression (24.9% vs. 20.2%, p < 0.01) and pain (28.0% vs. 22.4%, p < 0.01). On multivariable regression analysis, immigration status was associated with scores ≥ 4 for pain (OR 1.13, 95% CI 1.02-1.23). There was an association between moderate/severe pain and region of origin, but not length of stay in Canada or immigration class.

CONCLUSIONS

This is the first study comparing symptom burden amongst immigrant and non-immigrant women with breast cancer at a population-level. Immigrant women with breast cancer undergoing surgery were found to have a higher burden of pain.

摘要

目的

移民由于社会孤立、经济劣势和制度偏见而容易受到边缘化。我们的目标是比较在加拿大安大略省接受乳腺癌手术的移民和长期居民女性的症状负担。

方法

使用行政数据库进行了一项基于人群的回顾性队列研究。纳入 2010 年至 2016 年间在区域癌症中心接受新诊断乳腺癌手术治疗的女性。主要结局是埃德蒙顿症状评估系统量表(ESAS)上中度或重度(≥4)症状评分。

结果

有 12250 名(87.2%)长期加拿大居民和 1806 名(12.8%)移民。移民更年轻(平均年龄 53 岁 vs. 61 岁);居住在收入最低五分位数社区的比例更高(22.2% vs. 15.4%);在初级保健医生名单上的比例较低(83.7% vs. 90.4%);并且诊断为 I 期/II 期疾病的比例较低(80.9% vs. 84.6%)(均 p<0.01)。移民女性有 7/9 个症状类别的评分≥4 的比例明显更高;其中抑郁(24.9% vs. 20.2%,p<0.01)和疼痛(28.0% vs. 22.4%,p<0.01)的差异最大。多变量回归分析显示,移民身份与疼痛评分≥4 相关(OR 1.13,95%CI 1.02-1.23)。中度/重度疼痛与原籍国有关,但与在加拿大的居住时间或移民类别无关。

结论

这是第一项在人群水平上比较移民和非移民乳腺癌女性症状负担的研究。接受乳腺癌手术的移民女性疼痛负担更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1826/10119005/634bdb879a6d/10549_2023_6938_Fig1_HTML.jpg

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