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

Abstract

BackgroundLung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences.MethodsThis is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted.DiscussionThis is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds.Trial registrationThe project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392, date registered: 4th July 2017).

Equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia: a scoping review

“…Only one study examined the diagnostic pathway for CALD populations [ 51 ]. The LEAD protocol details a prospective observational cohort study to compare the diagnostic pathways for lung cancer between CALD and ‘Anglo-Australian’ populations, with no results available to date [ 51 ]. Eighteen studies analysed the treatment stage of the cancer care continuum [ 5 , 12 , 52 – 67 ].…”

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

“…LEAD was a prospective, observational cohort study using a mixedmethod approach (Mazza et al, 2018). Here, we report on the quantitative substudy, which comprised a case-note analysis of Anglo-Australian patients were defined as those born in Australia and four other major English-speaking countries (Canada, New Zealand, the United Kingdom and the United States).…”

“…As outlined in our protocol paper (Mazza et al, 2018), we aimed to recruit 724 patients (362 per group) (assuming a 50% patient survey completion rate and a 80% GP review completion rate, based on previous studies, e.g., Emery et al, 2013) in order to achieve a final sample of 290 participants (145 per group). This sample size provides 90% power for a log-rank test with a two-sided alpha of 0.05 to detect a difference in median intervals of 60 versus 88 days (assuming an exponential distribution of survival times).…”

Providing outpatient cancer care for CALD patients: a qualitative study

“…The perspectives of CALD patients, their families and communities, and of HCIs, are needed to comprehensively study these issues. The study examined care provided to those patients who have been referred and are being treated at cancer centres, while evidence indicates reduced screening rates and delays in presentations for CALD community members [ 39 , 40 ]; an important aspect of inequalities in cancer care not addressed in this paper. Overcoming language barriers was what was observed to dominate practice and is the focus of this paper; it is likely that some of the communication difficulties also reflect cultural differences [ 19 , 23 ], which were not systematically explored.…”