Waiting times and treatment following cancer diagnosis: comparison between immigrants and the Norwegian host population

Abstract

Background: There are concerns about timely access to appropriate cancer treatment for the growing immigrant population in Norway. This study aims to compare waiting times between cancer diagnosis and start of cancer treatment, as well as treatment patterns between immigrants in Norway and the host population. Material and methods: We performed a nationwide, registry-based study with individual-level data, including 213,320 Norwegians and 8324 immigrants diagnosed with breast, colorectal, lung or prostate cancer in 1990-2014. Differences in time from diagnosis to treatment and in treatment patterns were described for the selected cancer sites. The Cox and logistic regressions were used to adjust for patient and tumour characteristics. Results: After adjustment for covariates, hazard ratios for time from diagnosis to treatment for non-Western immigrants compared to Norwegians were 0.88 (95% confidence interval (CI): 0.82-0.95) for breast cancer and 0.84 (95% CI: 0.75-0.95) for lung cancer, indicating longer waiting times. Treatment patterns in the four major cancer sites were similar among immigrants and the Norwegian host population, except for breast cancer, where women from East and South Asia received less breast-conserving surgery than the Norwegian host population (adjusted odds ratios 0.65 (95% CI: 0.46-0.93) for East Asians and 0.75 (95% CI: 0.50-1.13) for South Asians). Conclusions: The present study reports delayed treatment for lung and breast cancer among immigrants from non-Western countries in Norway. Systematic differences in cancer treatment were not detected. However, less breast-conserving surgery among breast cancer patients from Asia compared to Norwegians was observed.

It is not just about molecules! Optimal cancer care for the future needs more research on external factors

“…When discussing disparity, many potential interacting factors must be considered, such as patient preferences and the cultural context that patients come from with potential mistrust of the health care system, higher rates of tobacco use, tumour characteristics, food interactions, comorbidities and access to health care. As discussed by the authors [11] and in line with our own experience from Stockholm County, patient navigation programmes could have the potential to reduce disparities, increase cancer screening rates and support the patients. The positive impact of the Affordable Care Act (ACA) in the USA to reduce the inequalities in cancer care shows that it is possible to make a difference [14].…”

“…Aspects around disparities are complex and multifactorial, which is also discussed by Thøgersen et al [11]. When discussing disparity, many potential interacting factors must be considered, such as patient preferences and the cultural context that patients come from with potential mistrust of the health care system, higher rates of tobacco use, tumour characteristics, food interactions, comorbidities and access to health care.…”

“…These challenges are even more evident today, when we see large populations of immigrants with other cultural contexts, and studies have implicated that immigrants interact differently with health care systems, raising concerns about appropriate management [9,10]. In a European context, knowledge about these issues is rather limited Therefore, it is of great value to see the important study by Thøgersen et al [11] in the present issue of Acta Oncologica.…”

“…The perception of the health care providers cannot be overestimated. Most physicians have the expected aim to follow clinical guidelines when available, but in other cases, faced with vague guidelines or multiple options, the physician's subjective assessment and the patient's influence become increasingly significant [9,11,[15][16][17]. Whether a more diverse work force both in care and in research could be of value for the development of our understanding of cancer disparities as well as of benefit for the whole cancer field is a topic that could be discussed.…”

The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care

“…Based on more than 15,000 patients with colon cancer above age 70, this patient group was less often adequately staged prior to surgery, were less likely to be discussed at a multidisciplinary team conference, showed higher rates of emergency surgery and lower rates of curative resections [65]. Clinical registries are also highly relevant to study the impact of and effects from geographical and socio-economic inequalities, e.g., related to differences in cancer incidence and outcomes [66][67][68][69]. Such studies have revealed geographical and socioeconomic disparities in stage distribution and excess mortality in malignant melanoma and suggest that highly educated patients with gastroesophageal cancer patients are 1.5-3 times more likely to be discussed at a multidisciplinary conference and receive treatment with curative intention [70,71].…”