Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Equity across the cancer care continuum for culturally and linguistically diverse migrant populations living in Queensland, Australia: An exploratory sequential mixed methods study (#105)

Brighid BS Scanlon 1 2 , Natasha NR Roberts 3 , David DW Wyld 2 4 , Ghasem (Sam) GT Toloo 1 , Jo JD Durham 1
  1. School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
  2. Royal Brisbane and Women's Hospital, Herston, QLD, Australia
  3. Surgical, Treatment and Rehabilitation Service (STARS), Metro North Health, Brisbane, Queensland , Australia
  4. Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Background: High-income countries, such as Australia have seen substantial advances in cancer screening, treatment and outcomes. International evidence suggests that Culturally and Linguistically Diverse (CALD) migrant populations experience significant cancer inequities spanning the cancer continuum, which have yet to be explored in the Australian context.

Methods: Equity was quantified and compared for CALD migrant and Australian born cancer patients through an exploratory sequential mixed methods study, incorporating a retrospective cohort study (n=523) and qualitative interviews (n=21) at a large, tertiary hospital in Queensland, Australia. Quantitative data were analysed through bivariate and multivariate logistic regression and qualitative data were analysed using The Framework Method.

Results: Firstly, CALD migrants exhibited lower odds of smoking (OR = 0.63, CI 0.401–0.972) and higher odds of ‘never drinking alcohol’ (OR = 3.4, CI 1.473–7.905) but had lower odds of cancer detection via screening (OR = 6.493, CI 2.429–17.359). Secondly, CALD migrants displayed a statistically significant delay in time from diagnosis to first treatment commencement for radiation (P=0.03) and surgery (P=0.02) and had 16.6 times higher odds of declining a recommended chemotherapy (OR=16.573, CI 4.604-59.665). Third, CALD migrants had a higher frequency of unplanned admissions (P=0.00), longer length of those admissions (P=<0.00) and higher failure to attend appointments (P=<0.00). The qualitative interviews revealed: i) a strong institutional focus on linguistic diversity, with little attention given to patients’ cultural needs; ii) a high institutional reliance on assumptions and informal mechanisms to identify CALD patients and assess their needs; and, iii) a common experience of moral conflict among healthcare staff when providing inequitable care, that is discordant with their professional values.

Conclusions: Several areas of concern have been identified regarding equitable cancer treatment and outcomes for CALD migrants. There is a demonstrable need for both cultural and structural change if equity is to be promoted and operationalised within Australian healthcare institutions.