Lung cancer diagnostic and treatment pathways: A comparison between Culturally and Linguistically Diverse (CALD) and Anglo-Australian patients - Findings from the LEAD study

Problem

Lung cancer is the leading cause of cancer mortality worldwide. Immigrant patients are especially vulnerable with higher mortality rates than non-immigrant patients. The reasons for this are unclear as there are few studies comparing the lung cancer pathway from patients first noticing symptoms to their diagnosis and treatment in these two groups. We therefore aimed to compare the lung cancer diagnostic and treatment pathway between Culturally and Linguistically Diverse (CALD) and Anglo-Australian patients and to explore factors underlying any observed differences.

Approach

Informed by the Aarhus Statement, the LEAD study used a mixed-method, observational cohort design. Anglo-Australian patients were those born in Australia and four other English-speaking countries (including Canada, New Zealand, the United Kingdom, and the United States). CALD patients were those born overseas and from the target CALD communities (i.e., Arabic, Chinese, Greek, Italian, and Vietnamese). This presentation will report findings from the quantitative arm of the LEAD study comprising a patient questionnaire and reviews of patients’ hospital and general practice records. A total of 577 (407 Anglo-Australian and 170 CALD) patients were recruited from three cities in Australia (Melbourne, Sydney and Brisbane). Hospital records were reviewed for all recruited patients. The questionnaire was returned by 189 (135 Anglo-Australian and 54 CALD) patients and a record review was conducted by the General Practitioners (GPs) of 99 (76 Anglo-Australian and 23 CALD) recruited patients. Survival and Cox Regression analyses were conducted to examine differences in the time intervals along the lung cancer pathway.

Findings

CALD patients reported a longer time from referral to diagnosis interval (Median = 30 days, 95% CI = 26 - 34 days) than Anglo-Australian patients (Median = 17 days, 95% CI = 14 - 20 days), p =. 003, Exp (B) = 1.319. This difference persisted after the impact of relevant factors, such as patient age and stage of lung cancer was taken into consideration. A trend towards longer time intervals amongst CALD patients in five other intervals was observed, including from 1) symptom notification to GP presentation, 2) GP presentation to referral to specialists or hospitals, 3) referral to treatment, 4) symptom notification to treatment, and 5) symptom notification to diagnosis. However, the differences in these five intervals failed to reach significance.

Consequences

LEAD is the first study to comprehensively document differences in time intervals along the lung cancer pathways between CALD and Anglo-Australian patients. Such information is vital for multicultural countries to understand ethnic disparities in lung cancer in order to design interventions to reduce these disparities.