Asian Cancer Survivors Report Poorer Care Communication and Care Quality
In a study reported in the Journal of Clinical Oncology, Palmer et al found that Asian cancer survivors reported poorer care communication and care quality compared with white patients.
Study Details
The study involved 1,196 survivors of breast, prostate, colorectal, ovarian, and endometrial cancers who had completed a mailed survey on cancer follow-up care in 2005 to 2006 and who had seen a physician for follow-up care in the past 2 years. Instruments for assessing patient-provider communication (overall communication and medical test communication), and patient activation in clinical care (self-efficacy in medical decisions and perceived control) were transformed to 0 to 100 scales. Perceived care quality was measured on a 5-point scale (poor to excellent).
Ethnic/Racial Differences
In analysis adjusting for age, sex, education, health insurance, comorbidities, stage at diagnosis, time since diagnosis, treatment, number of visits for cancer-related follow-up care, length of relationship with main follow-up care physician, and whether main follow-up care physician was the same physician seen for cancer treatment, there were significant differences among African American, Asian/Pacific Islander, white, and Hispanic groups with regard to overall communication, medical test communication, quality-of-care rating, and self-efficacy in medical decisions (all P <.01 for trends), with no difference observed for perceived control in clinical care.
Both Asian (mean score = 76.55) and Hispanic (79.95) survivors reported significantly lower overall communication scores compared with white survivors (85.16; P < .001 and P = .040). Asian survivors had lower overall communication scores vs African American survivors (83.63, P = .002). Only Asian survivors had a significantly lower medical test communication score compared with white survivors (79.97 vs 88.03, P < .001). Asian survivors were significantly less likely than white survivors to rate follow-up care as very good/excellent (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.30–0.72), and Asian survivors reported significantly lower self-efficacy in medical decisions (P < .001) compared with all other racial/ethnic groups.
Analysis Adjusting for Communication
Overall, both indicators of patient-provider communication (overall communication and medical test communication) were significantly associated with rating of care quality (P < .001 and P < .001) and self-efficacy in medical decisions (P < .001 and P = .004). In analysis adjusting for patient-provider communication indices and other covariates, Asian survivors were still significantly less likely to report high-quality care (OR = 0.50, 95% CI = 0.27–0.91) and reported lower self-efficacy in medical decisions (P = .006) vs white survivors.
The investigators concluded: “Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond [patient-provider communication], such as cultural influences and medical system factors.”
Nynikka R.A. Palmer, DrPH, MPH, of University of California, San Francisco, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by National Cancer Institute grants. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
