Patient-reported health experiences among US immigrant patients with cancer.

Abstract

11072 Background: Patients often experience complex, multifaceted challenges while navigating cancer care, including many interactions with the health system and care teams. For immigrant patients, language barriers may further complicate their cancer care experience. Methods: We used the Medical Expenditure Panel Survey database from 2019-2022 to study patient-reported differences in cancer care experiences based upon immigrant status and speaking another language at home. We extracted data about patient factors (age, sex, race, marital status, poverty levels from reported income, immigrant status [born in the US or not], speaking another non-English language at home) and cancer type for all adults > 18 years with self-reported history of cancer. We compared health experiences (i.e., if provider asks about treatments/medications from other providers, if provider explains all treatment options, includes patient in medical decision-making, delays in medical care) by immigrant status and speaking another language at home using Rao-Scott Chi-square test with person-level survey weight. Results: We identified 7,771 patients with cancer (63.4% age 65+, 59.4% female, 82.5% White, 50.6% married). Most common cancers were breast (21.6%) and prostate (15.3%). Overall, 10.3% were immigrants and 11.4% reported speaking another language at home; these patients were more commonly younger, female, Hispanic, less educated, living below the poverty line, and had non-private insurance (table). Immigrant patients were less likely to report a provider asked about other treatments (58.5% v 64.6%, p = .022), explained all treatment options (71.6% v 78.2%, p = .032), and included patient in making medical decisions (38.8% v 45.7%, p = .007). Immigrant patients were less likely to report delays in medical care due to cost (6.1% v 6.9%, p = .022) than patients born in the US. Patients who reported speaking another language at home were less likely to report a provider asked about other treatments (58.6% v 64.6%, p = .015), explained all treatment options (71.7% v 78.2%, p = .017), and included patient in making medical decisions (36.5% v 46.0%, p < .001). We found no differences in reporting delays in medical care due to cost (6.6% v 6.9%, p = .059). Conclusions: In this national survey study, we found patient-reported health experiences (i.e., discussions about treatment and shared decision-making) differed for immigrants and those speaking another language at home. Findings should inform future work to enhance the cancer care experience in culturally and language appropriate ways for all patients. Patient Factor Immigrant Speak another language at home Yes No P Yes No P Age 65+ 55.7% 64.3% .004 50.2% 65.1% <.001 Female 69.3% 58.2% <.001 67.3% 58.3% .014 Hispanic 49.3% 5.0% <.001 66.0% 2.4% <.001 < Bachelor’s Degree 58.2% 55.8% .001 65.0% 54.8% <.001 Below Poverty Level 22.8% 14.0% .001 25.8% 13.5% <.001 Privately Insured 45.3% 54.6% <.001 38.1% 55.6% <.001