Asian and Hispanic Cancer Survivors Reported Poorer Follow-up Care Communication With Providers

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Newswise — SAN DIEGO — Asian and Hispanic cancer survivors reported poorer patient–provider communication regarding their follow-up care compared with non-Hispanic white cancer survivors, according to data presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012.

“Many minority cancer survivors report poor communication with cancer health care providers after their cancer treatment, and this contributes to their perceptions of poor-quality care,” said Nynikka Palmer, Dr.P.H., M.P.H., a postdoctoral fellow in the department of social sciences and health policy at Wake Forest Baptist Medical Center in Winston-Salem, N.C.

“When discussing patient–provider communication, we are referring to patients feeling like they are listened to, things are explained to them in ways they understand, they are encouraged to ask questions, they are involved in medical decisions and they get the help they want,” added Palmer.

The researchers analyzed data from a study of 1,215 cancer survivors recruited from the Surveillance Epidemiology and End Results cancer registries in California. Patients completed a mailed survey on cancer follow-up care. Twenty-four percent were African-American, 22 percent were Asian/Pacific Islander, 13 percent were Hispanic and 39 percent were non-Hispanic white. Patients were survivors of breast, prostate, colorectal, ovarian and endometrial cancers.

Compared with non-Hispanic white survivors, all minority survivors reported poorer explanation of medical tests, according to the study results. Asian and Hispanic survivors reported poorer follow-up care communication.

In addition, Asian survivors were 54 percent less likely to report receiving desired help with symptoms/side effects. African-American and Asian survivors, respectively, were 45 percent and 47 percent less likely to report high overall ratings of follow-up care quality compared with non-Hispanic white survivors.

After adjusting for several factors including patient–provider communication, Asian survivors remained 49 percent less likely to rate overall follow-up care as good or excellent compared with non-Hispanic white survivors. No other significant racial/ethnic differences remained.

“We included many factors to try to explain racial/ethnic differences in perceived follow-up care quality, including patient–provider communication, but we are still not able to explain why Asian survivors report poorer care quality,” Palmer said. “It will be important to look at other factors such as cultural competency and possible language barriers.”

This study was funded by the National Cancer Institute.

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ABSTRACT:Racial-Ethnic Disparities in Patient-Provider Communication and Overall Perceptions of Follow-up Care Quality among Adult Cancer Survivors. Nynikka R.A. Palmer1, Neeraj K. Arora2, Erin Kent2, Laura Forsythe2, Julia H. Rowland2, Noreen Aziz2, Kathryn E. Weaver1. 1Wake Forest School of Medicine, Winston-Salem, NC, 2National Cancer Institute, Bethesda, MD.

Purpose: Poor patient-provider communication (PPC) may contribute to racial-ethnic disparities in healthcare, and is critical to quality cancer survivorship care. Racial-ethnic differences in PPC have been noted among cancer survivors; however, previous studies have focused primarily on comparing White and African American patients and survivors recently diagnosed or treated for cancer. This study examined racial-ethnic differences in PPC and its association with perceived follow-up care quality among a diverse sample of long-term cancer survivors. Methods: Survivors of breast, prostate, colorectal, ovarian and endometrial cancers were recruited from Surveillance Epidemiology and End Results cancer registries in California to complete a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic White (White) cancer survivors were selected for this analysis if they had seen a doctor for cancer-related follow-up care in the past two years (n=1215). We conducted linear regression analyses to identify racial-ethnic differences in PPC (general follow-up care communication and explanation of medical tests). We used logistic regression models to examine the association between race-ethnicity and dichotomized perceived follow-up care quality outcomes: overall rating (very good/excellent vs. poor/fair/good) and receipt of desired help with symptoms/side effects (usually/always vs. never/sometimes). Finally, we added PPC to the adjusted logistic regression models to assess the effect of PPC on racial-ethnic differences in perceived follow-up care quality, adjusting for covariates (age, gender, education, insurance, comorbidities, cancer treatment modalities, cancer site, stage at diagnosis, number of provider visits for follow-up care, time since most recent follow-up care visit, duration of relationship with follow-up care provider, and whether it was the same provider seen for cancer treatment).Results: Of the 1215 survivors, 24% were African American, 22% were Asian, 13% were Hispanic, and 39% were White. Compared to White survivors, all minority survivors reported poorer explanation of medical tests (F=4.69, p=0.003), and Asian and Hispanic survivors reported poorer follow-up care communication (F=11.42, p<0.001). Asian survivors were also less likely to report receipt of desired help with symptoms/side effects (OR=0.46, 95%CI: 0.27-0.79), and both African American and Asian survivors were less likely to report high overall ratings of follow-up care quality (OR= 0.55, 95%CI: 0.38-0.79 and OR=0.43, 95%CI: 0.30-0.62, respectively) compared to White survivors. In fully adjusted models, including PPC, Asian survivors remained less likely to rate overall follow-up care quality as good/excellent (OR: 0.51, 95%CI: 0.28-0.93) compared to White survivors. No other significant racial-ethnic differences persisted.Conclusions: Both Asian and Hispanic survivors reported poorer PPC. For some survivors, PPC may help to explain disparities in perceived follow-up care quality; however, Asian survivors reported poorer overall ratings of follow-up care, despite controlling for covariates and PPC. Addressing PPC is important as poor communication may also affect survivors’ ability to actively participate in follow-up care.