Impact of immigration status on health behaviors and perceptions in cancer survivors

Sophia Y Liu; Lin Lu; Dan Pringle; Mary Mahler; Chongya Niu; Rebecca Charow; Kyoko Tiessen; Christine Lam; Oleksandr Halytskyy; Hiten Naik; Henrique Hon; Margaret Irwin; Vivien Pat; Christina Gonos; Catherine W T Chan; Jodie Villeneuve; Ravi M Shani; Maha Chaudhry; M Catherine Brown; Peter Selby; Doris Howell; Wei Xu; Shabbir M H Alibhai; Jennifer M Jones; Geoffrey Liu; Lawson Eng

doi:10.1002/cam4.2079

Impact of immigration status on health behaviors and perceptions in cancer survivors

Cancer Med. 2019 May;8(5):2623-2635. doi: 10.1002/cam4.2079. Epub 2019 Mar 21.

Authors

Sophia Y Liu¹, Lin Lu², Dan Pringle³, Mary Mahler³, Chongya Niu³, Rebecca Charow³, Kyoko Tiessen³, Christine Lam³, Oleksandr Halytskyy³, Hiten Naik³, Henrique Hon³, Margaret Irwin³, Vivien Pat³, Christina Gonos³, Catherine W T Chan³, Jodie Villeneuve³, Ravi M Shani³, Maha Chaudhry⁴, M Catherine Brown³, Peter Selby^{4

5

6}, Doris Howell³, Wei Xu^{2

3

4}, Shabbir M H Alibhai⁷, Jennifer M Jones^{3

4

8}, Geoffrey Liu^{1

2

3

4}, Lawson Eng^{1

3

7}

Affiliations

¹ Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Hospital/University Health Network and University of Toronto, Toronto, ON, Canada.
² Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, ON, Canada.
³ Ontario Cancer Institute, Toronto, ON, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
⁶ Departments of Family and Community Medicine and Psychiatry, University of Toronto, Toronto, ON, Canada.
⁷ Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada.
⁸ Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.

Abstract

Background: Health behaviors including smoking cessation, physical activity (PA), and alcohol moderation are key aspects of cancer survivorship. Immigrants may have unique survivorship needs. We evaluated whether immigrant cancer survivors had health behaviors and perceptions that were distinct from native-born cancer survivors.

Methods: Adult cancer patients from Princess Margaret Cancer Centre were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5-year survival, and fatigue. Multivariable models evaluated the association of immigration status and region-of-origin on behaviors and perceptions.

Results: Of the 784 patients, 39% self-identified as immigrants. Median time of survey was 24 months after histological diagnosis. At baseline, immigrants had trends toward not meeting Canadian PA guidelines or being ever-drinkers; patients from non-Western countries were less likely to smoke (aOR_current = 0.46, aOR_ex-smoker = 0.47, P = 0.02), drink alcohol (aOR_current = 0.22, aOR_ex-drinker = 0.52, P < 0.001), or meet PA guidelines (aOR = 0.44, P = 0.006). Among immigrants, remote immigrants (migrated ≥40 years ago) were more likely to be consuming alcohol at diagnosis (aOR = 5.70, P < 0.001) compared to recent immigrants. Compared to nonimmigrants, immigrants were less likely to perceive smoking as harmful on QoL (aOR = 0.58, P = 0.008) and survival (aOR = 0.56, P = 0.002), and less likely to perceive that PA improved fatigue (aOR = 0.62, P = 0.04) and survival (aOR = 0.64, P = 0.08).

Conclusions: Immigrants had different patterns of health behaviors than nonimmigrants. Immigrants were less likely to perceive continued smoking as harmful and were less likely to be aware of PA benefits. Culturally tailored counselling may be required for immigrants who smoke or are physically sedentary at diagnosis.

Keywords: alcohol; cancer survivorship; health behaviors; immigration; patient perceptions; physical activity; smoking.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Alcohol Drinking
Cancer Survivors*
Emigrants and Immigrants*
Exercise
Female
Geography, Medical
Global Health
Health Behavior*
Humans
Male
Middle Aged
Neoplasms / epidemiology*
Perception*
Population Surveillance
Quality of Life
Smoking
Socioeconomic Factors
Young Adult