Colorectal cancer stage at diagnosis in migrants and non-migrants: a cross-sectional analysis of the KoMigra Study in Germany

Anne Dahlhaus; Andrea Siebenhofer; Corina Guethlin; Maja Taubenroth; Zeycan Albay; Sylvia Schulz-Rothe; Susanne Singer; Jasper Plath

doi:10.1055/a-0655-2352

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2018; 56(12): 1499-1506
DOI: 10.1055/a-0655-2352

Originalarbeit

Colorectal cancer stage at diagnosis in migrants and non-migrants: a cross-sectional analysis of the KoMigra Study in Germany

Tumorstadium des kolorektalen Karzinoms bei Diagnosestellung bei Migranten und Nicht-Migranten: eine Querschnittsanalyse der KoMigra Studie in Deutschland

Anne Dahlhaus

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

,

Andrea Siebenhofer

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

²Institute of General Practice and Evidence-Based Health Services Research, Medical University Graz, Graz, Austria

,

Corina Guethlin

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

,

Maja Taubenroth

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

,

Zeycan Albay

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

,

Sylvia Schulz-Rothe

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

,

Susanne Singer

³Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany

⁵German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany

,

Jasper Plath

¹Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany

⁴German Cancer Research Center (DKFZ), Heidelberg, Germany

⁵German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany

› Author Affiliations

Abstract

Background Colorectal cancer is one leading cause of cancer-related morbidity and mortality. Its prognosis depends largely on tumour stage at diagnosis. Migration status was associated with late stage at diagnosis in some studies, yet results are inconsistent.

Methods The cross-sectional study “The Diagnostics of Colorectal Carcinoma in Migrants and Non-Migrants in Germany” (KoMigra) investigated the association between migration background and tumour stage of colorectal cancer at diagnosis in a large German urban area. Patient variables were collected via a survey translated into nine languages. Data on tumour stage were extracted from medical records.

Results 437 patients could be recruited for analysis. Explorative logistic regression yielded no significant difference for tumour stage “I” versus “II-IV” according to the tumour classification “Union Internationale Contre le Cancer” (UICC) between migrants and non-migrants. Although the odds of a higher tumour stage were consistently higher in migrants than non-migrants, the effect estimates had wide confidence intervals. In descriptive analyses, migrants reported symptoms more often and for longer time than non-migrants. This was especially true for patients with poor proficiency of German.

Conclusions Migration background was not significantly associated with advanced tumour stage at diagnosis. However, the effect of poor language proficiency should be explored further.

Zusammenfassung

Hintergrund Das kolorektale Karzinom ist eine der führenden Ursachen krebsspezifischer Morbidität und Mortalität. Die Prognose hängt vom Stadium bei Diagnosestellung ab. Es wurde berichtet, dass das Vorliegen eines Migrationshintergrunds mit einem späteren Stadium bei Diagnose assoziiert sei; die Studienlage ist diesbezüglich jedoch nicht konsistent.

Methodik Die querschnittliche Studie „Diagnostik des Kolorektalen Karzinoms bei Migranten und Nicht-Migranten in Deutschland“ (KoMigra) untersuchte den Zusammenhang zwischen dem Vorliegen eines Migrationshintergrunds und dem Tumorstadium des kolorektalen Karzinoms bei Diagnosestellung in einer deutschen Großstadtregion. Patienteneigenschaften wurden über einen in neun Sprachen übersetzten Fragebogen und Tumordaten aus medizinischen Dokumenten erfasst.

Ergebnisse 437 Patienten konnten in die Analyse eingeschlossen werden. In der logistischen Regression zeigte sich kein Unterschied für Migranten versus Nicht-Migranten hinsichtlich des Tumorstadiums „I“ versus „II – IV“ nach der UICC-Tumorklassifikation („Union Internationale Contre le Cancer“). Obgleich die Odds für ein höheres Tumorstadium bei Migranten durchgehend höher lagen als bei Nicht-Migranten, wurde dies durch ein weites Konfidenzintervall relativiert. In der deskriptiven Analyse berichteten Migranten häufiger und über bereits seit Längerem bestehende Symptome als Nicht-Migranten. Dies traf besonders für Patienten mit eingeschränkten Deutschkenntnissen zu.

Schlussfolgerungen Das Vorliegen eines Migrationshintergrunds war nicht signifikant mit einem höheren Tumorstadium bei Diagnosestellung assoziiert. Dennoch sollten die Auswirkungen eingeschränkter Deutschkenntnisse weitergehend untersucht werden.

Key words

Colorectal cancer - cross-sectional analysis - migrants - UICC tumor stage

Schlüsselwörter

Kolorektales Karzinom - Querschnittsstudie - Migranten - UICC-Tumorstadium

Full Text

References

References
1 Ferlay JSoerjomataram. et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013 Available at: http://globocan.iarc.fr Accessed June 6, 2018
2 American Cancer Society. What are the survival rates for colorectal cancer, by stage?. Available at: 2018 http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-survival-rates Accessed June 6
3 Joachim C, Godaert L, Dramé M. et al. Overall survival in elderly patients with colorectal cancer. Cancer Epidemiol 2017; 48: 85-91
4 Ciccolallo L, Capocaccia R, Coleman MP. et al. Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery. Gut 2005; 54: 268-273
5 Majek O, Gondos A, Jansen L. et al. Survival from colorectal cancer in Germany in the early 21st century. Br J Cancer 2012; 106: 1875-1880
6 Barclay KL, Goh PJ, Jackson TJ. Socio-economic disadvantage and demographics as factors in stage of colorectal cancer presentation and survival. ANZ journal of surgery 2015; 85: 135-139
7 Askari A, Nachiappan S, Currie A. et al. The relationship between ethnicity, social deprivation and late presentation of colorectal cancer. Cancer Epidemiol 2017; 47: 88-93
8 Ward E, Jemal A, Cokkinides V. et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004; 54: 78-93
9 Chien C, Morimoto LM, Tom J. et al. Differences in colorectal carcinoma stage and survival by race and ethnicity. Cancer 2005; 104: 629-639
10 Daniel CR, Shu X, Ye Y. et al. Severe obesity prior to diagnosis limits survival in colorectal cancer patients evaluated at a large cancer centre. Br J Cancer 2016; 114: 103-109
11 Alexander DD, Waterbor J, Hughes T. et al. African-American and Caucasian disparities in colorectal cancer mortality and survival by data source: an epidemiologic review. Cancer Biomark 2007; 3: 301-313
12 Berry J, Bumpers K, Ogunlade V. et al. Examining racial disparities in colorectal cancer care. J Psychosoc Oncol 2009; 27: 59-83
13 Tawk R, Abner A, Ashford A. et al. Differences in colorectal cancer outcomes by race and insurance. Int J Environ Res Public Health 2016; 13: 48 . doi: 10.3390/ijerph13010048 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730439/
14 Soneji S, Iyer SS, Armstrong K. et al. Racial disparities in stage-specific colorectal cancer mortality: 1960–2005. Am J Public Health 2010; 100: 1912-1916
15 Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2012; 62: 10-29
16 Koo JH, Kin S, Wong C. et al. Clinical and pathologic outcomes of colorectal cancer in a multi-ethnic population. Clin Gastroenterol Hepatol 2008; 6: 1016-1021
17 Norredam M, Krasnik A, Pipper C. et al. Differences in stage of disease between migrant women and native Danish women diagnosed with cancer: results from a population-based cohort study. Eur J Cancer Prev 2008; 17: 185-190
18 Simon MS, Thomson CA, Pettijohn E. et al. Racial differences in colorectal cancer incidence and mortality in the women’s health initiative. Cancer Epidemiol Biomarkers Prev 2011; 20: 1368-1378
19 Thogersen H, Moller B, Robsahm TE. et al. Comparison of cancer stage distribution in the immigrant and host populations of Norway, 1990–2014. Int J Cancer 2017; 141: 52-61
20 White A, Vernon SW, Franzini L. et al. Racial disparities in colorectal cancer survival: to what extent are racial disparities explained by differences in treatment, tumor characteristics, or hospital characteristics?. Cancer 2010; 116: 4622-4631
21 Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB. et al. Contribution of screening and survival differences to racial disparities in colorectal cancer rates. Cancer Epidemiol Biomarkers Prev 2012; 21: 728-736
22 Tammana VS, Laiyemo AO. Colorectal cancer disparities: issues, controversies and solutions. World J Gastroenterol 2014; 20: 869-876
23 Mandelblatt J, Andrews H, Kao R. et al. The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health 1996; 86: 1794-1797
24 Halpern MT, Ward EM, Pavluck AL. et al. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 2008; 9: 222-231
25 Dahlhaus A, Guethlin C, Schall A. et al. Colorectal cancer stage at diagnosis in migrants versus non-migrants (KoMigra): study protocol of a cross-sectional study in Germany. BMC Cancer 2014; 14: 123
26 Federal Foreign Office. Official names of foreign states in the national language. Available at: 2018 http://www.auswaertiges-amt.de/DE/Infoservice/Terminologie/Uebersicht_node.html Accessed June 6
27 City of Offenbach – Department of Statistics and Elections. Nationalities in Offenbach am Main 2008 to 2012. Offenbach: 2012
28 City of Frankfurt am Main – Municipal Administration – Municipal Office, Statistics and Elections. Chapter 02: Population. Frankfurt: 2012
29 Schenk L, Bau AM, Borde T. et al. A basic set of indicators for mapping migrant status. Recommendations for epidemiological practice. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006 49. 853-860
30 Kleinbaum DG, Klein M. Logistic regression. New York: Springer; 2010
31 German Clinical Trials Register (DRKS). Available from: 2018 https://www.drks.de/drks_web/setLocale_EN.do Accessed June 6
32 Jackson CS, Oman M, Patel AM. et al. Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol 2016; 7: S32-S43
33 Robert Koch Institute and Society of Epidemiological Cancer Registries in Germany. Cancer in Germany 2011/2012, Berlin. 2015
34 Lebrun LA. Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Soc Sci Med 2012; 74: 1062-1072
35 Reiss K, Schunck R, Razum O. Effect of length of stay on smoking among Turkish and Eastern European immigrants in Germany – interpretation in the light of the smoking epidemic model and the acculturation theory. Int J Environ Res Public Health 2015; 12: 15925-15936
36 Moullan Y, Jusot F. Why is the “healthy immigrant effect” different between European countries?. Eur J Public Health 2014; 24 (Suppl. 01) 80-86
37 Duncan A, Wilson C, Cole SR. et al. Demographic associations with stage of readiness to screen for colorectal cancer. Health Promot J Austr 2009; 20: 7-12
38 Maier I, Ruf D, Pessentheiner J. et al. Barrieren von Migrantinnen und Migranten bei der Inanspruchnahme von Gesundheitsmaßnahmen. Gesundheitswesen 2009; 71: A159
39 Honein-AbouHaidar GN, Kastner M, Vuong V. et al. Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 2016; 25: 907-917
40 Niksic M, Rachet B, Warburton FG. et al. Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England. Br J Cancer 2016; 115: 136-144
41 Pati S, Hussain MA, Chauhan AS. et al. Patient navigation pathway and barriers to treatment seeking in cancer in India. Cancer Epidemiol 2013; 37: 973-978
42 Koo JH, Arasaratnam MM, Liu K. et al. Knowledge, perception and practices of colorectal cancer screening in an ethnically diverse population. Cancer Epidemiol 2010; 34: 604-610
43 Singer S, Roick J, Briest S. et al. Impact of socio-economic position on cancer stage at presentation: findings from a large hospital-based study in Germany. Int J Cancer 2016; 139: 1696-1702
44 Reiss K, Spallek J, Razum O. “Imported risk” or “health transition”? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany – analysis of microcensus data. Int J Equity Health 2010; 9: 15
45 Aichberger MC, Bromand Z, Heredia MontesinosA. et al. Socio-economic status and emotional distress of female Turkish immigrants and native German women living in Berlin. Eur Psychiatry 2012; 27: S10-S16
46 Müller MJ, Koch E. Perceived discrimination in patients with psychiatric disorder and Turkish migration background in Germany. J Nerv Ment Dis 2016; 204: 542-546
47 Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 2014; 348: g2467
48 Pan J, Xin L, Ma YF. et al. Colonoscopy reduces colorectal cancer incidence and mortality in patients with non-malignant findings: a meta-analysis. Am J Gastroenterol 2016; 111: 355-365
49 Schmiegel W, Buchberger B, Follmann M. et al. S3-Guideline “Colorectal Cancer”. Z Gastroenterol 2017; 55: 1344-1498
50 Doubeni CA, Weinmann S, Adams K. et al. Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Intern Med 2013; 158: 312-320
51 Riemann JF, Maar C, Betzler M. et al. Darmkrebsfrüherkennung im Nationalen Krebsplan – Aktueller Stand und Empfehlungen für die Weiterentwicklung. Z Gastroenterol 2011; 49: 1428-1431
52 Brenner H, Altenhofen L, Stock C. et al. Prevention, early detection, and overdiagnosis of colorectal cancer within 10 years of screening colonoscopy in Germany. Clin Gastroenterol Hepatol 2014; 13: 717-724
53 Hüppe D, Hartmann H, Felten G. et al. Die Vorsorgekoloskopie rettet Leben – Ergebnisse der Herner Vorsorgedatei. Z Gastroenterol 2008; 46: 193-200
54 Kowalski C, Ferencz J, Benz S. et al. Obstacles and facilitators of conducting studies – the perspective of colorectal cancer centers’ coordinators. Z Gastroenterol 2016; 54: 409-415
55 Latza U, Stang A, Bergmann M. et al. The problem of response in epidemiological studies in Germany (Part I). Gesundheitswesen 2004; 66: 326-336
56 Williams B, Irvine L, McGinnis AR. et al. When “no” might not quite mean “no”; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project. BMC Health Serv Res 2007; 7: 59
57 Hoffmann W, Terschüren C, Holle R. et al. The problem of response in epidemiological studies in Germany (Part II). Gesundheitswesen 2004; 66: 482-491
58 Symonds RP, Lord K, Mitchell AJ. et al. Recruitment of ethnic minorities into cancer clinical trials: experience from the front lines. Br J Cancer 2012; 107: 1017-1021
59 Network Migration in Europe and Federal Centre for Political Education. Report on population with a migration background Netzwerk Migration in Europa e. V. und Bundeszentrale für politische Bildung. 2017
60 Hesse Ministry of Integration and Social Affairs, and Hesse Association of Statutory Health Insurance Physicians. Regional Health Report. District of Gießen, Wiesbaden: 2014
61 Federal Statistics Office. Micro-census 2013: 16.5 million persons with a migration background. Wiesbaden: 2013