The effect of cultural and linguistic diversity on the timeliness of prostate cancer treatment: a registry-based retrospective cohort study

TL;DR

Non-English-speaking culturally and linguistically diverse individuals in Australia face longer delays in prostate cancer treatment, mainly due to being diagnosed at public hospitals.

Contribution

This study identifies public hospital diagnosis as a key mediator of treatment delays for non-English-speaking culturally diverse prostate cancer patients.

Findings

Non-English-speaking CALD individuals had a 2.54 times higher odds of treatment delay compared to Australian-born individuals.

The association between CALD status and treatment delay was fully mediated by diagnosis at public institutions.

Non-English-speaking CALD individuals experienced a median delay of 92 days compared to 64 days for Australian-born individuals.

Abstract

To examine associations between culturally and linguistically diverse (CALD) status and definitive treatment delay among individuals diagnosed with intermediate- or high-risk prostate cancer (PCa) in Victoria, Australia.

Data were sourced from the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic). Individuals with index diagnoses of intermediate- or high-risk PCa (February 2009–August 2022) who were receiving PCa-directed definitive treatment (radical prostatectomy or radiotherapy) were included. CALD status was defined as being born in non-English-speaking countries versus mainly English-speaking countries (MESC) or Australia. Additionally, using preferred spoken language, CALD individuals were categorized into English-speaking CALD and non-English-speaking CALD individuals. Binary logistic regression was used to examine associations between CALD status and definitive treatment delay (> 90 days from diagnosis to treatment). Mediation analysis was undertaken using generalized structural equation modeling.

Of 13,625 participants, 2,455 were from CALD backgrounds (18%). Nine per cent of 2,455 CALD individuals preferred speaking languages other than English. Median days to definitive treatment were longer for non-English-speaking CALD (92) compared to Australian-born (64) individuals. Non-English-speaking CALD individuals experienced significantly (adjusted odds ratio = 2.54, 95% confidence interval = 1.92–3.38) greater treatment delay than Australian-born individuals, adjusted for sociodemographic and clinical factors. The association between CALD status and definitive treatment delay was fully mediated by non-English-speaking CALD individuals being diagnosed mostly at public institutions.

Non-English-speaking-CALD individuals experienced greater delays in the definitive treatment of intermediate- and high-risk PCa than Australian-born individuals, which is largely explained by the type of diagnosing health institution. More timely treatment for non-English-speaking-CALD will require less delay in public hospitals.

The online version contains supplementary material available at 10.1007/s10552-025-02074-4.

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