# 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.

## Key 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.