It’s not too often researchers say they are proud when they get something wrong. But Sunnybrook medical oncologist Dr. Simron Singh and hematologist Dr. Matthew Cheung agree that their recent study (published in the Journal of Oncology Practice) looking at outcomes for immigrants to Canada who develop cancer made them feel just that: proud.
The pair looked at cancer-related deaths of recent immigrants to Canada diagnosed with cancer compared to non-immigrants and non-recent immigrants. Study subjects were followed from diagnosis to death (cancer specific or other causes).
The researchers found that fewer immigrants died from cancer during the study period compared to the Canadian-born population. It’s not what they thought they’d find when they set out on this research project.
Here, Drs. Singh and Cheung explain why they did this study and why they are proud they had it wrong.
What inspired you to do this research project?
Simron Singh: We’ve both been interested in the quality of the cancer health care system. We want to make sure that vulnerable populations are getting access to care. Are they able to advocate for themselves? Are they intimidated by the system? Do those things affect the outcomes?
And then on a personal level, we are both children of immigrants. My parents moved to Canada from India and Hong Kong, and Matthew’s parents moved here from China.
Matthew Cheung: Also, anecdotally, we both saw patients in our clinics who had immigrated to Canada and seemed to be having trouble navigating the healthcare system. Similar studies in the United States have found that immigrants there have poorer outcomes when diagnosed with cancer, meaning immigrants die sooner after diagnosis. We wondered if that would be the same here.
What did you think you were going to find?
MC: We thought we would find that immigrants to Canada had worse outcomes when they got diagnosed with cancer. We thought immigrants to Canada would have a higher risk of dying than Canadian-born people diagnosed with cancer.
And what did you find?
SS: The exact opposite. We found that immigrants to Canada had lower cancer-related death than the general population.
Did that surprise you?
SS: Absolutely. We really did set out thinking that we’d find that immigrants have worse outcomes.
MC: We second-guessed our results when we got them!
SS: We actually went back to the numbers to make sure we hadn’t flipped them at some point. We were really surprised.
How did that feel?
SS: It was actually a really happy moment. I felt really proud of the Canadian health-care system. To me, this study shows that the access to quality healthcare is available for immigrants, contrary to what the studies in the United States showed. To me, it validates the universal healthcare system in Canada.
What other factors could be at play here?
MC: We know that social factors, like poverty, definitely play a role in accessing healthcare. But these findings show us that being an immigrant to Canada doesn’t mean you will have worse outcomes if you get diagnosed with cancer.
It really is a complex topic and we are just scratching the surface with this study – though it’s a good start. We looked at urban versus rural healthcare access in this as well, and still the immigrant population fared better than Canadian-born patients. So what other things could influence better outcomes for immigrants? Are they treated differently once diagnosed? Are there different social supports? Is there different family or community support? Are decisions about care different? Or, is there something protective in the genes of some ethnicities? We still have lots of questions.
There’s been some other research lately comparing incidence of other diseases in immigrant populations. Those studies have found that immigrants to Canada tend to have higher incidences of some diseases. How is your research different than those studies?
SS: Those studies are looking at incidence – how many people are getting the disease? Our study looks at outcomes – what happens to you when you get the disease? A new clock starts when you get diagnosed.
MC: We want to look further at the quality of care as well as examine some of the other factors – like caregiver support, genes, and decision-making. Also we want to see if the protective affect of immigration extends to the second generation. We also wonder if different communities see and define ‘cancer’ in different ways – and maybe this affects how they make decisions about their care. We want to figure that out so we can be more person-centred in our treatment plans.