No evidence to support the impact of migration background on treatment response rates and cancer survival: a retrospective matched-pair analysis in Germany

Abstract

Background Immigration has taken the central stage in world politics, especially in the developed countries like Germany, where the continuous flow of immigrants has been well documented since 1960s. Strikingly, emerging data suggest that migrant patients have a poorer response to the treatment and lower survival rates in their new host country, raising concerns about health disparities. Herein, we present our investigation on the treatment response rate and cancer survival in German patients with and without an immigrant background that were treated at our comprehensive cancer center in Germany. Methods Initially, we considered 8162 cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (April 2002–December 2015) for matched-pair analysis. Subsequently, the German patients with a migration background and those from the native German population were manually identified and catalogued using a highly specific name-based algorithm. The clinical parameters such as demographic characteristics, tumor characteristics, defined staging criteria, and primary therapy were further adjusted. Using these stringent criteria, a total of 422 patients (n = 211, Germans with migration background; n = 211, native German population) were screened to compare for the treatment response and survival rates (i.e., 5-year overall survival, progression-free survival, and time to progression). Results Compared to the cohort with migration background, the cohort without migration background was slightly older (54.9 vs. 57.9 years) while having the same sex distribution (54.5% vs. 55.0% female) and longer follow-up time (36.9 vs. 42.6 months). We did not find significant differences in cancer survival (5-year overall survival, P = 0.771) and the response rates (Overall Remission Rate; McNemar’s test, P = 0.346) between both collectives. Conclusion Contrary to prior reports, we found no significant differences in cancer survival between German patients with immigrant background and native German patients. Nevertheless, the advanced treatment protocols implemented at our comprehensive cancer center may possibly account for the low variance in outcome. To conduct similar studies with a broader perspective, we propose that certain risk factors (country-of-origin-specific infections, dietary habits, epigenetics for chronic diseases etc.) should be considered, specially in the future studies that will recruit new arrivals from the 2015 German refugee crisis.

Influence of Turkish origin on hematology reference intervals in the German population

“…This algorithm has been successfully applied in several studies to identify individuals of Turkish origin in Germany, e.g. to evaluate differences between ethnic groups in cancer incidence rates, cancer treatment response rates or in participation in screening programs 26 – 28 .…”

Impact of patient nationality on the severity of early side effects after radiotherapy

“…However, given the primary focus of recent research on predictive genetic markers (Ginsburg and Phillips 2018 ; McCarthy et al 2013 ; Chin et al 2011 ; Dzau et al 2015 ; Golubnitschaja et al 2016 ), limited information is available on the influence of sociodemographic characteristics on therapeutic outcomes. Concerning patient nationality, studies focusing on foreign cancer patients have evaluated disease incidence, treatment response, progression, and survival (Arnold et al 2010 ; Budde 2020 ; Budde et al 2019 ; Fischer et al 2019 ; Hemminki et al 2013 ; Mousavi et al 2012 ; Rudiger et al 2021 ; Spix et al 2008 ; Thøgersen et al 2018 ; Hjerkind et al 2017 ) but have not sought to identify unique patient characteristics that predict beneficial or unwanted outcomes of therapy. Thus, a deeper understanding of the impact of sociodemographic characteristics on therapeutic outcomes, including unfavorable side effects, is needed to further personalize healthcare (England 2016 ).…”