The impact of medical tourism on colorectal screening among Korean Americans: A community-based cross-sectional study

"I can wait until I return home": healthcare utilization among Korean international students in the U.S

ObjectiveThis study aimed to understand healthcare utilization behavior among Korean international students in the U.S. Participants and methods: Seventeen Korean international students in New York City participated in in-depth personal interviews. Results: The participants passively utilized U.S. healthcare by minimizing, avoiding, or delaying needed healthcare. However, they actively utilized transnational healthcare (in Korea) as an alternative strategy. Participants' negative perception of the U.S. healthcare system (as a predisposing factor) influenced healthcare utilization in the U.S. The enabling transnational factors influenced their transnational healthcare utilization. Low perceived need for healthcare (as a need factor) determined the country where they utilized healthcare. Conclusion: Andersen's healthcare utilization model is applicable in explaining healthcare utilization behavior among Korean international students, who could be considered a nontraditional vulnerable population. On-campus health education and promotion may help international students receive timely healthcare, especially those who do not return to their home country routinely.

Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review

INTRODUCTION

Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening.

METHODS

Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes.

RESULTS

Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge).

CONCLUSIONS

US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.

Scoping the literature on patient travel abroad for cancer screening, diagnosis and treatment

The incidence of cancer is on the rise globally. Under particular circumstances, patients are willing to travel abroad for healthcare treatments. We know relatively little however about patients travelling overseas for cancer-related screening, diagnosis and treatment. Where do patients go, for what treatments, what are their motivations, decision-making processes and treatment experiences? What do we know about patient safety and risk, and outcomes? More broadly, what are the ethical and legal implications? This review presents the first published assessment of what we term 'transnational oncology treatment', defined as patients travelling overseas or across borders for cancer screening, diagnosis and treatment. The review undertakes detailed search and retrieval of the literature, using an accepted scoping review method. We present a narrative review of existing knowledge and themes, identifying coverage and gaps. There is a five-fold agenda for future investigation: trajectories and itineraries; in depth focus on treatment decisions, experiences and outcomes; locating patient travel within wider health system analysis; exploration of professional perspectives and coordination; and situating travel within the context of health trade. Such an agenda is multidisciplinary and wide-ranging, encompassing epidemiology, health economics, health policy ethics, health politics, health management, and health policy.

The impact of medical tourism on cervical cancer screening among immigrant women in the U.S

Background

Research on the relationship between medical tourism—traveling abroad for healthcare and cervical cancer screening is lacking. This study examines (1) the association between medical tourism and cervical cancer screening among immigrant women and (2) whether the association varies across years in the U.S.

Methods

We analyzed the New Immigrant Survey data of immigrant women aged 21–65 (n = 999). The outcome was having had a Pap smear since becoming a permanent resident, and the main predictor was medical tourism. Logistic regressions were conducted.

Results

Immigrant women who engaged in medical tourism had higher cervical cancer screening rates compared to those who did not engage in medical tourism (84.09% vs. 71.68%). This relationship was statistically significant only among women who have recently immigrated, after controlling for covariates.

Conclusions

Immigrant women who engaged in medical tourism had 2.18 higher odds of receiving a Pap smear than immigrant women who did not, after controlling for other covariates. Health educators should be aware of the practice of medical tourism and consider providing education on adherence to cancer screening guidelines and follow up abnormal results to ensure that immigrant women receive continuous cancer care.

A Qualitative Analysis of Barriers to Colorectal Cancer Screening among Korean Americans

Colorectal cancer (CRC) is the second most-commonly diagnosed cancer among Korean Americans after breast cancer, with incidence rates exceeding that of lung, prostate, and stomach cancers. However, CRC screening rates are lower among Korean Americans than the general U.S. population. To understand barriers to screening in this population, we conducted 11 focus groups with 51 Korean Americans ages 40+ in the Washington, DC, metropolitan area between 2011 and 2016. Our analysis used the Health Belief Model as a framework. Motivators to seek screening include a family or personal history of cancer or gastrointestinal disease (high perceived susceptibility), knowing people with CRC (high severity), favorable test results reducing worry (high benefits), and physician recommendations (cues to action). Barriers to screening include the common misperception that Korean lifestyles prevent CRC (low susceptibility), the belief that cancer is normal for older adults (low severity), the assumption that screening only benefits symptomatic people (low benefits), the costs and potential risks of testing along with a preference for traditional Korean approaches to wellness (high barriers), and lack of health insurance (low self-efficacy). Interventions seeking to increase the rate of cancer screening in the Korean American community will benefit from emphasizing the burden from CRC among Korean Americans (increasing perceived susceptibility to CRC), explaining that colonoscopies can prevent CRC rather than just diagnosing it (increasing perceived benefits of screening), reducing anxieties about test procedures and embarrassment (reducing perceived barriers to screening), and improving clinical communication (improving cues to action and self-efficacy).

Cancer Control Continuum in Korean American Community Newspapers: What Is the Association with Source Nationality-US vs. Korea?

Prior research suggests that cancer information obtained from Korean American community media, which are the primary health information sources among the population, does not connect to Korean Americans' increased cancer knowledge or cancer protective/detective behavior. We aim to identify the reason by analyzing cancer type, cancer control continuum, and cancer topic presented in Korean American community newspapers. The nationality of news source, US and Korea, and its association with the cancer coverage were examined. We found that among articles that cited any source, nearly one third used a source from Korea. The source nationality was associated with cancer coverage. In particular, cancer risk factors and screening were more likely to be discussed when a US source was cited as compared to when no source was cited. Korean sources were never or rarely observed in articles focusing on a few cancer sites (e.g., breast and prostate, which Korean Americans have higher risks compared to native Koreans), cancer preventive behaviors (diet, physical activity, no smoking), and specific cancer detection methods (mammogram, pap-smear). We suggest Korean American media to reflect the cancer priority and information needs among Korean Americans, which are varied from native Koreans, and to acknowledge the differences in cancer prevention and detection guidelines between the U.S. and Korean healthcare system. Also, the U.S. government should disseminate cancer screening and prevention guidelines, customized to racial/ethnic groups' cancer prevalence and communication preference.

Barriers to Breast Cancer Screening and Coping Strategies in Korean American Women

Introduction: To develop more culturally appropriate and effective intervention strategies, this qualitative study explored Korean American women's barriers to mammography and their coping strategies within their sociocultural context. Methodology: Semistructured individual interviews were conducted with 30 Korean American women in 2016. Thematic analysis was used to analyze the data and identify themes. Results: Four themes and their associated subthemes emerged from the data: (1) barriers to accessing mammography (cost, time consuming and complicated procedure, and language barriers), (2) psychosocial concerns related to mammography (pain, discomfort and embarrassment, and exposure to radiation), (3) strategies to access mammography (identifying ways to get a cost-free mammogram and having procedure done in home country), and (4) ways to deal with psychosocial concerns (being positive and avoiding or postponing the procedures). Discussion: Health professionals should account for cultural differences including, but not limited to, patients' concerns, access to care, and beliefs surrounding screening processes.

Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease

BACKGROUND

Few maintenance therapeutic options are available for inflammatory bowel disease (IBD). Data on the effects of continuing 5-aminosalicylic acid (5-ASA) treatment in patients who commence on biologics as maintenance treatment remain scarce. We evaluated IBD patient outcomes after continuation/discontinuation of 5-ASA when biologics were administered as maintenance treatment.

METHODS

We retrospectively reviewed the clinical, laboratory, and imaging data of patients diagnosed with IBD (ulcerative colitis (UC), 763; Crohn's disease (CD), 537) in the Gil Medical Center (GMC) from February 2005 to June 2018. We divided patients administered with biologics as maintenance treatment into those who did and did not continue on 5-ASA and compared the efficacies of the two treatment options using the log-rank test and Cox proportional hazards models.

RESULTS

Of 1300 total IBD patients, 128 (UC, 63; CD, 65) were prescribed biologics as induction and maintenance treatments. The median follow-up period was 109.5 weeks. All cases were divided into those who did or did not combine 5-ASA with biologics as maintenance treatments. Kaplan-Meier analysis showed that the event-free survival (exacerbation of disease activity) of UC patients treated with biologics and 5-ASA (n = 42) was not significantly lower than that of those taking biologics alone (n = 21) (log rank test, P = 0.68). The same was true of CD patients (n = 42, biologics and 5-ASA; n = 23, biologics only) (log rank test, P = 0.87).

CONCLUSIONS

Continuation of 5-ASA after initiation of anti-tumor necrosis factor-alpha agents did not improve prognosis in Korean IBD patients compared with that of those who discontinued 5-ASA during maintenance treatment, particularly in patients who experienced more than two disease aggravations.

Colorectal Cancer Screening among Korean Americans in Chicago: Does It Matter Whether They had the Screening in Korea or the US?

Background:

Colorectal cancer (CRC) is one of the most common cancers in Korean Americans (KAs) and CRC screening can detect CRC early and may reduce the incidence of CRC by leading to removal of precancerous polyps. Many KAs in the US leave the country, primarily to travel to Korea, for health screening. The aim of this study was to (a) assess CRC screening rates, including fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy and (b) explore factors related to these tests among KAs by location of CRC screening.

Methods:

Descriptive and correlational research design with cross-sectional surveys was used with 210 KAs. Socio-demographics (age, gender, years in the US, marital status, education, employment, household income, and proficiency in spoken English), access to health care (health insurance and usual source of health care), and location of CRC screening utilization (Korea, the US, or both Korea and US) were measured and analyzed using descriptive statistics and multinominal logistic regression.

Results:

Out of 133 KA participants who had had lifetime CRC screening (i.e., had ever had FOBT, flexible sigmoidoscopy, or colonoscopy), 19% had visited Korea and undergone CRC screening in their lifetimes. Among socio-demographic factors and access to health care factors, having a usual source of health care in the US (OR=8.45) was significantly associated with having undergone lifetime CRC screening in the US. Having health insurance in the US and having had lifetime CRC screening in the US were marginally significant (OR=2.54).

Conclusion:

Access to health care in the US is important for KAs to have CRC screening in the US. As medical tourism has been increasing globally, the location of CRC screening utilization must be considered in research on cancer screening to determine correlates of CRC screening.