Impact of English Proficiency on Cancer Treatment Decision Making and Outcomes

Abstract

With the increasing proportion of households in the US speaking a language other than English, it is important to understand the impact of limited English proficiency on health outcomes, in particular among patients with cancer diagnoses. A recognized indicator for reducing disparities in cancer outcomes in minority patients is participation in clinical trials. This study aimed to assess for differences in English proficient and Limited English Proficient (LEP) patients seeking or with established care at Providence Cancer Center in Portland, Oregon between July 2013 and June 2014. One hundred and seventy-three patient records were selected for review, with 103 classified as English proficient patients and 70 patients classified as LEP. Differences in cancer treatment decisions (defined as clinical trial enrollment, standard of care, and palliative care alone), time to first treatment from diagnosis, and overall and progression-free survival were assessed between the cohorts using chi-square methods. Using P<0.05 for significance, a difference was detected between the groups in treatment decisions. English proficient patients were 2.7 times more likely than LEP patients to participate in a clinical trial (P=0.016). No statistically significant differences were detected in time to first treatment, classified as treatment delay (>30 days to first treatment), or no treatment delay (≤30 days to first treatment). Additionally no statistically significant differences were detected in overall or progression-free survival. These results demonstrate a need for future study on effective strategies for enrolling LEP patients in clinical trials and a need for further research involving larger, more sociodemographically diverse patient populations to better assess for differences between English proficient and LEP patients in time to treatment and survival outcomes.