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. 2014 Nov;97(2):276-82.
doi: 10.1016/j.pec.2014.07.031. Epub 2014 Aug 11.

The influence of limited English proficiency on outcome in patients treated with radiotherapy for head and neck cancer

Muhammad M Qureshi  1 , Paul B Romesser  1 , Scharukh Jalisi  2 , Ken S Zaner  3 , Timothy P Cooley  3 , Gregory Grillone  2 , Lisa A Kachnic  1 , Minh Tam Truong  4
Affiliations

The influence of limited English proficiency on outcome in patients treated with radiotherapy for head and neck cancer

Muhammad M Qureshi et al. Patient Educ Couns. 2014 Nov.

Abstract

Objective: To evaluate how limited English proficiency affects treatment outcome in head and neck cancer (HNC) patients treated with curative intent radiation therapy (RT).

Methods: From 2004 to 2010, 131 patients with HNC underwent RT. Patient's self-reported primary language and race/ethnicity were obtained at hospital registration. English proficiency was categorized as being English proficient (EP) or limited English proficient (LEP). Race/ethnicity was categorized as white, black and other (Hispanics and Asians). Patients were evaluated for locoregional (LRC), distant control (DC), overall (OS) and disease-free (DFS) survival.

Results: Fewer LEP patients (60.0%) underwent chemoradiation compared to EP (83.8%), P=0.028. The three-year actuarial LRC for EP and LEP patients was 82.2% and 58.3%, respectively, P=0.038. LEP patients had an increased risk of locoregional failure on univariate Cox regression analysis (hazard ratio, HR 2.4, 95% CI, 1.0-5.8). No differences by English proficiency were seen for DC, OS and DFS. Race/ethnicity was not associated LRC, DC, OS and DFS.

Conclusion: Inferior locoregional control was observed in LEP patients receiving RT for HNC. Potential health disparities as a result of limited English proficiency require further investigation.

Practice implications: Patient education, use of culturally sensitive interpreter and patient navigation services, and improved patient compliance should be considered in head and neck cancer patients receiving complex multidisciplinary care.

Keywords: Head and neck cancer; Health disparities; Language disparities; Limited English proficiency; Race; Radiotherapy.

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Figures

Fig. 1
Fig. 1
Locoregional control according to English proficiency.
Fig. 2
Fig. 2
Locoregional control at 3 years according to English proficiency and treatment regimen.
Fig. 3
Fig. 3
Univariate and bivariate analysis of locoregional failure (LRF) by English proficiency. The adjusted hazard ratios are for risk of LRF adjusting individually for patient, tumor and treatment characteristics. Both univariate and bivariate models are based on 111 English Proficient and 20 limited English proficient patients.
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References

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