Hidden Disparities: How Language Influences Patients’ Access to Cancer Care
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Background: Patients with limited English proficiency, a vulnerable patient population, remain understudied in the literature addressing cancer disparities. Although it is well documented that language discordance between patients and physicians negatively impacts the quality of patient care, little is known about how patients’ preferred spoken language impacts their access to cancer care. Patients and Methods: Between November 2021 and June 2022, we conducted an audit study of 144 hospitals located across 12 demographically diverse states. Using a standardized script, trained investigators assigned to the roles of English-speaking, Spanish-speaking, and Mandarin-speaking patients called the hospital general information telephone line seeking to access care for 3 cancer types that disproportionately impact Hispanic and Asian populations (colon, lung, and thyroid cancer). Primary outcome was whether the simulated patient caller was provided with the next steps to access cancer care, defined as clinic number or clinic transfer. We used chi-square tests and logistic regression analysis to test for associations between the primary outcome and language type, region type, hospital teaching status, and cancer care requested. We used multivariable logistic regression analysis to determine factors associated with simulated patient callers being provided the next steps. Results: Of the 1,296 calls, 52.9% (n=686) resulted in simulated patient callers being provided next steps to access cancer care. Simulated non–English-speaking (vs English-speaking) patient callers were less likely to be provided with the next steps (Mandarin, 27.5%; Spanish, 37.7%; English, 93.5%; P<.001). Multivariable logistic regression found significant associations of the primary outcome with language spoken (Mandarin: odds ratio [OR], 0.02 [95% CI, 0.01–0.04] and Spanish: OR, 0.04 [95% CI, 0.02–0.06] vs English) and hospital teaching status (nonteaching: OR, 0.43 [95% CI, 0.32–0.56] vs teaching). Conclusions: Linguistic disparities exist in access to cancer care for non–English-speaking patients, emphasizing the need for focused interventions to mitigate systems-level communication barriers.
Submitted February 7, 2023; final revision received April 21, 2023; accepted for publication May 19, 2023.
Author contributions: Study concept and design: Chen, Banerjee, Veenstra, Haymart. Funding acquisition: Chen, Banerjee, Veenstra, Haymart. Data acquisition, analysis, and/or interpretation: All authors. Statistical analysis: Chen, Banerjee, Watanabe. Writing—original draft: Chen, Haymart. Writing—review & editing: Banerjee, He, Miranda, Watanabe, Veenstra.
Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by the Rogel Cancer Center, University of Michigan (Discovery Award; D.W. Chen) and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number T32DK07245 (D.W. Chen).
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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