Muhammad M Qureshi1, Paul B Romesser1, Scharukh Jalisi2, Ken S Zaner3, Timothy P Cooley3, Gregory Grillone2, Lisa A Kachnic1, Minh Tam Truong4. 1. Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA. 2. Department of Otolaryngology, Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA. 3. Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA. 4. Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA. Electronic address: mitruong@bu.edu.
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.
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 LEPpatients (60.0%) underwent chemoradiation compared to EP (83.8%), P=0.028. The three-year actuarial LRC for EP and LEPpatients was 82.2% and 58.3%, respectively, P=0.038. LEPpatients 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 LEPpatients 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 cancerpatients receiving complex multidisciplinary care.
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