While non-English language preference (NELP) is not tied to breast cancer survival outcomes, it can delay surgical management, according to research published June 5 in JAMA Network Open.
Compared with women who preferred that English language be used during breast care visits, NELP patients experienced significant delays in definitive surgical management, wrote a team led by Daphna Spiegel, MD, from the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, MA. However, the team also reported that differences in overall survival, disease-specific survival, and disease-free survival in both groups that were not statistically significant.
“This suggests the importance of having robust support systems to mitigate language-related disparities and preserve breast cancer outcomes in this vulnerable population,” Spiegel and colleagues highlighted.
Language barriers may deter women from getting their regular breast cancer screening exams or timely care after a diagnosis. A 2013 survey of over 700 U.S. breast care centers reported that nearly seven in 10 mammography results were available exclusively in English. And even after receiving appropriate care and counseling, many women with NELP are more likely to seek alternative treatments.
Spiegel and co-authors studied whether NELP is independently linked to breast cancer outcomes. They included data collected between 2000 and 2020 from 2,261 patients, with 2,240 being female. Of the total patients, 2,203 had an English language preference while 238 had NELP. The researchers also noted a median follow-up of five years.
The team found no significant differences in survival outcomes between the two groups.
5-year survival outcomes in breast care patients with ENLP, English language preference | |||
Measure | English language preferred | NELP | p-value |
Disease-specific survival | 99% | 98.5% | 0.39 |
Disease-free survival | 95.6% | 93.9% | 0.96 |
Overall survival | 96.7% | 94.4% | 0.26 |
However, patients with NELP had a significantly longer median time between biopsy and definitive surgery (49 days) compared to the English language preferred group (38 days, p < 0.001).
And when the researchers stratified the data by insurance, only patients with Medicare experienced significant delays between biopsy and surgery. This included 54 days for the NELP group and 36 days for the English language preferred group (p < 0.001).
The results highlight the role of system-level interventions toward providing equitable care, especially in diverse healthcare settings, the study authors wrote.
“Strengthening and expanding culturally and linguistically tailored support services may further enhance access to timely care and improve outcomes for patients with NELP,” they added.
The team also called for future research to explore the role of language barriers in other cancer-related end points. These may include quality of life, patient satisfaction, and adherence to follow-up care. The team added that studies assessing the effectiveness of targeted interventions in this area could improve equity in cancer care.
The full study can be accessed here.
