Delays in Care for Non-English Speaking Patients with Breast Cancer Undergoing Radiation Therapy

Abstract

Language discrepancies create barriers to healthcare that may impact a patient’s course of care including delays in diagnosis, biopsy, resection, and radiation treatment. The aim of this study was to determine if non-English speakers (NES) experience treatment delays within their path to radiation treatment compared to English-speaking patients. NES patients diagnosed with breast cancer and treated with radiation between 2016 and 2017 (n=67) were matched with English-speaking patients based on sex, age, cancer stage, and chemotherapy (neoadjuvant or adjuvant). A total of 27 NES were matched to 40 English speakers; 13 NES were matched to 2 English-speakers and 14 NES were matched to one English speaker. Conditional logistic regression on matched data was used to compare time between diagnostic mammogram and biopsy, resection, Radiation Oncology consult, and start of radiation treatment. We also evaluated the time from resection to Radiation Oncology consult, resection to start of radiation treatment, and Radiation Oncology consult to start of radiation treatment. The time from diagnostic mammogram to diagnostic biopsy was significantly longer for NES compared to English-speaking patients (p= 0.0322), with an average difference of 25 days and an odds ratio of 1.043, 95%CI [1.003, 1.102]. A one-week increase in time to biopsy increased the odds of a patient being NES by 34% (p=0.0322). Although not statistically significant, similar time delay trends were observed between NES and English-speaking patients for time from diagnostic mammogram to resection (p=0.0703), diagnostic mammogram to Radiation Oncology Consult (p=0.0702), and diagnostic mammogram to start of radiation treatment (p=0.0848). We did not observe a difference in time from resection to new visit (p=0.2197) or resection to start of treatment (p=.2004). Independent of sex, age, race/ethnicity, and receipt of chemotherapy, language predicted delays in care for patients undergoing treatment for breast cancer. The most pronounced delay in care for NES was the time from diagnostic mammogram to diagnostic biopsy. However, notable trends were observed as NES patients progressed to resection, Radiation Oncology consult, and the start of radiation treatment. Additional analyses are underway for a larger matched cohort to build on these findings. These results provide preliminary data to help guide future interventions for improving healthcare delivery for Non-English speaking patients.