Impact of language on distress screening in cancer patients at an NCI-Designated Comprehensive Cancer Center.

Abstract

e18070 Background: Psychological distress has been linked to poor outcomes among cancer patients. In 2007, the Institute of Medicine reported that distress is often unrecognized. While much is known about distress screening in English speaking populations, little is known about the provision of screening in Spanish. Methods: From 2009-2016, over 9000 solid tumor and lymphoma patients treated at an NCI CCC were prospectively administered a validated biopsychosocial distress questionnaire in their preferred language. The data was retrospectively stratified by language and Chi-square and ANOVA tests were performed to detect differences. Results: Spanish-speaking patients had the highest levels of reported distress in every category when compared to any other group. Of the 629 patients that reported Spanish as their preferred language, 400 (63.6%) took the questionnaire in Spanish (SS) with the rest taking it in English (SE). There was no difference in reported gender, marital status, education level or income between the two groups. The SS patients were younger (mean age 56 vs 60.5, P = 0.00) and reported significantly higher distress than the SE patients in every biopsychosocial domain except functional. The greatest difference was seen in “understanding treatment options” (40.1% SS vs 19% SE, p = 0.00) with a significant difference seen also in “fear of medical procedures” (38.2% SS vs 29.9% SE, p = 0.037), “finances” (66.5% SS vs 55.4% SE, p = 0.01), “finding community resources” (34.8% SS vs 26% SE, p = 0.03), “managing emotions” (40.3% SS vs 31.5% SE, p = 0.032), “needing help to coordinate care” (41% SS vs 23.4% SE, p = 0.00) and “transportation” (35.2% SS vs 21.9% SE, p = 0.001). The distress of the SE patients was more similar to that seen in the English-English patients, but was still significantly higher. Conclusions: These provocative data demonstrate distress levels are stratified by preferred language among cancer patients. Spanish speaking patients had the highest levels of reported distress but this difference was more pronounced when they were administered the questionnaire in Spanish. More studies are needed to determine culturally effective ways to identify distress in Spanish speaking populations.