The influence of limited English proficiency on outcome in patients treated with radiotherapy for head and neck cancer

• Head and neck cancer patients are at high risk of treatment failure.
• Role of English proficiency on treatment outcome requires investigation.
• Inferior locoregional control observed in limited English proficient patients.
• Culturally sensitive interpreter/navigation services should be considered.
• Improved patient compliance is required in limited English proficient patients.

ObjectiveTo evaluate how limited English proficiency affects treatment outcome in head and neck cancer (HNC) patients treated with curative intent radiation therapy (RT).MethodsFrom 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.ResultsFewer 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.ConclusionInferior 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 implicationsPatient 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.