2145 - Impact of Limited English Proficiency on Breast Cancer Outcomes

D. Spiegel¹, J. Willcox², A. M. Modest¹, N. Bhargava¹, and A. Recht¹; ¹Beth Israel Deaconess Medical Center, Boston, MA, ²Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA

Purpose/Objective(s): Limited English proficiency (LEP) poses a significant challenge in healthcare delivery and may contribute to disparate outcomes. Insights into the effects of LEP can provide valuable information for healthcare providers, policymakers, and advocates aiming to enhance the quality of care for diverse patient populations. This study investigates the impact of LEP on breast cancer-related outcomes. Materials/

Methods: We conducted a retrospective analysis of breast cancer patients treated with definitive-intent care at a single academic medical center between 2000-2020. A total of 23,237 patients were included in the initial patient cohort acquired through extraction of electronic medical record data. These patients were cross-referenced with those included in the institutional cancer registry to create a final cohort of 2,261 patients with complete data for analysis. Demographic information, cancer stage at diagnosis, treatment modalities, and follow-up information were collected. Statistical analyses, including Kaplan-Meier survival methods, were employed to assess the association between LEP and cancer-related outcomes.
Results: Median follow-up was 60.0 months (95% confidence interval [CI] 58.8-61.0). Clinical and treatment data were well-balanced between the LEP and English-proficient groups. The time between biopsy and definitive surgery was significantly longer for patients with LEP than for English-proficient patients (49 days [interquartile range (IQR) 29-75] vs. 38 days [IQR 24-57], p < 0.001). When stratified by type of insurance, only those with Medicare insurance had significant delays between biopsy and surgery (54 days [IQR 29-96] in the LEP group and 36 days [IQR 25-53] in the English-proficient group, p < 0.001). Five-year rates of overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were 94.4% (95% CI 89.3-97.1), 93.9% (95% CI 89.4-96.5), and 98.5% (95% CI 93.8-99.6) for LEP patients and 96.7% (95% CI 95.7-97.5), 95.6% (95% CI 94.4-96.5%), and 99.0% (95% CI 98.3-99.4%) for English-proficient patients (log-rank, p = 0.26, p = 0.96, and p = 0.39, respectively).
Conclusion: Limited English proficiency was associated with delays in definitive surgical management in breast cancer survivors and worse, but not statistically significant, OS, DFS, and DSS in our population. Delays in surgical management in breast cancer patients has been shown to be associated with worse overall survival in other studies. Addressing these barriers may improve timely diagnosis and treatment, care-plan adherence, and long-term follow-up, ultimately reducing disparities in breast cancer outcomes among patients with LEP. Future research should delve into specific interventions to mitigate language-related disparities and improve overall breast cancer outcomes in this vulnerable population.