Language Barriers and the Impact on Cancer Care

Health disparities, including the unequal treatment related to language barriers between patient and healthcare provider are generally associated with unequal access to healthcare, in turn resulting in unequal health outcomes. For instance, a study conducted in 2020 demonstrated that patients who do not speak the local language of the area where they are living are disadvantaged in terms of access to healthcare services.[1]

Over the last two decades growing evidence suggest that language barriers indirectly impact the quality of the healthcare patients receive. In addition, language barriers reduce both patient and medical provider satisfaction, as well as limit effective communication between medical providers and patients.[1]

A number of studies suggest that patients who face language barriers are more likely to consume more healthcare services but are also experiencing more adverse events.[2] These studies show that most of these increased costs were attributable to patients requiring and receiving interpreter services, while medical errors resulting in and adverse events occurred more frequently among patients with limited proficiency in English than among those who were proficient in English. [3]

Before the first appointment
Research from experts at Michigan Medicine shows that significant language-based disparities exist in patients’ access to cancer care services, and it’s well before their first appointment with a doctor. [4][5]

The audit study, supported by the Rogel Cancer Center, University of Michigan and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health,

The  set up simulated patient calls from English and non-English speakers to the hospital general information lines at 144 randomly selected hospitals across 12 demographically diverse states.

The rationale provided for contacting the hospital general information line is that it serves as an initial entry point for many patients who are seeking information about hospital services, and therefore, is a highly relevant site to evaluate cancer care access.<br<

Some patients aren’t even being matched with a doctor if they don’t speak English, study shows

Despite the calls being made to hospitals in the three most common spoken languages in the United States, researchers found that the Spanish-speaking and Mandarin-speaking patient callers were provided with next steps to access cancer care only 38% and 28% of the time, respectively, significantly less than the 94% of English-speaking patient callers who were provided with next steps to access cancer care.

“If cancer patients cannot access information about where to get appropriate cancer care services, what other critical information are they not able to access within our current healthcare system?” noted Debbie Chen, M.D.

Mitigating Communication Barriers
Chen proposes various potential interventions for hospitals and healthcare systems to implement to mitigate these communication barriers.

For example, the automated messages could be accessible in different languages, and those automations could always redirect to a live person instead of disconnecting when callers don’t provide a response to menu commands.

In addition, in situations when a language interpreter is needed, the hospital general information personnel could remain on the call, as language interpreters may not be able to provide the requested information about hospital-specific services.

Study conclusion
Based on the outcome of the study, the authors identified significant systems-level barriers that non–English-speaking patients may encounter when attempting to access cancer care well before they see a physician for treatment. Hence, they believe that it is essential to take a critical look at healthcare systems and mitigate language-based communication barriers that disproportionately impact the health of vulnerable patient populations.  By doing so, the authors believe that all patients diagnosed with cancer may have access to high-quality medical and surgical care, regardless of English language proficiency.[4]

References
[1] Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020 Apr 30;35(2):e122. doi: 10.5001/omj.2020.40. PMID: 32411417; PMCID: PMC7201401.
[2] Bischoff A, Denhaerynck K. What do language barriers cost? An exploratory study among asylum seekers in Switzerland. BMC Health Serv Res. 2010 Aug 23;10:248. doi: 10.1186/1472-6963-10-248. PMID: 20731818; PMCID: PMC2939598.
[3] Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005 Sep;116(3):575-9. doi: 10.1542/peds.2005-0521. PMID: 16140695.
[4] Chen DW, Banerjee M, He X, Miranda L, Watanabe M, Veenstra CM, Haymart MR. Hidden Disparities: How Language Influences Patients’ Access to Cancer Care. J Natl Compr Canc Netw. 2023 Sep;21(9):951-959.e1. doi: 10.6004/jnccn.2023.7037. PMID: 37673110.
[5] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30. doi: 10.3322/caac.21590. Epub 2020 Jan 8. PMID: 31912902.
[6] U.S. Centers for Disease Control and Prevention. Leading cancer cases and deaths, all races/ethnicities, male and female, 2017. Online .  Last accessed on September 14, 2023.

Featured imageby National Cancer Institute on Unsplash. Used with permission

How to Cite

DOI: https://doi.org/10.14229/onco.2023.09.16.010

Peter Hofland, Ph.D ¹
Language Barriers and the Impact on Cancer Care– Onco Zine – The International Oncology Network, September 16, 2023.
DOI: 10.14229/onco.2023.09.16.010
¹ Sunvalley Communication, LLC / Onco/Zine