title: The influence of limited English proficiency on outcome in patients treated with radiotherapy for head and neck cancer.
abstract: OBJECTIVE
  To evaluate how limited English proficiency affects treatment outcome in head and neck cancer (HNC) patients treated with curative intent radiation therapy (RT).
  
  
  METHODS
  From 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.
  
  
  RESULTS
  Fewer 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.
  
  
  CONCLUSIONS
  Inferior locoregional control was observed in LEP patients receiving RT for HNC. Potential health disparities as a result of limited English proficiency require further investigation.
  
  
  CONCLUSIONS
  Patient 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.
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Qureshi
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Romesser
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Scharukh
authors.initials: S
authors.lastname: Jalisi
authors.affiliation: Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Ken S
authors.initials: KS
authors.lastname: Zaner
authors.affiliation: Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Cooley
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Grillone
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA. Electronic address: mitruong@bu.edu.
authors.forename: Minh Tam
authors.initials: MT
authors.lastname: Truong
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003144:Communication Barriers; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006258:Head and Neck Neoplasms / Q000208:ethnology / Q000523:psychology / Q000532:radiotherapy*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data
keywords: Head and neck cancer; Health disparities; Language disparities; Limited English proficiency; Race; Radiotherapy