Qureshi Muhammad M, Romesser Paul B, Jalisi Scharukh, Zaner Ken S, Cooley Timothy P, Grillone Gregory, Kachnic Lisa A, Truong Minh Tam
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
Department of Otolaryngology, Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA.
Patient Educ Couns. 2014 Nov;97(2):276-82. doi: 10.1016/j.pec.2014.07.031. Epub 2014 Aug 11.
To evaluate how limited English proficiency affects treatment outcome in head and neck cancer (HNC) patients treated with curative intent radiation therapy (RT).
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.
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.
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.
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.
评估英语水平有限如何影响接受根治性放射治疗（RT）的头颈癌（HNC）患者的治疗结果。
2004年至2010年，131例HNC患者接受了RT治疗。在医院登记时获取患者自我报告的主要语言和种族/民族信息。英语水平分为英语熟练（EP）或英语水平有限（LEP）。种族/民族分为白人、黑人及其他（西班牙裔和亚裔）。评估患者的局部区域控制（LRC）、远处控制（DC）、总生存（OS）和无病生存（DFS）情况。
与EP患者（83.8%）相比，接受放化疗的LEP患者较少（60.0%），P = 0.028。EP和LEP患者的三年精算LRC分别为82.2%和58.3%，P = 0.038。单因素Cox回归分析显示，LEP患者局部区域失败风险增加（风险比，HR 2.4，95%CI，1.0 - 5.8）。DC、OS和DFS在英语水平方面未见差异。种族/民族与LRC、DC、OS和DFS无关。
接受RT治疗的HNC的LEP患者观察到较差的局部区域控制。英语水平有限导致的潜在健康差异需要进一步研究。
在接受复杂多学科护理的头颈癌患者中，应考虑患者教育、使用具有文化敏感性的口译员和患者导航服务，以及提高患者依从性。
