Riverside University Health System, Moreno Valley, California.
University of California Riverside School of Medicine, Riverside, California.
J Surg Res. 2022 Dec;280:404-410. doi: 10.1016/j.jss.2022.06.060. Epub 2022 Aug 27.
Lower screening rates and poorer outcomes for colorectal cancer have been associated with Hispanic ethnicity and Spanish-speaking status, respectively.
We reviewed sequential colorectal cancer patients evaluated by the surgical service at a safety-net hospital (SNH) (2016-2019). Insurance type, stage, cancer type, surgery class (elective/urgent), initial surgeon contact setting (outpatient clinic/inpatient consult), operation (resection/diversion), and follow-up were compared by patient-reported primary spoken language.
Of 157 patients, 85 (54.1%) were men, 91 (58.0%) had colon cancer, 67 (42.7%) primarily spoke Spanish, and late stage (III or IV) presentations occurred in 83 (52.9%) patients. The median age was 58 y, cancer resection was completed in 48 (30.6%) patients, and 51 (32.5%) patients were initially seen as inpatient consults. On univariate analysis, Spanish-speaking status was significantly associated with female sex, Medicaid insurance, being seen as an outpatient consult, and undergoing elective and resection surgery. On multivariable logistic regression, Spanish-speaking patients had higher odds of having Medicaid insurance (AOR 2.28, P = 0.019), receiving a resection (AOR 3.96, P = 0.006), and undergoing an elective surgery (AOR 3.24, P = 0.025). Spanish-speaking patients also had lower odds of undergoing an initial inpatient consult (AOR 0.34, P = 0.046).
Spanish-speaking status was associated with a lower likelihood of emergent presentation and need for palliative surgery among SNH colorectal cancer patients. Further research is needed to determine if culturally competent infrastructure in the SNH setting translates into Spanish-speaking status as a potentially protective factor.
结直肠癌的筛查率较低，预后较差，分别与西班牙裔和西班牙语使用有关。
我们回顾了 2016 年至 2019 年期间在一家安全网医院（SNH）接受外科服务评估的连续结直肠癌患者。根据患者报告的主要语言，比较了保险类型、分期、癌症类型、手术类别（择期/紧急）、初始外科医生联系地点（门诊诊所/住院会诊）、手术（切除/转流）和随访。
在 157 名患者中，85 名（54.1%）为男性，91 名（58.0%）患有结肠癌，67 名（42.7%）主要讲西班牙语，83 名（52.9%）患者为晚期（III 期或 IV 期）。中位年龄为 58 岁，48 名（30.6%）患者完成了癌症切除术，51 名（32.5%）患者最初被视为住院会诊。在单变量分析中，西班牙语使用与女性、医疗补助保险、门诊会诊和择期及切除术有关。多变量逻辑回归分析显示，西班牙语患者更有可能获得医疗补助保险（优势比 2.28，P = 0.019）、接受切除术（优势比 3.96，P = 0.006）和接受择期手术（优势比 3.24，P = 0.025）。西班牙语患者初始住院会诊的可能性也较低（优势比 0.34，P = 0.046）。
在 SNH 结直肠癌患者中，西班牙语使用与紧急就诊和姑息性手术的可能性降低有关。需要进一步研究以确定 SNH 环境中的文化能力基础设施是否转化为西班牙语使用状态，作为一个潜在的保护因素。
