Overcoming barriers to radiotherapy in at-risk urban populations: primary language as a driver of initiation disparity

Abstract

Objective

Delays in radiotherapy initiation are associated with increased local recurrence rates, but demographic drivers of initiation disparity have not been evaluated. Patient demographics have been shown to drive treatment disparities in radiotherapy, negatively influencing treatment recommendations, initiation, and compliance, indicating significant barriers to treatment in at-risk urban populations. Recent studies evaluating the effect of primary language on these disparities have produced conflicting results; studies have focused on specific disease sites and included varying treatment modalities in addition to radiotherapy. We examined time from diagnosis to initiation in all radiotherapy-receiving patients in an urban safety net hospital, stratified by primary language.

Methods

Demographic data, 1- and 5-­year mortality, disease extent, days from diagnosis to initiation (DtI), and primary language of 342 unique patients presenting to the Brookdale University Hospital Medical Center Department of Radiation Oncology from 2008 to 2012 were collected. Records with incomplete or outlying data were excluded from analysis. Data was de-identified and coded before analysis in SPSS v. 24 with a 95% confidence interval using ANOVA for data with normalized distribution and Mann-Whitney U/Kruskal-Wallis tests for differences in non-normally distributed data, as determined by the Shapiro-Wilk test.

Results

We found no difference in DtI between English-, Spanish-, and Haitian Creole-speaking patient populations. Age at diagnosis was greater in the Haitian Creole-speaking population (p < 0.001); gender (p < 0.05), disease extent (p < 0.001), and month of initiation (p < 0.001) had an effect on DtI. Race, age at diagnosis, and ethnicity did not have a significant effect on DtI.

Conclusion

Patient primary language does not have an effect on radiotherapy initiation time in an urban safety net hospital. At-risk urban patient populations face barriers to treatment that may confound previously reported differences in English- and non-English-speaking patients.

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