The impact of limited English proficiency on oncological outcomes in the United States: A systematic review

Abstract

AbstractBackgroundThe increasing number of immigrants in the United States (U.S.) has resulted in more patients with limited English proficiency (LEP). LEP contributes to patient‐provider language discordance, which may impact oncologic health outcomes.ObjectivesTo assess the effects of LEP compared to English proficiency (EP) for oncological outcomes in adult cancer patients in the United States.Search MethodsWe searched MEDLINE (Ovid), the Cochrane Library (Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials), PsycINFO, CINAHL and Scopus from data inception to 26 January 2023. We also searched the reference lists and cited lists of included studies. Studies were limited to the United States and the English language.Selection CriteriaWe included retrospective and cross‐sectional studies that analyzed one or more clinical outcomes (survival, readmission, length of stay, complications and discharge disposition) in LEP and EP cancer patients. Studies were eligible if they assessed cancer patients in the United States who were 18 years and older.Data Collection and AnalysisUsing a piloted, standardized data collection form, two non‐blinded, independent reviewers extracted data in duplicate from studies meeting our inclusion criteria. Reviewers resolved discrepancies through discussion. We then performed a qualitative assessment of the findings.Main ResultsWe retrieved 2425 records from the database searches. We screened 1496 records by title and abstract and reviewed the full text of eight records. We retrieved 347 records from additional search methods and reviewed the full text of six records. We included 14 papers in total for analysis. The studies included 55,141 total patients and assessed outcomes in brain, oesophageal, head and neck, pancreatic and skin cancer. Our qualitative assessment demonstrated limited information on whether LEP impacted survival, complications and discharge disposition. We found no significant association between LEP and readmission or length of stay.ConclusionsStudies assessing the impact of LEP and EP on the health outcomes of cancer patients are sparse and inconsistent in the measurements of outcomes and data reporting. The inconclusiveness of our study indicates that further standardized research is needed to assess the impact of LEP on the outcomes of cancer patients in the United States.