Hidden Disparities: Language Barriers and Cancer Care Access


Patients with cancer who don’t speak English may have trouble accessing cancer care in the United States, especially at nonteaching hospitals, a new study suggests.


  • Language barriers between patients and physicians negatively affect the quality of care patients receive; however, less is known about how language barriers may affect patients’ access to cancer care.

  • Researchers examined the impact of patients’ spoken language on their access to care for three types of cancer that disproportionately affect Hispanic and Asian populations (colon, lung, and thyroid cancer).

  • Trained investigators who speak English, Spanish, or Mandarin called the general information line of 144 US hospitals in 12 states seeking an appointment.

  • The primary outcome was whether the simulated patient caller was provided with next steps to access cancer care, defined as being given a clinic number or clinic transfer.


  • Of the 1296 calls made (432 in each language), 53% resulted in the caller receiving next steps to access cancer care.

  • Spanish- and Mandarin-speaking callers were significantly less likely to receive information on next steps (37.7% and 27.5%, respectively) compared with English-speaking callers (93.5%).

  • In multivariable logistic regression, non-English-speaking callers had lower odds of being given next steps to access cancer care (odds ratio [OR], 0.04 for Spanish speakers; OR, 0.02 for Mandarin speakers).

  • Compared with calls to teaching hospitals, calls to nonteaching hospitals were associated with lower odds of simulated callers receiving this next-step information (OR, 0.43).


“Our study provides actionable insights into existing linguistic disparities in cancer care access due to systems-level barriers present prior to evaluation by a physician,” the authors concluded. It is essential to “engage in efforts to mitigate these communication barriers that disproportionately impact the health of vulnerable patient populations with cancer.”


The study, led by Debbie Chen, MD, University of Michigan, Ann Arbor, was published online September 5 in the Journal of the National Comprehensive Cancer Network.


The researchers only assessed responses from the hospital general information line, and the findings do not reflect the type or quality of cancer care a patient may have received once seen and treated. The study did not capture the complexities of hospital call center workflows, which limited the authors’ ability to discern the reasons behind the observed outcomes.


The study was supported by the University of Michigan’s Rogel Cancer Center and the National Institute of Diabetes and Digestive and Kidney Diseases . The authors have disclosed no relevant conflicts of interest.

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