Clinical trials are essential for enhancing cancer care and providing the best possible treatment for patients with cancer. So, it is crucial to note that, despite HI being 18.9% of the US population per 2020 US Census and the fastest growing minority in the US, HIs only represent 4% of the patients enrolled in clinical trials.1 These disparities often originate from disparate social determinants of health, but could also be due to being restricted from participating simply for their lack of English proficiency. Effective doctor-patient communication is a fundamental clinical function in establishing a functional doctor-patient relationship and is vital in delivering high-quality health care. In this study, we question whether physician-patient language concordance affects clinical trial enrollment.
The study evaluated 233 patients diagnosed with breast cancer who consented to experimental clinical trials in a private practice in Houston, Texas, from 2008-2022. All trials had approved translations for English and Spanish. We used logistic regression to model the probability of treatment, while adjusting for the effects of cancer type, gender, race, ethnicity, and language (same or different as provider).
Of the 233 patients with breast cancer, 191(82%) were enrolled in a clinical trial, and 96% of these patients spoke the same language as their providers. 42 patients were not enrolled, with 95% of patients speaking the same language as their provider. There were 209 (90%) patients who spoke English, 22 (9%) were Spanish speakers and 2 (1%) were Arabic speakers. Of the Spanish speakers, 18 were enrolled, with 13 (72%) having language concordance with their provider. The ethnicity was evaluated, resulting in 72 (31%) patients being Hispanics, 55 (24%) African American, 94 (40%) Caucasian, 7 (3%) Asian, 4 (2%) Middle Eastern and 1 (0.4%) American Indian. It also evaluated the rate of consent withdrawal, showing only 6 (3%) patients. After evaluating the results, it was noted that there was no statistically significant association of physician-patient language concordance with enrollment rate (p=0.776). There was also no significant difference in consent withdrawal (p=0.626), and no change associated with gender (p=0.344) or ethnicity when evaluated (p=0.13).
In conclusion, our study confirms no significant difference in breast cancer patients’ enrollment in clinical trials if there is language concordance between physician and patient. The efforts of the medical workforce to use translators and translated versions of informed consents, surveys or outcome assessments, when available, seem enough for our patients to collect all the information required to agree to continue enrollment.