Delay in Care for Gynecologic Oncology Patients With Limited English Proficiency
OBJECTIVE:
To evaluate referral patterns and care delay for the growing population of patients with limited English proficiency (LEP) who seek treatment with gynecologic oncologists.
METHODS:
This is a retrospective cohort study of all patients seen by gynecologic oncologists at a National Cancer Institute–designated cancer center from 2013 to 2024 (referral cohort). Our primary outcome was the time to receipt of first treatment after the initial referral, by LEP status (among patients receiving treatment with a gynecologic oncologist—the treatment cohort) and with delay categorized using 4- and 6-week cutoffs. We compared referral patterns and sociodemographic, clinical, and temporal data by LEP status , defined as documented need for an interpreter. We employed χ 2 tests for categorical variables and two-sided t tests or Mann-Whitney U tests for continuous variables. Multivariable linear regression was performed.
RESULTS:
Of 9,915 patients seen for consultation, 5.8% (n=573) had LEP. Patients with LEP were significantly more likely to have referrals originating from the emergency department (6.5% vs 1.0%, P <.001), require multiple referrals to a gynecologic oncologist before initial consultation (9.4% vs 5.1%, P <.001), and be referred to other obstetrics and gynecology specialties before reaching gynecologic oncology (15.9% vs 8.7%, P <.001). Of 5,329 patients who received treatment with gynecologic oncologists, those with LEP were more likely to experience delays in receiving treatment after the initial diagnosis-related referral (63.2% with LEP vs 52.4% without LEP waiting more than 4 weeks, P <.001; 43.5% with LEP vs 35.7% without LEP waiting more than 6 weeks, P <.001). The time from consultation to treatment did not differ by language status. After adjusting for race, insurance status, and ethnicity, the time from referral to treatment remained 16.0% longer for patients with LEP.
CONCLUSION:
In this large, diverse cohort, patients with LEP experienced inequitable, cumulative health care delays. Inefficient referral patterns created delay before initial gynecologic oncology consultation.