P85. Language barriers to health literacy and mental health among non-English-speaking breast surgical oncology patients

Non-English-speaking (NES) patients experience increased language barriers navigating breast cancer care, leading to reduced understanding and heightened stress. We aim to compare health literacy barriers (HLB), mental health barriers (MHB), and concurrent health barriers (CHB) among NES compared to English-speaking (ES) breast surgical oncology patients.


Methods:

We retrospectively analyzed prospectively collected, multi-institutional data from breast surgical oncology patients between 2018 and 2025. Variables included validated surveys on health literacy, mental health, sociodemographic information, and preferred or primary language. CHB is defined as the report of both HLB and MHB. Descriptive and associative statistics were used to analyze the data.


Results:

 A cohort of 4,194 patients was included, of which 51.1% (n=2,147) had NES and 48.9% (n=2,047) had ES. The racial/ethnicity breakdown including NES (%) of each subgroup is as follows: 41.7% Other-Hispanic/Latinx (n=1,752; 90.1% NES); 29.0% Black/African American (n=1,219; 8.7% NES); 16.2% White/Caucasian (n=682; 42.0% NES); 8.2% Other-Unspecified (n=344; 20.6% NES); 3.6% Asian (n=154; 49.3% NES); and 1.0% Native American (n=43; 62.7% NES). Of NES languages, the most prevalent was predominantly Spanish (87.6%%, n=1,882) followed by Haitian Creole (2.5%, n=55) and Chinese dialects (1.7%, n=38). All other NES languages (8.0%, n=172) were infrequent (20 or fewer) or unspecified. Reporting HLB was significantly more prevalent in NES (61.5%, n=1,322) compared to ES (27.8%, n=571)(OR 95%CI 4.14 [3.63-4.71]). Reporting MHB was significantly more prevalent in NES (11.1%, n=240) compared to ES (7.2%, n=148)(OR 95%CI 1.61 [1.30-2.00]). Reporting CHB was significantly more prevalent in NES (10.6%, n=228) compared to ES (4.8%, n=100)(OR 95%CI 2.31 [1.81-2.95]). The majority of data was collected post-COVID pandemic (66%, n=2,769). Rates of reported barriers widened over time between NES vs ES comparing pre/intra- to post-COVID pandemic for HLB (NES 54.1% to 65.0%; ES 41.0% to 20.3%), MHB (NES 9.7% to 11.8%; ES 8.9% to 6.2%), and CHB (NES 9.0% to 11.3%; ES 6.5% to 3.9%).


Conclusions:

Significant health barriers exist for NES breast cancer patients compared to ES which may be worsening. NES patients receiving care in a predominantly ES health system may face increased communication challenges, which could be linked to other disadvantaged socioeconomic factors.