Abstract
BACKGROUND: In Germany, about 17% of households speak a non-German language, yet the absence of national guidelines in language-discordant encounters leaves hospitals to address these challenges individually. The impact of language barriers on cancer care in Germany also remains understudied. This study investigates the role of language barriers in the patient experiences of breast cancer patients and the influence of hospital and regional linguistic diversity on these measures. METHODS: Data were collected in 2022 from 4,822 breast cancer patients treated in 86 hospitals. The Cologne Patient Questionnaire measured unmet information needs and communication experiences. Linguistic diversity of hospitals was categorized by the proportion of non-native speaking patients. Multilevel logistic regression models were estimated, adjusting for sociodemographic (education, age, health insurance) and clinical variables (staging, surgery type, chemotherapy). RESULTS: Despite generally high average German proficiency, non-native speaking patients reported significantly greater unmet information needs regarding their disease and treatment compared with German native speakers, aligning with research in English-speaking countries. In hospitals with higher linguistic diversity, the negative association of non-native language status appeared reduced, with non-native patients reporting more favorable interactions with staff. CONCLUSION: Language barriers remain a critical but under-recognized determinant of cancer care quality in Germany. In the absence of standardized protocols for care of patients with language barriers, hospitals treating more linguistically diverse populations appear better equipped to navigate these challenges. These results point to an urgent need for national standards and targeted hospital-based strategies that systematically address language discordance, support guideline implementation, and promote equitable oncology care.