Limited English Proficiency Linked with Poor HSCT Outcomes

Parental limited English proficiency (LEP) was a risk factor for poor outcomes after hematopoietic stem cell transplant (HSCT) in Hispanic pediatric patients, according to a recent retrospective study.


“HSCT poses a significant set of challenges for families. This process involves a prolonged hospitalization, requires a good understanding of the diagnosis, and demands excellent medication adherence to achieve good outcomes,” study authors wrote. “Language discordance between clinicians and LEP families of pediatric patients undergoing HSCT may further complicate this process and potentially affect clinical outcomes.”


To investigate this issue, researchers reviewed HSCT outcomes in 83 Hispanic/Latino patients at a single institution. Families were classified as having LEP or English proficiency based on clinician notes, social work documentation, or the signature of a Spanish interpreter on treatment consents.


Of the 83 patients, 65.1% had parental LEP. Financial burden at pretransplant psychosocial evaluation was significantly more common in the LEP group (72.2% vs. 41.4%; P = 0.009). In addition, LEP patients were more likely to be insured through Medicaid (76.9% vs. 27.6%; P < 0.001).


LEP was also associated with a variety of HSCT outcomes. Specifically, LEP patients were hospitalized on average 13 days longer than English proficient patients, and LEP patients were more likely to have pretransplant cytomegalovirus (CMV) reactivity (P = 0.001).


“CMV infection in the posttransplant period has been associated with an increased risk of overall mortality and prolonged length of hospitalization,” the researchers wrote.


Rates of hospital readmission were similar between the two groups. Overall survival was also lower in LEP patients, but not significantly so.


The researchers noted that CMV seroactivity status, comorbidities, and socioeconomic status may have contributed to differences seen in the study.


“Our results suggest LEP families are at higher risk for poor HSCT outcomes,” the researchers wrote. “Further study is warranted in a larger cohort to distinguish whether the differences seen in our cohort are attributable to language barriers or a reflection of differences in socioeconomic status among LEP and EP groups, and to inform interventions to close the gap in outcome.”