For many cancer patients who receive potentially life-saving stem cell transplants (also known as bone marrow transplants)at specialized centers, the need for months of regular return visits to check for complications causes financial hardships, reduced income, additional stress, and lower quality of life.
In a move to ease those burdens, researchers at Dana-Farber Cancer Institute will test a “Shared Care” model that allows patients to receive half of their post-transplant monitoring from cancer specialists closer to their homes.
A team led by Gregory Abel, MD, MPH, a member of the division of Population Sciences as well as the division of Hematologic Malignancies at Dana-Farber has been selected to receive $2.6 million in funding from the Patient Centered Outcomes Research Institute (PCORI) for a five-year clinical trial to determine if the Shared Care program can be safe and effective in providing quality in follow-up care.
“Such a model may reduce patient-centered burdens post-transplant,” said Abel. “However, it is not known if, given its complexity, post-transplant care can truly be shared between transplant specialists and local oncologists without compromising transplant outcomes.”
Hematopoietic stem cell/bone marrow transplantation is the only potentially curative treatment for many patients with advanced blood cancers, but it is offered only at selected inpatient cancer centers in the United States that can safely provide this highly technical therapy. After discharge from the hospital, patients who have received bone-marrow or stem-cell transplants must be monitored closely – typically through weekly return visits to the center – for signs of complications such as infections or bleeding. In many cases, patients and family members or other caregivers travel long distances for follow-up visits with their specialist transplant teams.
Abel and colleagues at Dana-Farber recently published the results of a survey of transplant recipients revealing that 46 percent had a decline in their income and 56 percent reported financial hardship six months after their transplant. Factors contributing to hardship included costs of transportation and parking, time away from work, and work accommodations required of family members.
In the study to be supported by PCORI funding, transplant patients will be randomized either to receive all their follow-up care at Dana-Farber (the transplant center) or alternate visits between the center and a local oncologist closer to their home. These oncologists are located in New York, Connecticut, New Hampshire, and Maine. They will attend a multi-day transplant conference at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), and can confer about any concerns with DF/BWCC specialists via a tailored Web-based platform. If patients being seen by local oncologists develop a need to be hospitalized, they will be admitted to DF/BWCC, Abel said.
Dr. Abel and the team at Dana-Farber were selected for PCORI funding through a highly competitive review process in which patients, clinicians, and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria.
“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Executive Director Joe Selby, MD, MPH. “We look forward to following the study’s progress and working with Dana-Farber to share the results.”
PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions.