Patients undergoing a donor stem-cell transplant for leukemia or other blood-related cancer require months of specialized follow-up care, traditionally delivered at the center where they received their transplant - often a serious challenge for those who live far away. A large clinical trial by Dana-Farber Cancer Institute investigators shows that patients can fare just as well when they receive some of this care at a local hematology/oncology clinic.
The trial found that among patients treated via this "Shared Care" model, the non-relapse mortality rate - the percentage who died without their cancer returning or worsening 100 days after transplant - was no higher than that for patients who received usual care (coming to Boston for every visit). Moreover, quality of life at the 100-day mark was higher in the Shared Care group than in the usual care group.
The results suggest that Shared Care has the potential to become a routine model for care following a donor stem cell transplant, reducing some of the logistical and financial burdens that patients living far away face. The findings were published in JAMA Oncology.
"Due to methodological advances and improvements in supportive care, more and more patients are eligible for allogeneic [donor] stem cell transplantation, but transplant is a highly technical process and is available only at select centers," says Gregory Abel, MD, MPH, who led the study with Vincent Ho, MD, and Robert Soiffer, MD, all of Dana-Farber.
"In this study, we explored whether a Shared Care model could improve patient-centered outcomes like quality of life for patients with live far away without risking the success of the procedure itself."
The clinical trial involved 302 patients who underwent allogeneic transplant at one of eight centers in New England and New York State. After transplant, 152 of the patients received follow-up care under the Shared Care model while 150 received usual care.
Patients in the usual care group received all their follow-up care at Dana-Farber, while Shared Care patients alternated visits between Dana-Farber and their local hematology/oncology physician. The Shared Care model included four strategies to ensure patients could be safely seen locally: a formal online care coordination plan between Dana-Farber and the local care provider; enriched patient education; local physician education, including face-to-face training with Dana-Farber transplant physicians; and a web portal for patients, local physicians, and transplant physicians to communicate with one another.
At the 100th day after transplant, the non-relapse mortality rate for Shared Care patients was 2.6%, and the rate for usual care patients was 2.7%. While there were few differences in quality-of-life measures between the two groups at day 180, quality of life scores were higher for the Shared Care patients at day 100, encompassing physical as well as emotional well-being, researchers found.
"When undertaken with the safeguards we studied, partial decentralization of post-transplant care has the potential to reduce early patient burdens and may even improve access to this life-saving procedure," said Abel.
Funding support for this research was provided by the Patient-Centered Outcomes Research Institute (PCORI), an independent, nonprofit organization authorized by Congress with a mission to fund patient-centered comparative clinical effectiveness research.
