Feasibility and Implementation of a Multimodal Supportive Care Program to Improve Outcomes in Older Patients Undergoing Allogeneic Stem Cell Transplantation

Szewczyk, Nicholas A.; Ngo‐Huang, An; Soones, Tacara; Adekoya, Latoya; Fontillas, Rhodora C.; Ferguson, Jill; Gale-Capps, Haley E.; Kurse, Brittany C.; Lindsay, R; Ombres, Rachel; Rivera, Zandra; Gulbis, Alison; Neumann, Joyce; Braveman, Brent; Marín, David; Shigle, Terri Lynn; Whited, Laura; Wallis, Whitney; Sullivan, Hilary; Cao, Li-Hui; Champlin, Richard E.; Shpall, Elizabeth J.; Popat, Uday

doi:10.1016/j.jtct.2021.09.002

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…com/PHM/C278). 12 This ER-SCT program 11,13 includes older patients 65 yrs or older who received a multidisciplinary prehabilitation program before allo-HSCT. All allo-HSCT candidates 65 yrs and older were automatically referred to all components of this program.…”

Section: Methodsmentioning

confidence: 99%

“…This is a retrospective study of 50 consecutive patients referred to the Enhanced Recovery Stem Cell Transplant (ER-SCT) program 11 at a comprehensive cancer center between March 13, 2018, and February 28, 2019 (Protocol PA18-0227). A waiver of informed consent was granted by the institutional review board in compliance with federal and institutional guidelines due to the retrospective nature of this study.…”

Section: Methodsmentioning

confidence: 99%

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The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

Cheng,

Obaisi,

Yadav

et al. 2024

Am J Phys Med Rehabil

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Introduction Physical rehabilitation is increasingly incorporated throughout the allogeneic hematopoietic stem cell transplant (allo-HSCT) journey for older adults. Objective This study aimed to describe physical medicine and rehabilitation (PM&R)-related diagnoses, exercise barriers, and management recommendations for older adults before allo-HSCT. Design Fifty PM&R consults as part of the Enhanced Recovery-Stem Cell Transplant (ER-SCT) multidisciplinary prehabilitation program at a comprehensive cancer center were retrospectively reviewed. Results Many PM&R-related diagnoses (173), exercise barriers (55), and management recommendations (112) were found. Common diagnoses were musculoskeletal dysfunction (more commonly back, shoulder, then knee) (n = 39, 23%) and fatigue (n = 36, 21%). Common exercise barriers were also musculoskeletal dysfunction (more commonly back, knee, then shoulder) (total n = 20, 36%) and fatigue (n = 20, 36%). Most patients (n = 32, 64%) had 1 or more exercise barriers. Common PM&R management recommendations were personalized exercise counseling (n = 37, 33%), personalized nutrition management (n = 19, 17%), body composition recommendations (n = 17, 15%), medications (n = 15, 13%), and orthotics and durable medical equipment (n = 8, 7%). Conclusion Routine PM&R referral of older allo-HSCT patients for prehabilitation resulted in the identification of many rehabilitative needs and substantial additional management recommendations. Increased early, collaborative prehabilitation efforts between PM&R and allo-HSCT teams to optimize care for these patients is recommended.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

Cheng,

Obaisi,

Yadav

et al. 2024

Am J Phys Med Rehabil

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“…1 ). [ 55 ] For the physical prehabilitation, patients are seen by a senior PT and PM&R physician to assess for any neuromuscular, functional, or medical concerns that may interfere with physical activity. They are evaluated by OT to screen for and manage fatigue, sleep hygiene, and cognitive concerns, and to establish a routine conducive to recovery.…”

Section: Prehabilitation For Car T-cell Therapy—is It Possible?mentioning

confidence: 99%

Rehabilitation Needs for Patients Undergoing CAR T-Cell Therapy

et al. 2022

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Purpose of Review Chimeric antigen receptor (CAR) T-cell therapy is a relatively new, innovative treatment strategy to manage refractory hematological cancers, including some types of leukemia, lymphoma, and multiple myeloma. This article outlines the CAR T-cell therapy process, toxicity, and complications, along with an overview of the currently known short- and long-term physical and functional sequelae that will be helpful for general or oncology rehabilitation specialists caring for these patients. Recent Findings There is a dearth of literature on the topic of rehabilitation of patients receiving CAR T-cell therapy. Rehabilitation practices can be extrapolated from the limited functional information on patients who have completed treatment for lymphoma and multiple myeloma. Patients present with cognitive impairment, muscle weakness, reduced exercise capacity, neuropathy, and cancer-related fatigue. Physical activity and rehabilitation programs may be beneficial to address fatigue, psychological symptoms, and quality of life. Summary There is limited rehabilitation research in patients receiving CAR T-cell therapy. These patients may present with general deconditioning and neurological complications which translate to neuromuscular and cognitive impairment that benefit from multidisciplinary rehabilitation intervention prior to, during, and after treatment. Studies measuring the impairments at baseline and evaluation of the impact of rehabilitation practices are much needed to support this.

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“…1 At The University of Texas MD Anderson Cancer Center , more older patients are undergoing allogeneic transplantation, but their outcomes are inferior to younger patients. 2 In addition to chronological age, disease status, comorbidities, novel risk factors identified through comprehensive geriatric assessment, including impairments in instrumental activities of daily living (IADL), nutrition status, cognition, and physical function have emerged as predictors of survival in older adults with hematologic cancers. [3][4][5][6][7][8][9][10] Furthermore, frailty, a state of age-associated decreased physiologic reserve, increases the risk of poor health outcomes after HSCT.…”

Section: Introductionmentioning

confidence: 99%

“…1 At The University of Texas MD Anderson Cancer Center , more older patients are undergoing allogeneic transplantation, but their outcomes are inferior to younger patients. 2…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery Stem-Cell Transplantation: Multidisciplinary Efforts to Improve Outcomes in Older Adults Undergoing Hematopoietic Stem-Cell Transplant

Ngo‐Huang

Ombres

Saliba

et al. 2023

JCO Oncology Practice

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PURPOSE: Older adults have unique risk factors for poor outcomes after hematopoietic stem-cell transplant (HSCT). We sought to determine the impact of our multidisciplinary supportive care program, Enhanced Recovery after stem-cell transplant (ER-SCT), on survival outcomes in patients age 65 years and older who underwent HSCT. PATIENTS AND METHODS: In this retrospective study, clinicodemographic data, nonrelapse mortality (NRM), overall survival (OS), and relapse were compared between 64 patients age 65 years and older who underwent allogeneic stem-cell transplant during ER-SCT program's first year, October 2017 through September 2018, and 140 historical controls age 65 years and older who underwent allogeneic HSCT, January 2015 through September 2017. RESULTS: In the ER-SCT cohort, 41% (26 of 64) of patients were women, and the median (range) age was 68 (65-74) years; in the control cohort, 38% (53 of 140) of patients were women, and the median (range) age was 67 (65-79) years. Hematopoietic cell transplant comorbidity index and donor type/cell source were similar between cohorts. The ER-SCT cohort had a lower 1-year NRM rate (13% v 26%, P = .03) and higher 1-year OS rate (74% v 53%, P = .007). Relapse rate did not differ significantly between cohorts. In multivariate analyses, ER-SCT was associated with improved 1-year NRM (hazard ratio, 0.4; 95% CI, 0.2 to 0.9; P = .02) and improved 1-year OS (hazard ratio, 0.5; 95% CI, 0.3 to 0.9; P = .03). CONCLUSION: A multidisciplinary supportive care program may improve NRM and OS in older patients undergoing allogeneic HSCT. Randomized studies are warranted to confirm this benefit and explore which program components most contribute to the improved outcomes.

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Feasibility and Implementation of a Multimodal Supportive Care Program to Improve Outcomes in Older Patients Undergoing Allogeneic Stem Cell Transplantation

Cited by 6 publications

References 22 publications

The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

The Role of Outpatient Physical Medicine and Rehabilitation in a Multidisciplinary Prehabilitation Program for Older Adults before Allogeneic Hematopoietic Stem Cell Transplant

Rehabilitation Needs for Patients Undergoing CAR T-Cell Therapy

Enhanced Recovery Stem-Cell Transplantation: Multidisciplinary Efforts to Improve Outcomes in Older Adults Undergoing Hematopoietic Stem-Cell Transplant

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