Shared Care: Patient-Centered Management After Hematopoietic Cell Transplantation

Not Applicable

Completed

Brief Summary: This research study aims to evaluate the effectiveness of allowing patients who have had a hematopoietic cell transplant to receive some of their post-transplant care with a local oncologist rather than returning to the transplant center for all of their follow-up.

Detailed Description: Hematopoietic Cell Transplantation (HCT) - also known as bone marrow transplant - is only available at select centers in the United States which can collect and store stem cells, as well as care for patients before their new immune system cells take hold. For this reason, many patients who undergo HCT live at great distances from their HCT center. Also, after hospital discharge, the first 180 days post-HCT are very important, as patients must be managed closely with frequent follow-up visits.

A potential way to make life easier for HCT patients is to allow some of the post-transplant care to be provided by local oncologists who practice closer to where patients live. This could reduce the burden on patients and their caregivers; however, it is not known if a shared care model would ultimately benefit them. The investigators want to assess the effectiveness of a Shared Care program which allows patients to receive half of their post-HCT care at the HCT center, and the other half with their local oncologist

Recruitment & Eligibility

Inclusion Criteria

Age >= 18 years of age
Scheduled to receive an allogeneic HCT at the Dana-Farber Inpatient Hospital or BWH under the care of a DFCI physician
Residence in New York, Maine, New Hampshire, Vermont, Connecticut, or Massachusetts
Referred from or live less than 1 hour from one of the local participating centers.
Ability to read English (to fill out standard QOL forms)

Exclusion Criteria

Age <18 years of age
Scheduled to receive an autologous HCT
Has received an allogeneic transplant in the past; scheduled to receive a second allogeneic transplant
Did not receive an allogeneic HCT at Dana-Farber
Does not live in New York, Maine, New Hampshire, Vermont, Connecticut, or Massachusetts

Arm && Interventions

Group	Intervention	Description
Non-Randomized	Standard Care	Patients receive all follow-up care at DFCI only (Standard Care).
Usual Care	Standard Care	* Patients receive all follow-up care at DFCI only, which is currently the Standard Care. * Majority of routine visits in first 180 days will be at DFCI.
Shared Care	Shared Care	* For the first 90 days, patients alternate between local oncologist and DFCI for weekly visits. * From 90 to 180 days, patients alternate between local and DFCI every 2-3 weeks. * Shared Care include the following * Formal Care Coordination Plan * Patient Engagement and Education * Local Oncologist Engagement and Education * Patient/Local Oncologist/Transplant Oncologist Web Portal

Primary Outcome Measures

Name	Time	Method
European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer (EORTC QLQ-C30) at Day 180	180 days	European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer GLOBAL health status subscale. Higher values (range: 0 to 100) represent higher quality of life. This was selected by a consensus of patient stakeholders.
Functional Assessment of Cancer Therapy - Bone Marrow Transplantation (FACT-BMT) at Day 180	180 days	Functional Assessment of Cancer Therapy - Bone Marrow Transplantation TOTAL score. The TOTAL score is a summed combination of the Physical Well-Being (PWB), Social/Family Well-Being (SWB), Emotional Well-Being (EWB), Functional Well-Being (FWB) and Bone Marrow Transplant Subscales (BMTS). Higher scores (range: 0 - 148) represent better transplant-related quality of life. It was selected by a consensus of patient stakeholders as a patient-reported outcome (PRO) for the trial.
100-day Non-relapse Mortality (NRM) for Patients in Shared Care Versus Usual Care	100 days	Non-relapse mortality is a common measure to assess early outcomes for stem cell transplant, given that there can be a high level of early mortality from the transplant itself even in the absence of relapse. It is defined as a death occurring while in continuous remission. NRM is reported as a binary outcome.

Secondary Outcome Measures

Name	Time	Method

Locations (9): Dana-Farber at South Shore Hospital
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Weymouth, Massachusetts, United States
Dana-Farber Cancer Institute
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Boston, Massachusetts, United States
Northern Light Cancer Center dba Eastern Maine Medical Center
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Bangor, Maine, United States
New York Oncology Hematology
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Albany, New York, United States
Lifespan Cancer Institute at Rhode Island Hospital
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Providence, Rhode Island, United States
Dana-Farber at Milford
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Milford, Massachusetts, United States
Dana-Farber at Londonderry
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Londonderry, New Hampshire, United States
New England Cancer Specialists
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Brunswick, Maine, United States
Stamford Hospital
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Stamford, Connecticut, United States