Preventative Care and Follow-up:
The current updated recommended guidelines for preventive care and follow up in Hematopoietic Cell Transplant (HCT) focus on the risks faced by HCT survivors (autologous and allogeneic) who have survived 6 months or more post- transplant (Majhail et al., 2012). Adherence to care guidelines for HCT survivors has many challenges because of the lack of a standardized patient care plans specific to HCT survivors (Majhil et al., 2012). Also, long-term HCT survivors may not always return to their transplant center for care, but instead seek health care at other outpatient facilities that are not familiar with the recommended guidelines. There are few studies that examine the adherence to guidelines in HCT survivors. A study by Khera et al.(2011) examined that age and gender specific adherence rates to preventative care guidelines were approximately 75% between July 2008 and July 2009 in those >2 years post HCT. The authors also identified that lower adherence was seen in the autologous HCT survivors, survivors who were experiencing financial difficulties, were a non-white race, male gender, had lower overall physical functioning, who didn’t suffer from GVHD, larger amount of time passed since their transplant, and lack of education and poor knowledge of their own follow-up recommendations. Armenian et al. (2012) sought to determine the prevalence of cancer screening practices among HCT survivors, as well as their likelihood to engage in risky health behaviors that may negatively impact quality of life and decrease adherence to follow-up care. The authors found that HCT recipients had similar or better cancer screening practices than their paired siblings. They also found that HCT survivors were more likely to be concerned about their future health care when compared to their siblings (51.9% vs 39.7%), however they were less likely to report current smoking (7% vs 12.9%) and risky alcohol intake (8.5% vs 14.6%). Also, they found that younger age (<35) at time of HCT, lack of health insurance, and lower education were significant predicators of risky health behaviors, furthering the need of APNs to identify these individuals so they can provide health promotion education in hopes to decrease their risky health behaviors . Additionally, a study performed by Buchsel (2009) suggests that increasing awareness in prevention, diagnosis, and lifelong surveillance of HCT recipients can help to decrease long-term complications, and educating and caring for survivors can help establish clinical best practice and decrease poor outcomes. Among these long-term complications can include pulmonary complications, cardiovascular risks, renal dysfunction, decreased bone health, second malignancies, neurological impairments, thyroid dysfunctions, and GVHD. Health Outcomes: HCT survivors have reported multiple adverse outcomes. Sun et al. (2011) found that that one in five HCT survivors reported poor psychological outcomes, in comparison to less than one in ten in their healthy siblings. They also found that HCT survivors were at an almost three-fold higher risk of reporting somatic distress than their siblings. In addition, patients with low annual household income, impaired self-reported health status, active chronic GVHD, and those managed with prednisone …show more content…
Beeken, Eiser & Dalley (2011) reported that patients feeling optimism about treatment, having social support to help cope, having social comparisons with others who have received HCT, changing their expectations (accepting that things will be different and adapting) and setting goals to create a sense of achievement were important in managing threats to their HRQOL. A study completed by Cohen et al. (2012), identified that the type of treatment a preparatory regimen are the most important factors that influence post-HCT symptoms and HRQOL. The data showed that allogeneic transplant patients with myeloablative regimens showed more sleep disturbances and poorer HRQOL than autologous recipients. Also, it showed that patients with good functional status had a higher HRQOL and reported less symptoms, and patients with GVHD reported more severe symptoms than those without GVHD. They also determined that ethnicity was not a significant factor in symptom severity or HRQOL. However, in a study completed by Brown-lannuzzi et al. (2014) found that higher socioeconomic status (SES) was associated with lower depressive symptoms, less generalized distress, and better overall HRQOL eluding that a person’s relative rank in society has important health consequences and must be taken into consideration by
The current updated recommended guidelines for preventive care and follow up in Hematopoietic Cell Transplant (HCT) focus on the risks faced by HCT survivors (autologous and allogeneic) who have survived 6 months or more post- transplant (Majhail et al., 2012). Adherence to care guidelines for HCT survivors has many challenges because of the lack of a standardized patient care plans specific to HCT survivors (Majhil et al., 2012). Also, long-term HCT survivors may not always return to their transplant center for care, but instead seek health care at other outpatient facilities that are not familiar with the recommended guidelines. There are few studies that examine the adherence to guidelines in HCT survivors. A study by Khera et al.(2011) examined that age and gender specific adherence rates to preventative care guidelines were approximately 75% between July 2008 and July 2009 in those >2 years post HCT. The authors also identified that lower adherence was seen in the autologous HCT survivors, survivors who were experiencing financial difficulties, were a non-white race, male gender, had lower overall physical functioning, who didn’t suffer from GVHD, larger amount of time passed since their transplant, and lack of education and poor knowledge of their own follow-up recommendations. Armenian et al. (2012) sought to determine the prevalence of cancer screening practices among HCT survivors, as well as their likelihood to engage in risky health behaviors that may negatively impact quality of life and decrease adherence to follow-up care. The authors found that HCT recipients had similar or better cancer screening practices than their paired siblings. They also found that HCT survivors were more likely to be concerned about their future health care when compared to their siblings (51.9% vs 39.7%), however they were less likely to report current smoking (7% vs 12.9%) and risky alcohol intake (8.5% vs 14.6%). Also, they found that younger age (<35) at time of HCT, lack of health insurance, and lower education were significant predicators of risky health behaviors, furthering the need of APNs to identify these individuals so they can provide health promotion education in hopes to decrease their risky health behaviors . Additionally, a study performed by Buchsel (2009) suggests that increasing awareness in prevention, diagnosis, and lifelong surveillance of HCT recipients can help to decrease long-term complications, and educating and caring for survivors can help establish clinical best practice and decrease poor outcomes. Among these long-term complications can include pulmonary complications, cardiovascular risks, renal dysfunction, decreased bone health, second malignancies, neurological impairments, thyroid dysfunctions, and GVHD. Health Outcomes: HCT survivors have reported multiple adverse outcomes. Sun et al. (2011) found that that one in five HCT survivors reported poor psychological outcomes, in comparison to less than one in ten in their healthy siblings. They also found that HCT survivors were at an almost three-fold higher risk of reporting somatic distress than their siblings. In addition, patients with low annual household income, impaired self-reported health status, active chronic GVHD, and those managed with prednisone …show more content…
Beeken, Eiser & Dalley (2011) reported that patients feeling optimism about treatment, having social support to help cope, having social comparisons with others who have received HCT, changing their expectations (accepting that things will be different and adapting) and setting goals to create a sense of achievement were important in managing threats to their HRQOL. A study completed by Cohen et al. (2012), identified that the type of treatment a preparatory regimen are the most important factors that influence post-HCT symptoms and HRQOL. The data showed that allogeneic transplant patients with myeloablative regimens showed more sleep disturbances and poorer HRQOL than autologous recipients. Also, it showed that patients with good functional status had a higher HRQOL and reported less symptoms, and patients with GVHD reported more severe symptoms than those without GVHD. They also determined that ethnicity was not a significant factor in symptom severity or HRQOL. However, in a study completed by Brown-lannuzzi et al. (2014) found that higher socioeconomic status (SES) was associated with lower depressive symptoms, less generalized distress, and better overall HRQOL eluding that a person’s relative rank in society has important health consequences and must be taken into consideration by