Shared Model of Care Post-HCT Offers Safe Follow-Up, Reduces Patient Burden

NRM at day 100 was noninferior in the group receiving shared care compared to usual care.

A shared care model after allogeneic hematopoietic cell transplantation (HCT) achieved noninferior non-relapse mortality (NRM) at day 100, along with similar quality of life (QOL) scores at day 180, compared with usual care at HCT specialty centers in a multicenter, collaborative, randomized clinical trial.¹

Investigators found that NRM at day 100 was noninferior for those receiving shared care (2.6%; 95% CI, 0.7%-6.6%) compared with standard of care (SOC) (2.7%; 95% CI, 0.7%-6.7%; P = .98).

“Our data suggest it is safe, improves patients’ lived experiences in the early post-HCT period and has the advantage of potentially allowing overburdened specialized centers to treat more patients by off-loading some volume of post-HCT care to local practices,” study investigators wrote in the study, published in JAMA Oncology.

QOL at day 100 was a secondary end point of the trial. Patients in the shared care group reported higher day 100 FACT-BMT and QLQ-C30 global scores than those in the SOC group, with mean differences of 6.6 points (95% CI, 1.0-12.1; P = .02) and 8.8 points (95% CI, 1.8-15.7; P = .02), respectively.

However, at day 180, no difference in QOL metrics was observed, at which point 260 patients were alive; complete FACT-BMT information was available for 94 participants receiving shared care and 88 receiving SOC. Mean differences in FACT-BMT and QLQ-C30 scores between shared and SOC arms were 3.8 points (95% CI, -2.1 to 9.6; P = .20) and 1.9 points (95% CI, -4.9 to 8.8; P = .58), respectively.

FACT-BMT physical well-being scores were significantly greater among patients receiving shared care vs SOC, with a mean difference of 1.9 points (95% CI, 0.3-3.5; P = .02).

A difference in overall survival (OS) at day 100, an additional secondary end point, was not observed between shared care and SOC arms (94% [95% CI, 89%-97%] vs 95% [95% CI, 90%-98%]; P = .62).

Methods and Design

Participants whose HCT was planned from December 2017 to December 2021 were stratified by location and randomized to shared care (n = 152) or SOC (n = 150). Those who received shared care alternated visits post-HCT between Dana-Farber Cancer Institute in Boston, Massachusetts, and local practice up to day 100 and starting with the first outpatient clinic post-HCT.

Measures to ensure safe local care for those receiving intervention consisted of patient engagement and education; local oncologist engagement and education; an online coordination plan; and a web-based communication platform accessible to patients, local oncologists, and transplant specialists.

Training was provided to 2 oncologists per local site as well as advanced practice providers (APP), with guaranteed access to local specialized HCT laboratory capabilities. Additionally, a dedicated shared-care attending physician from Dana-Farber Cancer Institute was on call for consultation at all times.

Patient and Location Data

For those receiving shared care, median numbers of visits were 5 (range, 1-17) at local centers and 6 (range, 1-19) at Dana-Farber Cancer institute; likewise, the median number of visits for those receiving SOC were 0 (range, 0-3) at local centers and 11 (range, 6-18) at Dana-Farber Cancer Institute.

Distances from local oncology centers (n = 8) to Boston ranged from 40 minutes to 4 hours in approximate commute times. All patients lived 30 minutes or more from Boston. It is estimated that patients reduced travel time by a mean of 146.5 km per local visit.

“Although the shared care model may create local burdens that will also need to be addressed, partial decentralization of post-HCT care has the potential to improve care equity for patients who live far from specialized oncology centers,” the researchers added.

In the shared care group, most patients (53.0%) had HCT comorbidity indices from 3-6, followed by 0-2 (41.0%), and 7 or greater (5.0%). Most patients in the SOC group had HCT comorbidity indices from 0-2 (51.0%), followed by 3-6 (41.0%), and 7 or greater (8.0%).

Participant ages ranged from 20-79, and the median age was 63. The patient population was 38.7% female and 91.7% White.

Additional Outcomes

At 1 year, OS and progression-free survival (PFS) were higher in the SOC group, but the difference was not statistically significant. The 1-year OS rate for the shared care arm was 71% (95% CI, 63%-78%) compared to 75% (95% CI, 67%-81%; P = .48) in the SOC group. Similarly, the 1-year PFS rates were 61% (95% CI, 53%-68%) vs 64% (95% CI, 56%-72%; P = .51), respectively.

One-year cumulative NRM was 10.6% (95% CI, 6.3%-16%) for shared care and 9.4% (95% CI, 5.4%-15%; P = .70) for SOC. Cumulative incidence of relapse was 29% (95% CI, 22%-36%) vs 26% (95% CI, 19%-33%; P = .67), respectively.

References

1. Abel GA, Kim HT, Zackon I, et al. Shared Local Oncology Care After Allogeneic Hematopoietic Cell Transplantation: A Randomized Clinical Trial. JAMA Oncol. Published online January 9, 2025. doi:10.1001/jamaoncol.2024.5786