Primary preventative care of hematopoietic stem cell transplant survivors: time to educate and empower recipients and providers

Increased use of hematopoietic stem cell transplantation (HCT) and improvements in recipient outcomes has led to a steady increase in the number of allogeneic HCT survivors. In addition to complications specific to the transplant process, HCT recipients are at increased risk of developing cardiovascular disease (CVD) and subsequent neoplasms (SN). Strict adherence to general population CVD risk factor and cancer surveillance is recommended as an essential component of long-term follow-up (LTFU) care of HCT survivors but implementation of this has been suboptimal. Models to improve the provision of survivorship care have been proposed including a hybrid/combined care approach where the HCT providers manage transplant-specific complications and the primary care physician (PCP) provides general medical care including surveillance and aggressive management of CVD risk factors and screening for subsequent neoplasm (SN). This model also offers a practical approach to LTFU care for HCT survivors who live at a distance from the HCT center which is a reality for many recipients of HCT at the Ottawa hospital (TOH). As the success of such a hybrid approach to survivorship care is dependent on the engagement of HCT recipients with their PCP and compliance with recommended general population surveillance, the aim of the study reported here was to assess the rates of PCP attendance and adherence to recommended preventive-medicine interventions in the years immediately prior to and following HCT. We hypothesized that rates would be sub-optimal and planned to use these results as a baseline for an educational initiative aimed at increasing awareness of HCT recipients and their PCPs about embracing a preventative survivorship care. This was a single center cohort study of allogeneic HCT recipients transplanted at TOH with linkage to population-based health administrative data. Published clinical practice guidelines were used to define recommended screening for CVD risk factors and cancer. In the 5 years prior to and following HCT, the rates of annual PCP visits and utilization of recommended preventative care interventions were calculated for all eligible patients. Between 2014 and 2020, 409 patients with provincial healthcare coverage underwent allogeneic HCT at TOH. Median age was 51 (range 15-73) with a male predominance (60.9%). Approximately one quarter of recipients did not attend their PCP in the five years before and after transplant and this proportion increased to one third in the 5th year post-HCT. For those recipients who were eligible, only 20-25% underwent recommended screening for dyslipidemia and diabetes. Cancer screening rates were also low at 16-18% for cervical cancer, 18-22% for colon cancer and 30-31% for breast cancer. Results highlight the need to increase awareness of HCT recipients and their PCPs about the risk of developing CVD and SN post-transplant, and to emphasize the potential to mitigate this risk by adhering to recommendations for surveillance to enable prompt intervention. Patient education should incorporate this information and empower HCT survivors to actively engage in their follow-up care and optimize their long-term outcomes.