1
|
Fein JA, McAuliffe A, Fischer K, Brady O, Devlin SM, Willumsen S, Ozcan G, Montanaro P, Pristyazhnyuk Y, Digiuseppe J, Perales MA, Pfister DG, Giralt S, Dailey M, Yu PP, Sauter CS. Impact of a shared-care model between community and academic centers for facilitating access to allogeneic and autologous stem cell transplantation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1510 Background: Despite curative or disease-controlling roles in AML/MDS and MM, access to allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (SCT) remains far from universal. Socioeconomic status (SES) and geographic distance from SCT centers have been shown to be barriers to SCT access. In 2016, Hartford HealthCare (HHC) and the Memorial Sloan Kettering Cancer Center (MSK) pioneered a Shared-Care Model (SCM) to streamline access to allo and auto SCT at MSK, featuring a dedicated nurse SCT coordinator, shared hematology tumor boards, MSK-led didactics for HHC providers, and an electronic health record sharing pipeline. We sought to determine if this has improved access to SCT for HHC patients. Methods: A retrospective chart review was conducted of HHC patients aged 18-70 with new diagnoses of AML, MDS, and MM between 2016 and 2020. Socioeconomic status (SES) was estimated by 9-digit zip-code using the Area Deprivation Index (ADI), shown to be a surrogate for healthcare access. Referral or not to a SCT center, referral to MSK through the SCM, and reasons for non-referral were abstracted from the medical record. For patients referred for SCT at MSK, we also captured the number of peri-SCT days in New York City (NYC) and number of subsequent MSK and HHC clinic visits/hospitalizations within 1-year post-SCT. Results: A total of 126 patients was included, with 81 (64%) treated for AML/MDS and 45 (36%) for MM. The median age was 60 years (interquartile range [IQR]: 53-66). The majority were white (n = 101, 80%) followed by 10% (n = 13) Black/African American; 10% (n = 12) were of Hispanic ethnicity. The median ADI percentile was 38 (IQR: 20-51; higher percentiles reflect decreased SES). The median ADI for MSK SCT referrals from New York, New Jersey, and Connecticut 2016-2020 for the same indications was 19 (IQR: 10-30, p < 0.001). A total of 90 patients (71%) were referred to SCT centers. Leading reasons for no referral were favorable-risk disease (n = 10), goals of care (n = 9), and death prior to referral (n = 5); 3 patients were not referred due to comorbidities/performance status. No differences were found between patients referred to MSK vs. other centers. Thirty-four HHC patients were referred to MSK (21 AML/MDS, 13 MM), vs. 3 between 2010 and 2015. Twelve patients underwent allo SCT, with median 97 days in NYC (range: 68-247); 8 underwent auto SCT, with median 21 days in NYC (range: 15-48). Conclusions: Our findings show the feasibility of a shared-care model between a non-SCT-providing large regional hospital system and a major academic transplantation center. Close collaboration between institutions may minimize time patients spend away from home. The SES of HHC referrals was lower than the general MSK population, suggesting that a shared-care model may facilitate access to SCT for patients with previous barriers for this potentially curative therapy.
Collapse
Affiliation(s)
| | | | | | - Owen Brady
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Dailey
- Hartford HealthCare Cancer Institute, Hartford, CT
| | | | | |
Collapse
|
14
|
Crosby ET, Halpern S, Bill KM, Flynnn RJ, Moore J, Navaneelan C, Cunningham A, Yu PYH, Gamling DR, McMorland GH, Perreault C, Guay J, Gaudreault P, Hollman C, Meloche R, Hackman T, Sheps SB, Murray WB, Heiman PA, Slinger P, Triolet W, Jain U, Rao TLK, Dasari M, Pifarre R, Sullivan H, Calandra D, Friesen RM, Bjornson J, Hatton G, Parlow JL, Casey WF, Broadman LM, Rice LJ, Dailey M, Andrews WR, Stigi S, Jendrek V, Shevde K, Withington DE, Saoud AT, Ramsay JG, Bilodeau J, Johnson D, Mayers I, Doran RJ, Wong PY, Mullen BJ, Wigglesworth D, Byrick RJ, Kay JC, Stubbing JF, Sweeney BP, Dagher E, Dumont L, Lagace G, Chartrand C, Badner NH, Sandier AN, Leitch L, Koren G, Erian RF, Bunegin L, Shulman DL, Burrows F, O’Sullivan K, Bouchier D, Kashin BA, Wynands JE, Villeneuve E, Blaise G, Guerrard MJ, Buluran J, Effa E, Vaghadia H, Jenkins LC, Janisse T, Scudamore CH, Patel PM, Mutch WAC, Ruta TS, McNeill BR, Murkin JM, Gelb AW, Farrar JK, Johnson GD, Adams MA, Lillicrap DP, Lindblad T, Beattie WS, Buckley DN, Forrest JB, Lessard MR, Trépanier CA, Baribault JP, Brochu JG, Brousseau CA, Cote JJ, Denault P, Whang P, Moudgil GC, Daly N, Morrison DH, Ogilvie R, Man J, Ehler T, Leitch LF, Dupuis JY, Martin R, Tessonnier JM, Barry AW, Milne B, Quintin L, Gillon JY, Pujol JF, DeMonte F, Zhang C, Hamilton JT, Zhou Y, Plourde G, Picton TW, Kellett A, Pilato MA, Bissonnette B, Lerman J, Brown KA, Dundee JW, Sosis M, Dillon F, Stetson JB, Voorhees WD, Bourland JD, Geddes LA, Shoenlein WE, O’Leary G, Teasdale S, Knill RL, Rose EA, Berko SL, Smith CE, Sadler JM, Bevan JC, Donati F, Bevan DR, Tellez J, Turner D, Kao YJ, Salidivia V, Roldan L, Orrego H, Carmicheal FJ, Kent AP, Parker CJR, Hunter JM, Finley GA, Goresky GV, Klassen K, McDiarmid C, Shaffer E, Vaughan M, Randolph J, Szalados JE, Lazzell VA, Creighton RE, Poon AO, Mclntyre B, Douglas MJ, Swenerton JE, Farquharson DF, Landry D, Petit F, Riegert D, Koch JP, Maggisano R, Devitt JH, Jense HG, Dubin SA, Silverstein PI, Rodriguez N, Wakefield ML, Williams R, Dubin S, Smith JJ, Hofmann VC, Jarvis AP, Forbes RB, Murray DJ, Dillman JB, Dull DL, Cohen MM, Cameron CB, Johnston RG, Konopad E, Jivraj K, Hunt D, Eastley R, Strunin L, Fairbrass MJ, Laganiere S, McGilvery M, Foster B, Young P, Weisel D, Parra L, Suarez Isla BA, Lopez JR, Hall RI, Hawwa R, Kashtan H, Edelist G, Mallon J, Kapala D, Dhamee MS, Reynolds AC, Olund T, Entress J, Kalbfleisch J, Bell SD, Goldberg ME, Bracey BJ, Goldhill DR, Bennett MH, Emmott RS, Innis RF, Yate PM, Flynn PJ, Gill SS, Saunders PR, Geisecke AH, Feldman JM, Banner MJ, Siriwardhana SA, Kawas A, Lipton JL, Giesecke AH, Doyle DJ, Volgyesi GA, Hillier SC, Gallagher J, Hargaden K, Hamil M, Cunningham AJ, Scott WAC, Sielecka D, Illing LH, Jani K, Scarr M, Maltby JR, Roy J, McNulty SE, Torjman M, Carey C, Bracey B, Markham K, Durcan J, Blackstock D, DaSilva CA, Demars PD, Montgomery CJ, Steward DJ, Sessler DI, Laflamme P, McDevitt S, Kamal GD, Symreng T, Tatman DJ, Durcharme J, Varin F, Besner JG, Dyck JB, Chung F, Arellano R, Lim G, Bailey DG, Bayliff CD, Cunningham DG, Ewen A, Sheppard SD, Mahoney LT, Bacon GS, Rice LR, Newman K, Loe W, Toth M, Pilato M, Classen K, McDiamid C, Burrows FA, Irish CL, Casey W, Hauser GJ, Chan MM, Midgley FM, Holbrook PR, Elliott ME, Man WK, Finegan BA, Clanachan AS, Hudson RJ, Thomson IR, Burgess PM, Rosenbloom M, Fisher JM, O’Connor JP, Ralley FE, Robbins GR, Moote CA, Manninen PH, English M, Farmer C, Scott A, White IWC, Biehl D, Donen N, Mansfield J, Cohen M, Wade JG, Woodward C, Ducharme J, Gerardi A, Mijares A, Code WE, Hertz L, Chung A, Meier HMR, Lautenschlaeger E, Seyone C, Wassef MR, Devitt FH, Cheng DCH, Dyck B, Chan VWS, Ferrante FM, Arthur GR, Rice L, Annallah RH, Etches RC, Loulmet D, Lacombe P, Hollmann C, Tanguay M, Blaise GA, Lenis SG, Fear DW, Lang SA, Ha HC, Germain H, Neion A, Dorian P, Salter D, Pollick C, Cervenko F, Parlow J, Pym J, Nakatsu K, Elliott D, Miller DR, Martineau RJ, Ewing D, Martineau RJ, Knox JWD, Oxorn DC, O’Connor JP, Whalley DG, Rogers KH, Kay JC, Mazer CD, Belo SE, Hew-Wing P, Hew E, Tessonier JM, Thibault G, Testaert E, Chartrand D, Cusson JR, Kuchel O, Larochelle P, Couture J. Abstracts. Can J Anaesth 1989. [DOI: 10.1007/bf03005330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|