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1.
J Oncol Pharm Pract ; 26(1): 23-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30854925

RESUMO

INTRODUCTION: Filgrastim, a granulocyte colony-stimulating factor, is commonly used in autologous hematopoietic stem cell transplants (HSCTs) to assist with peripheral blood progenitor cell (PBPC) collection and to support stem cell engraftment. In the United States, tbo-filgrastim is approved under its own Biologic License Application and is limited to a single indication excluding the HSCT population. METHODS: Approximately one year after a system-wide formulary change to tbo-filgrastim for all on- and off-label indications, our institution conducted an IRB-approved retrospective comparison of tbo-filgrastim to filgrastim in the autologous HSCT setting. The study included 71 patients who received an autologous HSCT from 1 January 2013 to 31 December 2016 with a documented administration of tbo-filgrastim or filgrastim. RESULTS: There were no statistically significant differences noted on CD34 + counts during stem cell mobilization, neutrophil engraftment, infection rates during the engraftment phase, nor duration of hospitalization during the engraftment phase. More patients in the tbo-filgrastim group received plerixafor per protocol resulting in more patients meeting their PBPC collection goal in one day with fewer collection days overall, a result potentially confounded by institutional protocol changes. Utilizing tbo-filgrastim offered an average cost savings per patient of $2664.26 ($1907.33 for PBPC mobilization and $756.93 for stem cell engraftment) when comparing dollars spent on granulocyte colony-stimulating factor products only. CONCLUSION: Tbo-filgrastim demonstrates comparable efficacy with a cost savings benefit compared to filgrastim for autologous PBPC mobilization and stem cell engraftment.


Assuntos
Filgrastim/uso terapêutico , Fármacos Hematológicos/uso terapêutico , Mobilização de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas/métodos , Idoso , Feminino , Filgrastim/economia , Rejeição de Enxerto/economia , Rejeição de Enxerto/prevenção & controle , Fármacos Hematológicos/economia , Mobilização de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/economia , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo/economia , Transplante Autólogo/métodos
3.
Biol Blood Marrow Transplant ; 25(2): 398-402, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30292010

RESUMO

Hematopoietic stem cell transplantation (HCT) is a curative treatment for patients with myelofibrosis (MF); however, many HCT-eligible patients decline this potentially life-saving procedure. The reasons behind this decision are not clear. We sought to survey patients with MF to understand their perspective on HCT. A 63-question survey was posted on myeloproliferative neoplasm patient advocacy websites. A total of 129 patients with MF responded to the survey. Among these patients, 49 (41%) were referred for HCT, and 41(32%) attended the transplantation consult. Of the patients who attended the transplantation consult, 24 (59%) did not plan on going on to HCT, and 16 (41%) intended to proceed with HCT. Reasons for the decision to not undergo transplantation included the desire to not be ill, desire to not spend time in the hospital, and concerns about overall quality of life. Specifically, concerns related to financial impact and the risk of graft-versus-host disease (GVHD) were expressed. Patients who decided to proceed with HCT felt that this would extend their survival and allow them to be around family for longer. This is the first survey to investigate patient perceptions regarding HCT for MF. Less than one-half of the patients were referred for HCT, and of those, less than one-half planned on proceeding with the transplantation, suggesting that many patients do not receive this life-saving procedure. Further exploration of the basis of patients' reluctance to proceed with HCT is warranted.


Assuntos
Transplante de Medula Óssea/economia , Transplante de Células-Tronco Hematopoéticas/economia , Aceitação pelo Paciente de Cuidados de Saúde , Mielofibrose Primária , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Aloenxertos , Feminino , Doença Enxerto-Hospedeiro/economia , Doença Enxerto-Hospedeiro/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Mielofibrose Primária/economia , Mielofibrose Primária/terapia
4.
Pediatrics ; 142(5)2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30279236

RESUMO

Many foreign parents bring their children to the United States for medical treatments that are unavailable in their own country. Often, however, parents cannot afford expensive treatments. Doctors and hospitals then face a dilemma. Is it ethically permissible to consider the patient's citizenship and ability to pay? In this Ethics Rounds, we present a case in which a child from another country needs an expensive treatment. His parents cannot afford the treatment. He has come to a public hospital in the United States. We present responses from experts in pediatrics, bioethics, and health policy.


Assuntos
Tomada de Decisões/ética , Assistência à Saúde/ética , Custos de Cuidados de Saúde/ética , Cuidados para Prolongar a Vida/ética , Criança , Dissidências e Disputas , Emigrantes e Imigrantes , Ética Médica , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/ética , Humanos , Cuidados para Prolongar a Vida/economia , Masculino , Pais , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Estados Unidos
5.
Laryngoscope ; 128(12): 2688-2692, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30239988

RESUMO

OBJECTIVES/HYPOTHESIS: To determine the impact of sinusitis on outcomes of hematologic transplant procedures. STUDY DESIGN: Retrospective analysis of a national hospital database. METHODS: The National Inpatient Sample database for 2012 to 2013 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients undergoing hematologic transplants. Patients were divided based upon the presence or absence of a concomitant diagnosis of acute or chronic sinusitis. Patient demographics, clinical characteristics, discharge results, lengths of stay (LOS), and costs were compared between groups. RESULTS: There were 7,069 hematologic transplant cases identified, 2.7% of which had a diagnosis of sinusitis. Sinusitis patients had a longer LOS after transplant (24.9 ± 15.9 days vs. 19.1 ± 17.4 days, P < .001) and higher total hospital charges ($487,941 ± $447,532 vs. $322,300 ± $369,596, P < .001) than nonsinusitis patients. There was no difference in mortality between the two groups (P = .75). The 23 (12%) sinusitis patients who underwent sinus procedures had a longer LOS after transplant (34.8 ± 25 days vs. 23.5 ± 13.7 days, P = .001) and higher total hospital charges ($857,891 ± $718,456 vs. $437,293 ± $372,075, P < .001) than sinusitis patients without sinus procedures. Linear regression showed that sinusitis patients had excess LOS after transplant of 2.442 days and cost of $82,000.098. CONCLUSIONS: This study demonstrates that presence of sinusitis in patients undergoing hematologic transplant is associated with increased LOS and higher total hospital charges. Increased focus on diagnosis and if possible treatment of sinusitis prior to admission for transplantation may help reduce the impact of sinusitis after hematologic transplant. LEVEL OF EVIDENCE: NA Laryngoscope, 128:2688-2692, 2018.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Preços Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Complicações Pós-Operatórias/economia , Sinusite/economia , Adulto , Doença Crônica , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Transplante de Células-Tronco Hematopoéticas/economia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sinusite/etiologia
6.
J Child Neurol ; 33(14): 882-887, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30261790

RESUMO

Inherited leukodystrophies are a group of diseases affecting central nervous system myelin that lead to death or significant health problems. Although for most leukodystrophies there are no curative treatments, for a handful of diseases hematopoietic stem cell transplantation (HSCT; bone marrow transplant) can stop disease progression, and if initiated in a timely fashion, prevent many or all neurologic and other systems involvement. However, HSCT is a complex procedure with significant morbidity and mortality risks. The study goal was to determine whether HSCT was being more widely used outside of those leukodystrophies for which HSCT is typically employed. The authors conducted a 2-year retrospective review of HSCT performed across the United States in 51 children's hospitals that are part of the Pediatric Health Information System. The authors screened for 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes for leukodystrophies in which HSCT is "nonstandard," including sphingolipidoses, Fabry disease, Gaucher disease, and Niemann-Pick disease, and excluded patients who had ICD-10 codes for leukodystrophies that are HSCT candidates, specifically X-linked adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe disease, and Hurler disease. The authors identified 91 patients (from a total cohort of 937) with one of the nonstandard leukodystrophies who had HSCT. HSCT was performed at 20 of the hospitals, with the majority performed at only 6 hospitals. Average costs ($786 846) per patient were more than 6 times higher than patients who did not have HSCT. The data show that an unexpectedly large number of leukodystrophy patients are receiving transplants for conditions in which HSCT is not typically used, and which are associated with high medical costs.


Assuntos
Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/métodos , Leucoencefalopatias/economia , Leucoencefalopatias/cirurgia , Resultado do Tratamento , Adolescente , Criança , Estudos de Coortes , Análise Custo-Benefício , Bases de Dados Bibliográficas/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Masculino , Estados Unidos
7.
J Med Econ ; 21(11): 1119-1130, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30122084

RESUMO

AIM: Acute myeloid leukemia (AML) is associated with high disease burden. This analysis estimated HRU and costs among newly diagnosed AML patients in a US commercially insured population. MATERIALS AND METHODS: This was a retrospective observational study using the IMS Health PharMetrics Plus and Hospital Charge Detail Master databases. Patients included adults who were newly diagnosed with AML between January 2007 and June 2016 ("study period"). Patients with <12 months of continuous enrollment prior to the index date were excluded, as were those whose first diagnosis was AML in remission/relapse, those diagnosed with acute promyelocytic leukemia, those on Medicare supplemental insurance, or those with a diagnosis of AML in remission/relapse without evidence of treatment during the study period. Patients were stratified by receipt of AML treatment (chemotherapy/hematopoietic cell transplantation [HCT]), and their follow-up was partitioned into initial, remission, and relapsed health states. Mean HRU and costs were tallied by treatment and, for treated patients, by health state and time since entry into health state (≤6 vs >6 months). RESULTS: A total of 9,455 patients met study criteria, including 6,415 (68%) treated and 3,040 (32%) untreated patients, with mean follow-up of 18.3 and 16.4 months, respectively. Mean age was 55 years in treated patients and 60 years in untreated patients. Mean total costs per patient were $386,077 in treated patients and $79,382 in untreated patients. For treated patients, 60% of total costs ($231,867 per patient) were incurred during the initial health state, representing time without remission/relapse. Mean monthly total healthcare costs were $21,055 and $4,854 among treated and untreated patients, respectively. LIMITATIONS AND CONCLUSIONS: HRU and costs of managing AML patients are substantial. In treated patients, the majority of costs were incurred during the initial treatment period, without claims indicating remission/relapse.


Assuntos
Antineoplásicos/economia , Transplante de Células-Tronco Hematopoéticas/economia , Leucemia Mieloide Aguda/economia , Leucemia Mieloide Aguda/terapia , Idoso , Antineoplásicos/uso terapêutico , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Humanos , Leucemia Mieloide Aguda/diagnóstico , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
8.
Pediatr Transplant ; 22(7): e13279, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30091256

RESUMO

Use of TCR α+ ß+ /CD19+ depletion in a pediatric setting has improved the utility of haploidentical donor material, resulting in better rates of engraftment, lower rates of graft vs host disease (GVHD), and improved transplant-related mortality. There are currently no data available on the costs of TCR α+ ß+ /CD19+ depletion. This study assessed the costs of acquiring and preparing TCR α+ ß+ /CD19+ depleted haploidentical donor cells in comparison with matched unrelated donor (MUD) products for use in pediatric patients in Australia. Data from four pediatric transplant centers were used to estimate the resources required for donor work-up, graft acquisition, and laboratory procedures for graft preparation. Information on MUD work-up and graft acquisition was also acquired from these sites and from the national coordinating donor center in Australia. Australian-specific prices and fees were used to estimate total average costs for each transplant type, converted to USD. Preparation of graft material (including work-up, acquisition, and laboratory processes) costs USD 28 963 for TCR α+ ß+ /CD19+ depleted haploidentical grafts and USD 27 297 for MUD grafts. The estimated difference of USD 1666 is largely attributed to the process and consumables to perform TCR α+ ß+ /CD19+ depletion. Given the potential for recipients of TCR α+ ß+ /CD19+ depleted grafts to require minimal GVHD prophylaxis and experience less transplant-related morbidity and mortality, use of TCR α+ ß+ /CD19+ depletion appears favorable despite the higher initial cost. Research is currently ongoing to assess the clinical effectiveness and potential cost-effectiveness of TCR α+ ß+ /CD19+ depletion over a patients' lifetime.


Assuntos
Antígenos CD19/metabolismo , Custos de Cuidados de Saúde/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/economia , Depleção Linfocítica/economia , Linfócitos T/metabolismo , Transplante Haploidêntico/economia , Doadores não Relacionados , Austrália , Biomarcadores/metabolismo , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Depleção Linfocítica/métodos , Transplante Haploidêntico/métodos
9.
Rev. enferm. UFPE on line ; 12(7): 1923-1930, jul. 2018.
Artigo em Português | BDENF - Enfermagem | ID: biblio-986681

RESUMO

Objetivo: analisar o custo-minimização do TCTH Alogênico antes e após a implementação da SAE. Método: estudo quantitativo, avaliativo e retrospectivo, utilizando o modelo da árvore de decisão para análise do custo-minimização, sendo utilizadas variáveis relacionadas às complicações infecciosas em transplante e os seus respectivos custos. Resultados: comprovou-se um custo mais elevado no ano de 2006 quando a Sistematização da Assistência de Enfermagem (SAE) não havia sido implantada se comparado ao ano de 2012. Conclusão: a análise de custo-minimização mostrou um custo menor para o TCTH alogênico aparentado em 2012 (R$ 431.482,71), se comparado aos realizados em 2006 (R$574.688,22) sugerindo que a SAE tenha colaborado na redução dos custos do procedimento, com custo incremental de R$143.205,51 para 2006.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Institutos de Câncer , Transplante de Células-Tronco Hematopoéticas , Transplante de Células-Tronco Hematopoéticas/economia , Controle de Custos , Custos e Análise de Custo , Neoplasias/enfermagem , Processo de Enfermagem , Árvores de Decisões , Registros Médicos , Estudos Retrospectivos
10.
Sci Rep ; 8(1): 6825, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29717163

RESUMO

The impact of underlying immune-mediated inflammatory diseases (IMID) in patients undergoing hematopoietic stem cell transplant (HSCT) is unclear. Hematopoietic cell transplantation co-morbidity index (HCT-CI) is gaining acceptance as a reliable clinical method to score pre-transplant co-morbidities. Higher HCT-CI from a co-morbid IMID implies higher NRM. However, HCT-CI integrates many IMIDs with different pathogenesis and treatment together which may lead to spurious results. We performed a cross-sectional study using Nationwide Inpatient Sample dataset from 1998 to 2011 to compare the outcomes of HSCT in patients with different co-morbid IMIDs with patients without any co-morbid IMIDs. In both our multivariate and stringent matched-pair analysis, ulcerative colitis (UC) was associated with increased mortality while rheumatoid arthritis and psoriasis were associated with lower mortality as compared to no IMID group. Furthermore, in allogeneic HSCT subgroup, UC was associated with higher mortality and psoriasis was associated with lower mortality. In conclusion, we found that depending on the type of HSCT, each IMID has a different impact on outcomes of HSCT. Furthermore, UC patients had increased mortality if they had primary sclerosing cholangitis and had a higher risk of opportunistic infections like tuberculosis and cytomegalovirus suggesting the need for increased vigilance in this cohort.


Assuntos
Artrite Reumatoide/epidemiologia , Colite Ulcerativa/epidemiologia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Pacientes Internados , Avaliação de Resultados da Assistência ao Paciente , Psoríase/epidemiologia , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Estudos de Coortes , Comorbidade , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas/economia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Doenças Linfáticas/epidemiologia , Doenças Linfáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias , Prevalência , Estatísticas não Paramétricas , Transplante Autólogo , Transplante Homólogo , Estados Unidos/epidemiologia
11.
Biol Blood Marrow Transplant ; 24(10): 2119-2126, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29673692

RESUMO

Hematopoietic stem cell transplantation (HSCT) is the only cure for thalassemia major (TM), which inflicts a significant 1-time cost. Hence, it is important to explore the cost effectiveness of HSCT versus lifelong regular transfusion-chelation (TC) therapy. This study was undertaken to estimate incremental cost per quality-adjusted life-year (QALY) gained with the intervention group HSCT, and the comparator group TC, in TM patients. A combination of decision tree and Markov model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. Results are presented using societal perspective. Incremental cost per QALY gained with use of HSCT as compared with TC was 64,096 (US$986) in case of matched related donor (MRD) and 1,67,657 (US$2579) in case of a matched unrelated donor transplantation. The probability of MRD transplant to be cost effective at the willingness to pay threshold of Indian per capita gross domestic product is 94%. HSCT is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of TC.


Assuntos
Transfusão de Sangue/economia , Quelantes/economia , Transplante de Células-Tronco Hematopoéticas/economia , Modelos Econômicos , Talassemia beta/economia , Aloenxertos , Quelantes/uso terapêutico , Análise Custo-Benefício , Feminino , Humanos , Masculino , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida , Talassemia beta/terapia
12.
Bone Marrow Transplant ; 53(9): 1096-1104, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523885

RESUMO

Due to limited donor availability, high comorbidities, and cost issues, allogeneic hematopoietic stem cell transplant is not universally accessible. The aim of this study was to conduct a cost-effectiveness analysis of haploidentical vs matched unrelated transplant. This retrospective study included patients with hematological malignancies older than 55 years who underwent haploidentical or matched unrelated transplant between 2011 and 2013 in Marseille. The incremental cost-effectiveness ratio has been calculated using the mean overall survival and the mean transplant costs. Costs were calculated using a micro-costing strategy from the hospital perspective and a time horizon at 2 years. Haploidentical transplant was considered an innovative procedure and matched unrelated transplant as the reference. Probabilistic and sensitivity analyses were performed on the incremental cost-effectiveness ratio. During inclusion, 29 patients underwent haploidentical transplant and 63 matched unrelated transplant. In haploidentical and matched unrelated transplant, the mean overall survival was 19.4 (1.6) months and 15.1 (1.2) months (p = 0.06), respectively, and the mean cost was 98,304 (40,872) € and 151,373 (65,742) € (p < 0.01), respectively. The incremental cost-effectiveness ratio was assessed to -148,485 (-1,265,550; -64,368) € per life year gained. Among older patients suffering from hematological malignancies, haploidentical transplant seemed in our analysis to be cost-effective compared with matched unrelated transplant.


Assuntos
Análise Custo-Benefício , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/métodos , Transplante Haploidêntico/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Transplante de Células-Tronco Hematopoéticas/mortalidade , Transplante de Células-Tronco Hematopoéticas/normas , Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Haploidêntico/mortalidade , Transplante Homólogo , Doadores não Relacionados
13.
Biol Blood Marrow Transplant ; 24(9): 1928-1935, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29567340

RESUMO

For patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (alloHCT) offers a potential cure. Life-threatening complications can arise from alloHCT that require the application of sophisticated health care delivery. The impact of country-level economic conditions on post-transplantation outcomes is not known. Our objective was to assess whether these variables were associated with outcomes for patients transplanted for ALL. Using data from the Center for Blood and Marrow Transplant Research, we included 11,261 patients who received a first alloHCT for ALL from 303 centers across 38 countries between the years of 2005 and 2013. Cox regression models were constructed using the following macroeconomic indicators as main effects: Gross national income per capita, health expenditure per capita, and Human Development Index (HDI). The outcome was overall survival at 100 days following transplantation. In each model, transplants performed within lower resourced environments were associated with inferior overall survival. In the model with the HDI as the main effect, transplants performed in the lowest HDI quartile (n = 697) were associated with increased hazard for mortality (hazard ratio, 2.42; 95% confidence interval, 1.64 to 3.57; P < .001) in comparison with transplants performed in the countries with the highest HDI quartile. This translated into an 11% survival difference at 100 days (77% for lowest HDI quartile versus 88% for all other quartiles). Country-level macroeconomic indices were associated with lower survival at 100 days after alloHCT for ALL. The reasons for this disparity require further investigation.


Assuntos
Transplante de Células-Tronco Hematopoéticas/economia , Leucemia-Linfoma Linfoblástico de Células Precursoras/economia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Condicionamento Pré-Transplante/economia , Adolescente , Feminino , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Masculino , Análise de Sobrevida , Condicionamento Pré-Transplante/mortalidade
15.
Oncol Nurs Forum ; 45(2): 148-158, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29466341

RESUMO

PURPOSE: To explore the transition to self-care among a sample of emerging adult cancer survivors after hematopoietic cell transplantation (HCT). 
. PARTICIPANTS & SETTING: 18 HCT survivors who were aged 18-29 years at the time of HCT for a primary hematologic malignancy and were 8-60 months post-HCT participated in the study. The study took place in the hematology outpatient setting at City of Hope National Medical Center.
. METHODOLOGIC APPROACH: The authors conducted in-depth semistructured interviews and analyzed interview transcripts using grounded theory methodology.
. FINDINGS: Health-related setbacks following HCT disrupted not only participants' journey toward self-care, but also their overarching developmental trajectory toward adulthood. Physically, participants struggled with lack of personal space around caregivers, but felt unready to live on their own. Socially, they relied on multiple caregivers to avoid relying too much on any one person. Financially, participants worried about prolonged dependence and increased needs in the future.
. IMPLICATIONS FOR NURSING: Nurses can support the transition to self-care among emerging adults after HCT by recognizing the broader developmental impact of their cancer experience.


Assuntos
Adaptação Psicológica , Sobreviventes de Câncer/psicologia , Neoplasias Hematológicas/economia , Neoplasias Hematológicas/psicologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/psicologia , Adolescente , Adulto , Fatores Etários , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Adulto Jovem
16.
Cancer Epidemiol Biomarkers Prev ; 27(3): 345-347, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29440120

RESUMO

Background: Financial hardship is a growing challenge for patients with blood cancer who undergo hematopoietic cell transplantation (HCT), and it is associated with poor patient-reported outcomes. In contrast, little is known about the potential impact of patient-reported financial hardship on post-HCT survival.Methods: We sought to describe the association of financial hardship with survival after HCT in a prospectively assembled cohort of patients from three large transplant centers (n = 325).Results: There was no association between financial hardship measures assessed at 6 months post-HCT and 1- or 2-year survival after HCT.Conclusions: Patient-reported financial distress after HCT does not seem to adversely affect post-HCT survival.Impact: When assessing the effectiveness of interventions to ameliorate familial financial burden among HCT, the focus should be on patient-reported outcomes rather than survival. Cancer Epidemiol Biomarkers Prev; 27(3); 345-7. ©2018 AACR.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Neoplasias Hematológicas/mortalidade , Transplante de Células-Tronco Hematopoéticas/economia , Medidas de Resultados Relatados pelo Paciente , Fatores Socioeconômicos , Feminino , Neoplasias Hematológicas/economia , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autorrelato/economia , Autorrelato/estatística & dados numéricos , Análise de Sobrevida , Resultado do Tratamento
17.
Curr Hematol Malig Rep ; 13(2): 125-134, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29484578

RESUMO

PURPOSE OF REVIEW: Improved tolerability and outcomes after hematopoietic cell transplantation (HCT), along with the availability of alternative donors, have expanded its use. With this growth, and the development of additional cellular therapies, we also aim to increase effectiveness, efficiency, and the quality of the care provided. Fundamentally, the goal of value-based care is to have better health outcomes with streamlined processes, improved patient experience, and lower costs for both the patients and the health care system. HCT and cellular therapy treatments are multiphase treatments which allow for interventions at each juncture. RECENT FINDINGS: We present a summary of the current literature with focus on program structure and overall system capacity, coordination of therapy across providers, standardization across institutions, diversity and disparities in care, patient quality of life, and cost implications. Each of these topics provides challenges and opportunities to improve value-based care for HCT and cellular therapy patients.


Assuntos
Seleção do Doador , Transplante de Células-Tronco Hematopoéticas/economia , Qualidade de Vida , Doadores não Relacionados , Custos e Análise de Custo , Seleção do Doador/economia , Seleção do Doador/métodos , Humanos
18.
Biol Blood Marrow Transplant ; 24(7): 1497-1504, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29410296

RESUMO

Tandem autologous stem cell transplantation (ASCT) improves long-term survival of platinum-refractory germ cell tumors (GCT) patients. Studies, predominantly in lymphoma, showed that CD34+ cell doses > 5.0 × 106/kg/single transplant led to decreased resource utilization. Because most GCT patients have received prior cisplatin-based treatment, collecting >10 × 106 CD34+ cells/kg is challenging. We analyzed the effect of CD34+ cell dose on resource utilization and outcome in 131 GCT patients, median age 29.5 years (range, 16 to 58), undergoing tandem ASCT. Of 262 individual transplants performed, 120 were performed as inpatient and 142 as planned outpatient. Overall, median CD34+ dose per transplant was 3.1 × 106/kg (range, 0.8 to 16.0), with no significant difference between inpatient and outpatient transplants. Patients were divided into quartiles based on the CD34 cell dose infused: Q1, 0.8 to 1.9 × 106/kg; Q2, 2.0 to 2.9 × 106/kg; Q3, 3.0 to 4.1 × 106/kg; and Q4, 4.2 to 16.0 × 106/kg. For all patients higher CD34+ cell doses were associated with significantly shorter times to neutrophil (P <.001) and platelet recovery (P <.001). For inpatient transplants higher CD34+ doses were significantly associated with shorter length of hospital stay (P <.001), fewer days of filgrastim (P <.001), i.v. antibiotic (P = .012) and antifungal (P = .03) usage; and fewer RBC (P = .001) and platelet units transfused (P <.001), resulting in overall lower cost of care (P < .001). Of the 142 planned outpatient transplants, 100 admissions were required for a median length of hospital stay of 7.0 days (range, 1 to 18). Although there was no significant difference in the rates of hospitalization between patients in different CD34+ cell dose quartiles, a significant trend was observed for shorter hospitalization (P = .01) and fewer RBC (P = .002) and platelet (P = .005) transfusions with higher CD34+ cell dose quartile. Patients receiving CD34+ cell doses in the lowest dose quartile (Q1) had significantly worse progression-free survival and overall survival compared with patients receiving higher CD34+ cell doses. Overall, resource utilization, including cost of care, is significantly reduced when patients receive higher CD34+ cell doses, indicating greater efforts to improve peripheral blood stem cell collection in this population are needed.


Assuntos
Antígenos CD34/metabolismo , Transplante de Células-Tronco Hematopoéticas/economia , Neoplasias Embrionárias de Células Germinativas/economia , Neoplasias Embrionárias de Células Germinativas/terapia , Transplante Autólogo/economia , Adolescente , Adulto , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Embrionárias de Células Germinativas/patologia , Recidiva , Transplante Autólogo/métodos , Adulto Jovem
19.
Cancer ; 124(9): 1946-1953, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29461639

RESUMO

BACKGROUND: The treatment of multiple myeloma (MM) has become costly and difficult to access for patients living in low-income to middle-income countries. METHODS: The current retrospective study included 148 patients in Mexico with newly diagnosed MM, and was performed to compare the outcomes of patients with and without access to novel agents. The records of 77 patients admitted to a public hospital (PubC) and 71 patients cared for within private health systems (PrivC) from November 2007 to July 2016 were reviewed. RESULTS: Compared with those treated in PrivC, patients receiving care at PubC were more likely to be diagnosed with advanced disease. A thalidomide-based regimen was the most common induction treatment used at PubC, whereas a bortezomib-based regimen was used most often in PrivC. The median follow-up was 41 months. Patients in PrivC demonstrated better response rates and survival; 65% of patients treated in PrivC versus 41% treated at PubC achieved a very good partial response or better (P = .005). The median progression-free survival and median overall survival were 23 months and 51 months, respectively, for patients treated at PubC and 41 months and 79 months, respectively, for those treated in PrivC (P<.001). More patients underwent autologous stem cell transplantation in PrivC. When adjustments were made for covariates, patients treated at PubC experienced a higher risk of death compared with patients receiving care in PrivC (hazard ratio, 2.0; 95% confidence interval, 1.0-4.3 [P = .04]). CONCLUSIONS: Stage at diagnosis, induction regimen, and autologous stem cell transplantation were found to be contributors to survival disparities between patients with MM treated at PubC compared with PrivC in Mexico. These findings underscore the need to improve access to novel agents and stem cell transplantation in public health systems. Cancer 2018;124:1946-53. © 2018 American Cancer Society.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Custos de Medicamentos , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Transplante de Células-Tronco Hematopoéticas/economia , Mieloma Múltiplo/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Bortezomib/economia , Bortezomib/uso terapêutico , Intervalo Livre de Doença , Feminino , Seguimentos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mieloma Múltiplo/economia , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Estudos Retrospectivos , Talidomida/economia , Talidomida/uso terapêutico , Transplante Autólogo/economia , Transplante Autólogo/estatística & dados numéricos , Resultado do Tratamento
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