Oliver Marian M, Meng Qingrui, Hageman Lindsey, Landier Wendy, Balas Nora, Ross Elizabeth, Francisco Liton, Bosworth Alysia, Te Hok Sreng, Wong F Lennie, Bhatia Ravi, Forman Stephen J, Armenian Saro H, Weisdorf Daniel J, Bhatia Smita
Institute for Cancer Outcomes and Survivorship, Division of Pediatric Hematology/Oncology, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Population Sciences, Hematologic Malignancies Research Institute, Department of Pediatrics, City of Hope, Duarte, California, USA.
Cancer. 2024 Mar 1;130(5):803-815. doi: 10.1002/cncr.35076. Epub 2023 Oct 25.
Blood or marrow transplantation (BMT) survivors carry a high burden of morbidity, yet health care utilization by this vulnerable population remains understudied. Patterns and predictors of various domains of health care utilization in long-term BMT survivors were evaluated.
Study participants were drawn from the Bone Marrow Transplant Survivor Study (BMTSS). Patients transplanted between 1974 and 2014 at one of three transplant centers who had survived ≥2 years after BMT and were aged ≥18 years at the time of the study were included. A BMTSS survey served as the source of data for health care utilization, sociodemographics, and chronic health conditions. Domains of health care utilization in the 2 years preceding study participation included routine checkups, BMT-related visits, transplant/cancer center visits, emergency room (ER) visits, hospitalizations, and high health care utilization (≥7 physician visits during the 2 years before the study). Clinical characteristics and therapeutic exposures were abstracted from medical records.
In this cohort of 3342 BMT survivors (52% allogeneic), the prevalence of health care utilization declined over time since BMT for both allogeneic and autologous BMT survivors, such that among those who had survived ≥20 years, only 49%-53% had undergone routine checkups, 37%-38% reported BMT-related visits, and 28%-29% reported transplant/cancer center visits. The presence of severe/life-threatening conditions and chronic graft-vs-host disease increased the odds of health care utilization across all domains. Lower education, lack of insurance, and Hispanic ethnicity were associated with a lower prevalence of routine checkups and/or transplant/cancer center visits. Lower income increased the odds of ER visits but reduced the odds of hospitalizations or high health care utilization.
This study identified vulnerable populations of long-term BMT survivors who would benefit from specialized risk-based anticipatory care to reduce high health care utilization, ER visits, and hospitalizations.
血液或骨髓移植（BMT）幸存者承受着较高的发病负担，但这一弱势群体的医疗保健利用情况仍未得到充分研究。本研究评估了长期BMT幸存者医疗保健利用各领域的模式及预测因素。
研究参与者来自骨髓移植幸存者研究（BMTSS）。纳入1974年至2014年间在三个移植中心之一接受移植、BMT后存活≥2年且研究时年龄≥18岁的患者。BMTSS调查作为医疗保健利用、社会人口统计学和慢性健康状况的数据来源。研究参与前2年的医疗保健利用领域包括常规体检、BMT相关就诊、移植/癌症中心就诊、急诊室（ER）就诊、住院以及高医疗保健利用（研究前2年内科医生就诊≥7次）。临床特征和治疗暴露情况从病历中提取。
在这3342名BMT幸存者队列中（52%为异基因移植），异基因和自体BMT幸存者自BMT后的医疗保健利用患病率随时间下降，以至于在存活≥20年的患者中，只有49%-53%接受过常规体检，37%-38%报告有BMT相关就诊，28%-29%报告有移植/癌症中心就诊。严重/危及生命的疾病和慢性移植物抗宿主病的存在增加了所有领域医疗保健利用的几率。较低的教育水平、缺乏保险以及西班牙裔与常规体检和/或移植/癌症中心就诊的较低患病率相关。较低的收入增加了急诊室就诊的几率，但降低了住院或高医疗保健利用的几率。
本研究确定了长期BMT幸存者中的弱势群体，他们将受益于基于风险的专门预防性护理，以减少高医疗保健利用、急诊室就诊和住院情况。
