Pituskin Edith, Foulkes Stephen, Skow Rachel J, McMurtry Thomas, Kruger Calvin, Bates Janet E, Lamoureux Daena, Brandwein Joseph, Lieuw Elena, Wu Cynthia, Zhu Nancy, Wang Peng, Sawler Daniel, Taparia Minakshi, Hamilton Marlene, Comfort-Riddle Tiffany, Meyer Tara, Gyenes Gabor T, Paterson Ian, Prado Carla M, Haykowsky Mark J, Greiner Justin G, McNeely Margaret L, Tandon Puneeta, Thompson Richard B
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Edmonton Clinic Health Academy (ECHA), University of Alberta, Edmonton, AB, 141, T6G 1C9, Canada.
BMC Cancer. 2025 Jan 28;25(1):163. doi: 10.1186/s12885-025-13502-8.
Hematopoietic stem cell transplantation (HSCT) is a common therapy for many hematologic malignancies. While advances in transplant practice have improved cancer-specific outcomes, multiple and debilitating long term physical and psychologic effects remain. Patients undergoing allogeneic bone marrow transplantation (allo-BMT) are often critically ill at initial diagnosis and with necessary sequential treatments become increasingly frail and deconditioned. Despite modern treatment regimens and support, cardiovascular disease remains a leading cause of non-relapse mortality among allo-BMT survivors. Well-established multi-disciplinary care models such as cardiac rehabilitation offer holistic care including exercise training, nursing support, physical/occupational therapy, psychosocial support and nutritional education. HSCT patients may be excluded from conventional outpatient physical rehabilitation programs due to prolonged pancytopenia and frequent hospital admissions. In Canada, dedicated cancer-specific rehabilitation programs are available only at major tertiary academic centers.
The primary aim of this study will evaluate the feasibility and acceptability of a multimodal care navigation (nursing, exercise, nutrition) intervention with content delivery facilitated by a supportive care web-based 'app' extending from diagnosis to 1 year in the allogeneic bone marrow transplant population. Adult patients scheduled for allo-BMT will receive support from exercise specialist, nursing support and dietician expertise alongside a supportive care 'app' with additional in-person or virtual cardiac rehabilitation support.
To our knowledge, no research team is taking such a holistic, multidisciplinary approach to address the debilitating physiologic and psychological consequences of allo-BMT. We expect the findings to inform the optimal timing and patient preferences to develop studies examining risk-specific, individualized interventions (including exercise, pharmacotherapy, combination treatments) to reduce or prevent symptoms and dysfunction. We expect this innovative program to identify ways to benefit innumerable patients with hematologic and other malignancies. Ultimately, we hope to transform supportive care in hematopoietic stem cell transplantation.
Clinicaltrials.gov ID: NCT05579678.
造血干细胞移植（HSCT）是许多血液系统恶性肿瘤的常见治疗方法。虽然移植实践的进展改善了癌症特异性结局，但多种使人衰弱的长期身体和心理影响仍然存在。接受异基因骨髓移植（allo-BMT）的患者在初次诊断时往往病情危急，并且随着必要的序贯治疗，身体越来越虚弱，机能下降。尽管有现代治疗方案和支持措施，心血管疾病仍然是allo-BMT幸存者非复发死亡率的主要原因。完善的多学科护理模式，如心脏康复，提供包括运动训练、护理支持、物理/职业治疗、心理社会支持和营养教育在内的整体护理。由于长期全血细胞减少和频繁住院，HSCT患者可能被排除在传统的门诊物理康复项目之外。在加拿大，专门针对癌症的康复项目仅在主要的三级学术中心提供。
本研究的主要目的是评估一种多模式护理导航（护理、运动、营养）干预措施的可行性和可接受性，该干预措施通过一个基于网络的支持性护理“应用程序”提供内容，从诊断到异基因骨髓移植人群的1年期间。计划接受allo-BMT的成年患者将获得运动专家的支持、护理支持和营养师的专业知识，以及一个支持性护理“应用程序”，并额外获得面对面或虚拟的心脏康复支持。
据我们所知，没有研究团队采用如此全面、多学科的方法来解决allo-BMT使人衰弱的生理和心理后果。我们期望这些发现能够为最佳时机和患者偏好提供信息，以便开展研究，检验针对特定风险的个体化干预措施（包括运动、药物治疗、联合治疗），以减轻或预防症状和功能障碍。我们期望这个创新项目能够找到使无数血液系统和其他恶性肿瘤患者受益的方法。最终，我们希望改变造血干细胞移植中的支持性护理。
Clinicaltrials.gov标识符：NCT05579678。
