Transplant Wellness Clinic for Elderly or High Risk Patients Undergoing BMT

N/ACompletedNCT04194840

Case Comprehensive Cancer Center20 enrolled

Overview

As the average age of individuals undergoing stem cell transplant continues to increase, challenges associated with balancing the side effects of cancer treatments while also managing other medical conditions develop. Studies have shown these individuals develop more treatment related side effects and take longer to leave the hospital due to complications. The purpose of this study is to develop a multiple provider clinic that will help identify any additional needs in the more complicated and generally older transplant patient population. If needed, this clinic will recommend interventions or referrals to the appropriate specialties to the participant and the transplant physician for the participant before your transplant procedure. Examples of potential areas of improvement include a course of physical therapy, nutritional supplements, or modifications of medications, among others with the goal to make your transplant safer and to decrease length of time in the hospital.

This is a supportive interventional study to assess frailty in at risk geriatric cancer patients undergoing stem cell transplant and to determine if specific interventions are feasible and will improve overall outcomes. A total of 20 participants will be enrolled in this study with the first 10 participants limited to myeloma or lymphoma patients who meet eligibility criteria and are candidates for autologous transplantation. The second 10 participants enrolled will be either allogeneic or autologous stem cell transplant candidates who meet eligibility criteria. The objectives of this study are as follows: * To pilot a comprehensive multidisciplinary geriatric assessment clinic. * To determine whether a comprehensive geriatric assessment (outside of physical therapy assessment) can be performed in a time efficient manner. The goal is to complete all questionnaires and the multidisciplinary assessments in \<90 minutes. * To assess participant and physician satisfaction * To determine if interventions recommended in the clinic are achievable for each participant * Examples of interventions could include, medication changes, management of depression, dietary modifications, physical therapy three times a week, etc. * To determine if participation in the transplant wellness clinic reduces length of stay and readmission rate compared to historical controls at our institution

Study Type

INTERVENTIONAL

Allocation

Interventions

physical therapy consultOTHER

Physical therapy consult to assess physical functioning on a separate office visit prior to attending the Transplant Wellness Clinic. Full evaluation that incorporates several tools to measure the risk of falling and to assess mobility and strength

Cognitive AssessmentOTHER

Montreal cognitive assessment (MoCA) and the Blessed Orientation-Memory-Concentration Test (BOMC)

Cancer Aging Research Group (CARG) assessmentOTHER

CARG assessment - utilized to capture information about a participant's medical history as well as functional, cognitive, and psychosocial status

Medication ReviewOTHER

Medication Review via Beers Assessment

Nutrition assessmentOTHER

Nutrition assessment Via Mini Nutrition Assessment (MNA)

Laboratory studiesOTHER

Laboratory studies including urine toxicology screen, C-reactive protein, albumin, pre-albumin, vitamin D

Patient satisfaction questionnaireOTHER

Patient satisfaction questionnaire

Physician QuestionnaireOTHER

Physician Questionnaire: Questionnaire to learn about physician satisfaction with information received from reports and participant questionnaires.

Patient follow-up questionnaireOTHER

Patient follow-up questionnaire: Questionnaire to learn more about participant opinions concerning the clinic and the quality of care received during visits with specialists

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Deemed candidate for autologous or allogeneic transplantation by their Stem Cell Transplant Attending Physician * Stem cell transplant candidates \> 60 years * Younger patients with age adjusted HCT- CMI\> 4 * Outpatient at time of enrollment. * Must have at a minimum 4 weeks and a maximum of 12 weeks before anticipated start of transplant procedures, ie initiation of preparation regimen or beginning of peripheral stem cell mobilization * Must have transportation to outpatient appointments * Must be able to read and understand English to complete the required questionnaires Must be able to read and understand protocol consent Exclusion Criteria: \- Those who are not felt to be candidates for autologous or allogeneic stem cell transplantation

Outcomes

Primary Outcomes

Time to complete geriatric assessment clinic

Time to complete geriatric assessment clinic will be collected. Feasibility will be defined if 7 or more of the first 10 patients are able to complete the geriatric assessment clinic in under 90 minutes.

Time frame: at time of assessment (an average of 90 minutes)

Patient satisfaction as determined by "patient follow-up quesitonnaire"

Analysis of patient and physician questionnaires will be tabulated and results reported in a descriptive fashion

Time frame: at time of assessment (less than 1 hour)

Physician satisfaction as determined by "physician questionnaire"

Analysis of patient and physician questionnaires will be tabulated and results reported in a descriptive fashion

Time frame: at time of assessment (less than 1 hour)

Length of transplant stay in days

Length of transplant stay will be collected for all participants and compared to historical controls of similar age

Time frame: Assessed up to 6 months after transplant

Readmission rates

Readmission rates in the first 100 days post-transplant will be collected and compared to historical controls using Chi-square test

Time frame: Up to 100 days after transplant