Inadequate survivorship care after allogeneic hematopoietic cell transplantation: A retrospective chart review [version 1; peer review: 1 approved, 1 not approved]

Background: Hematopoietic cell transplant (HCT) survivors are at risk of developing long-term complications. Guidelines for survivorship care of HCT recipients were published in 2012; however, the degree to which these guidelines are incorporated into clinical practice is unknown. The purpose of this study was to determine whether providers utilize the 2012 guidelines and analyze whether survivorship-focused providers, provider gender, or provider year of practice influenced adherence to these guidelines. Methods: Adult allogeneic HCT recipient’s medical records were reviewed at the University of Minnesota between 2010 and 2012; only patients who survived without relapse to their 2-year follow-up visit after HCT were included. A semi-quantitative scoring system was developed providing 1 point for each of the 13 organ systems assessed by the 2012 survivorship care guidelines. Data was collected on history, clinical exam, laboratory tests, preventive measures, and counseling. The primary endpoint was the overall score for adherence to the survivorship care guidelines. Wilcoxon rank-sum tests for continuous and Chi-square tests for categorical factors were used to compare the overall score between provider groups (survivorship-focused providers vs others), provider gender, and provider year of practice (≥10 years vs <10 years). Results: Fifteen providers (9 male, 3 survivorship-focused, 7 with <10 years of practice) provided follow-up care to 77 HCT survivors. Survivorship-focused providers had a higher median overall score than other providers (median 10 vs 8, p<0.01). Female providers had a higher median overall score than male providers (median 9.0 vs 8, p<0.01). There was no difference in median overall score based on provider year of experience (p=0.43). Conclusions: In conclusion, survivorship-focused providers were more likely to achieve long-term screening recommendations. However, even within this group, adherence to the 2012 screening and preventive practice guidelines was incomplete. Further efforts to automate and standardize the survivorship assessments in HCT survivors are necessary.