Hematopoietic cell transplantation (HCT) is a complex treatment for several hematological disease groups, including many types of cancer. In a new study published in AJMC, researchers found that low risk HCT patients have had similar survival outcomes irrespective of whether they underwent transplant at higher- or lower-risk centers, even when they adjusted for sociodemographics.
The research conducted by University of Minnesota health policy experts Drs. Schelomo Marmor in the Department of Surgery, with James W. Begun, Jean Abraham and Beth A. Virnig, in the Department of Health Policy and Management. The research group wanted to investigate if facilities that developed an expertise with high risk HCT patients influenced their ability to treat lower risk HCT patients.
“Our initial thought was that it would always be beneficial to seek care at the health care facilities that have a record of treating the more complex and higher risk patients” said Marmor, the lead author of the study.
Marmor and his colleagues used a de-identified 2008-2010 Center for International Blood & Marrow Transplant Research data set that included all HCT sociodemographic information and other medical diagnoses from all transplant centers in the US.
“We expected to see that establishing processes to successfully manage high-risk patients could benefit lower-risk patients as well,” said Marmor. “However, even with concurrent medical conditions and socio-demographic characteristics, we still saw that lower risk HCT patients received comparable care if they were treated at centers that had no experience with high risk HCT patients.”
Based on previous research from the group, the outcomes for a complex HCT patient treated at accredited centers was superior to outcomes at non accredited centers.
“Most low risk HCT patients assume they should travel to accredited centers or centers that are accustomed to treating “high risk” patients. This is not always the case and it might be beneficial for some lower risk patients to stay closer to home.”
“We would like to understand the advantages of treating high risk patients” said Marmor. “Is there a trickledown effect for the lower risk patient population treated at the same center”
Although they say more research is needed before considering changes in counseling patients, the findings have prompted them to rethink assumptions about providers that have more experience with high risk patients. High risk experience need not necessarily produce better outcomes for all other patients.
“We want to direct both researchers and patients to our findings, so through more research and collaboration, we can all work together to learn how to help each patient identify his or her best treatment options and appropriate treatment center,” said Marmor.
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