Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 50

When does survivorship care start? Most studies on late effects after HSCT include recipients surviving two years or longer after transplantation when they are in remission of their primary disease. However, in daily routine, the precise timing of long‐term survivorship care is not stringent. In cancer patients, it is usually defined by the time the primary treatment ends. In many HSCT centers, the posttransplant survivorship begins when the patient no longer needs regular posttransplant care. At that time, annual survivorship visits are considered as a standard for long‐term follow‐up. With growing numbers of long‐term survivors after HSCT, many centers refer their patients back to the primary care provider or to the referring hemato‐oncology center. However, some long‐term follow‐up may need to be conducted by the transplant center or a specialized LTFU clinic, especially if patients present transplant‐related complications such as chronic GVHD (cGVHD) [16]. The transition to long‐term follow‐up care from the HSCT team to another set of providers, ensuring optimal care of long‐term survivors is a vulnerable period. This transition may result in fragmentation of care and poor communication between the different care providers and for some groups of patients represent a risk being lost in transition. Continuity of care implicates an adapted model of LTFU clinic, but also optimal coordination between the LTHU clinic, the primary care provider and the long‐term survivor, with a clear definition of the responsibilities of each part. An HSCT long‐term survivorship care lasts until the recurrence of the primary disease, development of a subsequent cancer, or death of the patient. In the case of relapse or secondary cancer, survivors become cancer patients again, reentering possibly in the acute phase of cancer treatment [12]. Some of the controversial issues of a survivorship program concern the type and frequency of optimal follow‐up care, the increased expenses caused, as well as the extra time and the physical space needed to run such a program. In many countries, insurances that cover expenses of the HSCT, will not cover the costs of the follow‐up care.