Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 61

The risk of certain late conditions may be relatively higher in developing countries, which needs special consideration compared to developed countries. This includes a higher risk of certain infections e.g. tuberculosis, malaria, hepatitis B and C, and invasive fungal infections. Thus, late‐effect monitoring should ideally include surveillance for endemic infections. Another neglected area of survivorship care is the risk of dying from road traffic accidents. Unfortunately, road traffic injuries are the leading cause of death for children and young adults aged 5–29 years and 93% of the world's fatalities on the roads occur in low‐ and middle‐income countries [44]. Thus, education on risk‐reduction strategies for accidents can be one of the aims of survivorship education. Another challenge peculiar to developing countries is the near complete absence of effective primary care setting which poses additional burden on the LTFU clinic team for screening for common preventable conditions in HSCT survivors (e.g. routine mammograms and bone densitometry scans). Potential solutions to this issue would include computerized checklists for the entire preventative screening panels, and also provision, not only of these preventive services (e.g. mammogram machines), but also of social workers who can try to potentially get the preventive screening covered.

The affordability issue does impact the long‐term care significantly and thus mechanisms should be in place to alleviate this issue else the effectiveness of a LTFU clinic will be low. Though most developing countries have a universal healthcare provision regulation, the quality of healthcare provision at governmental institutions may not be appropriate in some countries. Additionally, buying private healthcare insurance is beyond the reach of majority of the population in the developing countries, thereby, before one establishes an LTFU clinic, the priorities for screening of most prevalent late effects should be clearly delineated since many patients will still be paying out of pocket for all healthcare visits, tests and medications.

Another challenge for HSCT survivors stems from medical tourism. Many patients travel to Europe or the US for receipt of HSCT. When they come back, they are prone to face many difficulties in longitudinal care since, quite often, it is hard to travel back to the original transplant center for follow‐up visits. Thus, an ideal LTFU clinic should be prepared to deal with HSCT survivors returning from foreign countries and have effective mechanisms of communication with the primary transplant teams in the foreign countries.

Thus, to summarize, there are many unique concerns pertaining to long‐term care in the developing countries but potential solutions exist. There is very little published data on long‐term outcomes, and these data are essential to prioritize the essentials of a fully functional LTFU clinic. There remains an essential and unmet need for establishment of such LTFU clinics in these countries as the transplant activity continues to increase.