Experience With Applying And Improving Feasibility Of An Enhanced Recovery Model For Allogenic Stem Cell Transplant Patients Aged 65 And Older

Topic Significance & Study Purpose/Background/Rationale Patients of advancing ages represent a significant proportion of allogeneic hematopoietic stem cell transplants (HSCT). In recent years, up to 30% of patients receiving an allogeneic HSCT are older than 60 with about 5% greater than 70. This trend is also occurring at our large (over 700 HSCT per year) program at a major Southwest comprehensive cancer center. As a result, a multi-departmental and multidiscipline effort was formed to evaluate HSCT patients aged 65 and older for conditions which can lead to increase frailty, cognitive impairments, and malnutrition potentially leading to increased morbidity and mortality. Methods, Intervention, & Analysis Our team approach assesses for early identification of these conditions to minimize, prevent, and mitigate the HSCT complications in the pre-transplant phase and follow the patients’ progress throughout their first 100 days post-HSCT. We applied the principles of Enhanced Recovery after Surgery (ERAS) programs which have shown to impact outcomes related to decreased opiate use and pain levels, shortened average length of stay, increased patient satisfaction, and reduce cost. Literature is limited for enhanced recovery pathway within the HSCT population. Our program, entitled Enhanced Recovery Stem Cell Transplant (ER-SCT), has utilized similar approaches of ERAS. This includes evaluation by Prehabilitation (Physical Therapist (PT), Occupational Therapist (OT) and Rehabilitation MD evaluation), Gerontologist, Clinical Nutritionist, clinical pharmacist, and by our Advanced Practice Providers (APPs) and nursing coordinators. Additionally, ER-SCT patients are followed by our inpatient RNs, APPs, PT/OT and nutrition teams, with discharge follow-up with Prehabilitation and Clinical Nutrition. Findings & Interpretation Feasibility of the applying ERAS principles, foundation, and elements was established through a quality improvement (QI) project. Through application of the Model of Improvement (part of the QI program), a need was discovered to improve scheduling, care coordination, and multidisciplinary approaches to patient care; resulting in the creation of an ER-SCT clinic. This was shown to reduce patient appointments and decrease time from enrollment in ER-SCT to completion of pre-HSCT visits. Discussion & Implications ER-SCT is currently looking evaluating program outcomes through the development of an research protocol. There is discussion about broadening this program to younger HSCT patients at higher risk for prolonged recovery and to the autologous HSCT population.