Life 2.0: A Comprehensive Cross-Sectional Profiling of the ‘New Normal’ in 244 Long-Term Allogeneic Hematopoietic Cell Transplantation Survivors Compared to the General Population

Abstract

We performed a cross-sectional study to describe the survivorship profile of a convenience sample of 244 allogeneic hematopoietic cell transplantation (HCT) recipients based on a comprehensive health status model and we compared them to controls from the general Belgian population using the Health Interview Survey database (matched 1:3 based on age, gender and province of residence), a national assessment performed every five years since 1997 to evaluate the general health status of the population. Included patients were above age 18, at least 2 years post-HCT and presented to our center for a scheduled outpatient appointment. Patients hospitalized for a life-threatening condition, presenting with any other major illness (resulting in an expected survival of less than 6 months) or any major visual, hearing, cognitive or psychiatric conditions precluding consent were excluded. We performed a comprehensive evaluation including a medical evaluation and record review, a directed interview and a self-reported survey on the patient's physical, psychosocial and behavioral functioning using standardized instruments. Descriptive statistics and conditional logistic regressions were used as appropriate. 244 out of 300 eligible survivors (81% response rate) participated (median 8.4 years post HCT; IQR 7.9; range 2.3-24.4). The most prevalent issues noted were graft versus host disease (46.7%), impaired kidney function (63.9%), the presence of a metabolic syndrome (33.6%), medication non-adherence (for immunosuppressive medication: 60.4% implementation issues, 7.5% non-persistence issues; for other medication: 53.8% omission issues), low physical activity (54.5%) and inappropriate UV exposure (44.7%). Compared to the general population, survivors were significantly more likely to report a sub-optimal overall perceived health status (82.0% versus 52.1% respectively, OR 4.58 (3.08-6.80), p These findings point towards the complex care needs of HCT survivors and call for the implementation of chronic care models for follow-up care. We currently are planning an eHealth powered model of care intervention to address these issues.