Effect of Hematopoietic Cell Transplant (HCT) Survivorship Program on Screening for Late Effects over Time

Background Since HCT survivors have unique needs from late treatment effects, they may benefit from intensive medical screenings. However, the efficacy of survivorship efforts to promote adherence to screenings is uncertain. Methods We conducted a retrospective analysis of a HCT Survivorship Program at an academic center. The program included primary (Day 100 HCT clinician visit) and specialty (1-year HCT survivorship clinician consult) components. We included patients who underwent allogeneic HCT and were alive at 1 year post-HCT without disease relapse. We excluded patients who died prior to 2 years post-HCT. We measured adherence to medical screening using the electronic health record and classified screenings as cardiovascular (lipids and diabetes), pulmonary (pulmonary function test), ocular (ophthalmology exam), cancer (screening discussion), and endocrine (Vitamin D, thyroid, iron, and bone density). Our primary outcome was proportion of patients completing ≥1 evaluation per screening domain prior to 2 years post-HCT. We examined 3 time periods: Pre-Survivorship (2012-2014) and Post Survivorship (2016-2018 and 2019-2021), including the COVID-19 pandemic. We conducted multivariate logistic regression adjusting for comorbidities (HCT-CI), donor, and GVHD prophylaxis regimen. Results 410 patients (Pre-Survivorship: n = 136, Post-Survivorship 2016-2018: n = 153, Post-Survivorship 2019-2021: n = 121) were included. Study periods differed by median HCT-CI score (1, 2, 2, p =0.001), number of cord HCTs (6, 0, 0, p=0.009), and use of post-transplant cyclophosphamide (8.8%, 26.1%, 28.9%, p<0.0001). Figure 1 illustrates the proportion of patients receiving screening per domain within 2 years post-HCT by study period. Compared to baseline (16.9%), patients in Post-Survivorship 2016-2018 (47.7%, OR=4.9, p<0.0001) and 2019-2021 (34.7%, OR=2.7, p=0.001) were more likely to complete at least one evaluation per screening domain prior to 2 years post-HCT. In Post-Survivorship #1 and #2, 31 (20.3%) and 21 (17.4%) patients received 1 year consults. Figure 2 illustrates the proportion of patients receiving screening per screening domain by receipt of a consult. Survivorship consult had similar effect on the primary screening outcome in 2016 – 2018 and 2019 - 2021 (consult*time interaction OR: 2.5, p=0.2). However, patients who received a consult in 2019-2021 were more likely to complete all screenings (consult*time interaction: OR:5.7, p=0.03). Discussion The HCT Survivorship Program improved adherence to cardiovascular, ocular, cancer, and endocrine screenings. The COVID-19 pandemic negatively impacted pulmonary screening and maintenance of screening benefit. Care models with primary and specialty survivorship components may help promote screening efforts. Additional studies are needed to evaluate HCT survivorship care models and their implementation.