Health Care Utilization by Hematopoietic Cell Transplantation (HCT) Survivors: A Report from the Bone Marrow Transplant Survivor Study.
Authors: Bhatia Smita , Carter Andrea , Francisco Liton , Baker K. S. , Forman Stephen J. , Grant Marcia , Robison Leslie L. , Weisdorf Daniel J. , Gurney James G. 
Published: October 2019

Abstract
HCT is increasingly being used to successfully treat a variety of malignant and nonmalignant disorders with an attendant growing population of survivors. We determined the type of outpatient medical care reported by adult survivors of HCT and examined factors associated with limited medical care. Eligible subjects were individuals who had undergone HCT at either City of Hope Cancer Center or the University of Minnesota between 1974 and 1998, were age 21 years or older at time of transplant, and had survived two or more years after HCT. We analyzed data from 755 adult HCT survivors enrolled in this retrospective cohort study who had completed a 255-item health questionnaire (Allogeneic HCT: n=424; autologous HCT: n=331), representing over 70 percent participation among those successfully contacted. Because of the widely divergent health-related issues among the autologous and allogeneic HCT recipients, the results of the analysis for the two groups are presented separately. Median age at HCT for the allogeneic and autologous HCT survivors was 35.4 and 39.5 years respectively, and the median length of follow-up 7.3 and 6.2 years respectively. Four self-reported outcome measures were used to determine outpatient medical care in the most recent 2-year period: general contact with health care system, general physical examination, HCT-related medical visit, and medical visit at a cancer center, with the percentage of patients reporting such visits shown in the Table below. Among allogeneic HCT recipients, the risk of not reporting a general physical examination, HCT-related visit, or a cancer center visit was decreased among male survivors (OR=0.46, 95% CI, 0.29–0.73) when compared with females, and among patients who received cyclosporine as part of their GVH prophylaxis (OR=0.42, 95% CI, 0.24 to 0.74), when compared with those who had not. Among autologous HCT recipients, the risk of not reporting a medical visit was increased among patients who reported a lack of concern for future health (OR=6.3, 95% CI, 1.4–27.8) and decreased among older survivors (>45 yr. at HCT, OR=0.47, 95% CI, 0.3–0.8). The likelihood of reporting a general physical examination increased as the interval from HCT to questionnaire completion increased (p<0.001), while the likelihood of reporting an HCT-related or cancer center visit decreased (p<0.001). This study demonstrates that although 20% of the allogeneic survivors continued to report a cancer-center visit 18 years on average from HCT, primary care physicians provide health care for most of this growing high-risk population, necessitating effective and ongoing communication between cancer centers and primary care physicians.
Health care Utilization by HCT Survivors
HCT Type General Medical Contact General Physical Examination HCT-related visit Cancer center visit Allogeneic HCT 98% 67.8% 81.5% 54.3% Autologous HCT 97% 73.3% 80.8% 53.3%