Barriers to Hematopoietic Cell Transplantation for Adults in the United States: A Systematic Review with a Focus on Age

Colin Flannelly , Bryan E-Xin Tan , Jian Liang Tan , Colin M. McHugh , Chandrika Sanapala , Tara Lagu , Jane L. Liesveld , Omar Aljitawi , Michael W. Becker , Jason H. Mendler , Heidi D. Klepin , Wendy Stock , Tanya M. Wildes , Andrew Artz , Navneet S. Majhail , Kah Poh Loh
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引用次数: 24

Abstract

Hematopoietic cell transplantation (HCT) is an effective treatment for many hematologic malignancies, and its utilization continues to rise. However, due to the difficult logistics and high cost of HCT, there are significant barriers to accessing the procedure; these barriers are likely greater for older patients. Although numerous factors may influence HCT access, no formal analysis has detailed the cumulative barriers that have been studied thus far. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to better categorize the barriers to access and referral to HCT, with a focus on the subgroup of older patients. We searched for articles published in English from PubMed, Embase, Cumulative Index for Nursing and Allied Health, and Cochrane Central Register of Controlled Trials between the database inception and January 31, 2020. We selected articles that met the following inclusion criteria: (1) study design: qualitative, cross-sectional, observational cohort, or mixed-method study designs; (2) outcomes: barriers related to patient and physician access to HCT; and (3) population: adults aged ≥18 years with hematologic malignancies within the United States. Abstracts without full text were excluded. QUALSYST methodology was used to determine article quality. Data on the barriers to access and referral for HCT were extracted, along with other study characteristics. We summarized the findings using descriptive statistics. We included 26 of 3859 studies screened for inclusion criteria. Twenty studies were retrospective cohorts and 4 were cross-sectional. There was 1 prospective cohort study and 1 mixed-method study. Only 1 study was rated as high quality, and 16 were rated as fair. Seventeen studies analyzed age as a potential barrier to HCT referral and access, with 16 finding older age to be a barrier. Other consistent barriers to HCT referral and access included nonwhite race (n = 16/20 studies), insurance status (n = 13/14 studies), comorbidities (n = 10/11 studies), and lower socioeconomic status (n = 7/8 studies). High-quality studies are lacking related to HCT barriers. Older age and nonwhite race were consistently linked to reduced access to HCT. To produce a more just health care system, strategies to overcome these barriers for vulnerable populations should be prioritized. Examples include patient and physician education, as well as geriatric assessment guided care models that can be readily incorporated into clinical practice.

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美国成人造血细胞移植的障碍:一项以年龄为重点的系统综述
造血细胞移植(HCT)是一种有效的治疗许多血液系统恶性肿瘤,其使用率持续上升。然而,由于HCT的后勤困难和高成本,在获得该程序方面存在重大障碍;这些障碍对老年患者来说可能更大。虽然有许多因素可能影响HCT的获取,但迄今为止还没有正式的分析详细说明所研究的累积障碍。我们根据系统评价和荟萃分析指南的首选报告项目进行了系统评价,以更好地分类获得和转诊HCT的障碍,重点关注老年患者亚组。我们检索了从数据库建立到2020年1月31日之间从PubMed、Embase、护理和联合健康累积索引和Cochrane中央对照试验注册中心发表的英文文章。我们选择符合以下纳入标准的文章:(1)研究设计:定性、横断面、观察队列或混合方法研究设计;(2)结果:与患者和医生获得HCT相关的障碍;(3)人群:美国境内年龄≥18岁的恶性血液病患者。没有全文的摘要被排除在外。采用QUALSYST方法确定文章质量。提取了关于HCT获取和转诊障碍的数据,以及其他研究特征。我们用描述性统计对研究结果进行了总结。我们纳入了3859项研究中的26项。20项研究为回顾性队列研究,4项为横断面研究。有1项前瞻性队列研究和1项混合方法研究。只有1项研究被评为高质量,16项研究被评为一般。17项研究分析了年龄作为HCT转诊和获取的潜在障碍,其中16项研究发现年龄较大是一个障碍。其他一致的HCT转诊和获取障碍包括非白人种族(n = 16/20项研究)、保险状况(n = 13/14项研究)、合并症(n = 10/11项研究)和较低的社会经济地位(n = 7/8项研究)。缺乏与HCT障碍相关的高质量研究。年龄较大和非白种人始终与较少获得HCT有关。为了建立一个更加公正的卫生保健系统,应优先考虑为弱势群体克服这些障碍的战略。例子包括病人和医生教育,以及可以很容易地纳入临床实践的老年评估指导护理模式。
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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
期刊最新文献
Table of Contents Editorial Board Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major Early Mixed Lymphoid Donor/Host Chimerism is Associated with Improved Transplant Outcome in Patients with Primary or Secondary Myelofibrosis Real-World Issues and Potential Solutions in Hematopoietic Cell Transplantation during the COVID-19 Pandemic: Perspectives from the Worldwide Network for Blood and Marrow Transplantation and Center for International Blood and Marrow Transplant Research Health Services and International Studies Committee
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