Bone Marrow Transplant Survivorship Coordinator

SITUATION ~
Bone Marrow transplant team is requesting 1.0 FTE to be added to the BMT Admin Cost
Center (!"#$ %or a BMT &ur'i'orship (urse Coordinator.
BACKGROUND ~
Coordinators are responsible %or the management and assuran)e that our patient*s
transplants o))ur and also assist patients in na'igating the e+tremel, )omple+ pro)ess
o% Bone Marrow Transplant. This is a highl, te)hni)al -ob that requires in.depth training
o% not onl, the /C0 &,stem but also the regulating requirements o% FACT1 the intri)a)ies
o% insuran)e )o'erage and the BMT nursing 2nowledge to be able to assist and edu)ate
patients through medi)al and ps,)h3so)ial )ompli)ations o% transplant.
A))ording to the (ational Marrow 4onor 5rogram1 sur'i'al rates are greatl, in%luen)ed
b, re)ogni6ing post.transplant )ompli)ations earl,1 establishing long.term post.
transplant s)reening and pre'entati'e pra)ti)es1 'a))inations and s)reening %or 7804.
Compli)ations %rom Bone Marrow Transplant )an de'elop long a%ter a patient lea'es
/C0 and returns to a 5C5 or lo)al on)ologist. 9n an arti)le published in :011 in Blood
&a'ani states ;These patients <post.transplant= ha'e in)reased ris2s %or 'arious late
)ompli)ations1 whi)h )an )ause morbidit, and mortalit,. Most long.term sur'i'ors return
to the )are o% their lo)al hematologists3on)ologists or primar, )are ph,si)ians1 who ma,
not be %amiliar with spe)iali6ed monitoring re)ommendations %or this patient population.>
9t is important that we dedi)ate a substantial amount o% time1 energ, and e+pertise to this
part o% the patient*s )are.
A Bone Marrow Transplant &ur'i'orship Coordinator is a 'ital role %or maintaining a
su))ess%ul program. The goal o% this position would be to pro'ide an indi'idual who
)ould assist in )oordinating the )omple+ )are that post.transplant patients require.
Thereb, in)reasing the patient*s qualit, o% li%e1 satis%a)tion and ultimatel, impro'ing their
long.term sur'i'al.
ASSSSMNT ~
As our patient numbers ha'e in)reased1 this is one area o% )are that is not getting the
attention that is needs. 9t is 'ital to our patients and their sur'i'al that we in'est as mu)h
dedi)ation1 attention and time into their post.transplant )are as we do into their pre.
transplant )are. ?e ha'e had )ontinued growth in the number o% transplants o'er the
past %ew ,ears1 in :011 transplant totals were @A1 :01: . B and in :01! 101. ?e
)ontinue to ha'e an in)rease in new patient re%errals (:"C in) annuali6ed FD 1A o'er FD
1!$ whi)h then translates to in)reased number o% transplants per%ormed at this )enter.
9n a poll o% " other transplant )enters in the /&1 /C0 is the onl, program that utili6es the
BMT Transplant Coordinators as the patient*s sole )onta)t %rom 5re.Transplant to
&ur'i'orship. E% the )enters polled # o% the " ha'e dedi)ated F( )oordinators to assist
patient through the pre.transplant to 4a, 0 pro)ess. To a))ommodate the ongoing
growth o% this program and to maintain patient sa%et, this is a model that /C0 must
adopt.
RCOMMNDATIONS~
&ee2 appro'al %or 1.0 FTE in !"# %or a new nurse transplant )oordinator dedi)ated to
sur'i'orship o% our patients. 4ra%t -ob duties atta)hed.
BMT Survivorship Coordinator !o" Duties
Care Startin# at Da$ %&& throu#h % $ear post transplant'
- Ensure patients are re)ei'ing the appropriate %3u post.transplant wor2ing )losel,
with the B9C sta%%1 pra)titioners and patients.
- Coordinate the patient*s da, 100 and da, !"# post.transplant e'aluation at /C0.
o Feturn 'isit with 5s,)hologist1 nutritionist1 reprodu)ti'e medi)ine (i%
needed$ and attending M4
Gabs
5ET3CT
EC0E
M/7A
CHF
5ro)edures (Bone Marrow Biops,1 Gumbar 5un)ture et).$
- Gaborator, monitoringI
- Fegularl, )ommuni)ate with the patients* re%erring En)ologist regarding the
patient*s status.
o En)e the patient is read, to return homeI
Coordinator the trans%er o% )are to the re%erring on)ologist.
Ensure the patient is set up %or the appropriate appointments.
&end all appropriate transplant re)ords to the re%erring on)ologist.
- ?or2 with patients to in)rease )omplian)e with 5C5 proph,la+is %or " months
post.transplant.
- ?or2 with patients to in)rease )omplian)e with antimi)robial35C5 proph,la+is %or
the duration o% immunosuppressi'e therap,.
- Assist with Medi)ation Fe%ills.
- Coordinate post.transplant dental )are at " months post.transplant.
o &)reening %or &i))a &,ndrome1 Caries1 5eriodontal disease and oral
)an)er
o &et up proph,la)ti) antibioti)s a))ording to the Ameri)an 0eart
Asso)iation 7uidelines.
- 0elp the patient to re.establish )are with a 5C5 at " months post.transplant.
o Fa+ or mail all the appropriate re)ords to the 5C5.
o Communi)ate the needs o% the post.transplant patient to the 5C5I
8a))ines (see atta)hment$
Fe%erral %or ophthalmologi) e+am
&)reenings3Fe%erralsI pap smear1 Mammogram1 Colonos)op,1
4ermatolog, re%erral1 osteopenia3osteoporosis1 et).
Da$ %&& and "e$ond (ollow up )are'
- &ur'i'orship Coordinator will )ontinuall, %ollow up with the patient and re%erring
on)ologist35C5I
o Ensure the patient is seen appropriatel,
o Fa+ results o% 4a, 100 and 4a, !"# post.transplant e'aluation test
results and )lini) notes.
o Ensure that the re%erring on)ologist is in)luded in the o'erall plan and
management o% )are
o Ensure the patient is not lost to %ollow up.
o En)ourage ,earl, %ollow up with 5C5.
- Coordinate %ollow up3)ommuni)ation between donors and patients1 i% needed1 at
1 ,ear post transplant.

*s$)hoso)ial+du)ational ,ollow Up'
- Fe%er as appropriate to the %ollowingI
o BMT 5s,)hologist
o 9ntegrati'e medi)ine.
o ?9( Clini). (?hat is (e+t &ur'i'orship Clini)$
o 5h,si)al Therap,
- Edu)ate and )ounsel on ;heart health,> li%est,le.
- 0elp the patient to manage e+pe)tations1 long.term ps,)hoso)ial e%%e)ts1
depression1 an+iet,1 li'ing with un)ertaint,1 returning to wor21 intima),
Sour)e
&a'ani B(1 7ri%%ith MG1 Jagasia &1 et al. (2011) How I treat late effects in adults after
allogeneic stem cell transplantation. Blood 117:3002300.