New Survivorship Clinic Targets Long-Term Challenges of Blood and Marrow Transplant Patients

A concerted effort to improve outcomes for long-term leukemia and blood and marrow transplant (BMT) patients is at the heart of Cleveland Clinic’s new Victor Fazio, MD BMT Cancer Survivorship Clinic. Opened in October, the clinic provides clinical survivorship care and monitors patients for late complications of chemotherapy and BMT, including post-transplant immune complication graft-versus-host disease (GvHD).

Long-term, the clinic will investigate the ongoing and late effects of cancer treatment and GvHD and serve as a resource for oncologists and primary care physicians who treat leukemia and BMT patients.

Survivors of BMT remain at risk for late complications related to chemotherapy and other treatment exposures. These include organ failure (heart, kidney, lung, liver), bone loss and bone complications, new cancers, endocrine disorders, quality of life impairments and psychosocial issues that can contribute to significant morbidity and mortality. The survivorship clinic aims to help patients overcome these late complications through a comprehensive program of screening, treatment, education and research.

The clinic, led by Betty Hamilton, MD, a medical oncologist in the Department of Hematology and Oncology and the Blood and Marrow Transplant Program, and Christina Ferraro, CNP, a nurse practitioner in Cleveland Clinic’s Adult Blood and Marrow Transplant Program, is named in honor of esteemed Cleveland Clinic colorectal surgeon Victor W. Fazio, MD. The Chairman of Cleveland Clinic’s Department of Colorectal Surgery for more than three decades, Dr. Fazio was dedicated to education and patient care. He was diagnosed with leukemia and underwent a transplant at Cleveland Clinic. The Victor Fazio, BMT Cancer Survivorship Program is dedicated to his passion for education and a tribute to his legacy of improving patient care and quality of life. Support from his family helped make the survivorship clinic a reality.

The clinic will initially focus on BMT survivors — patients who have completed the acute phase of transplant and are most at risk for developing late complications.

“This is a great opportunity to educate patients about late effects of transplant and survivorship and to help them with screening and treatment for chronic GvHD,” says Dr. Hamilton. “I think that this is an opportunity, not only for us as physicians and caregivers in general, but for patients to be able to take ownership of their care and learn about what they can do to continue to stay in good health long-term.”

According to Navneet Majhail, MD, MS, Director of Cleveland Clinic’s Blood and Marrow Transplant Program, “We are deeply grateful and honored to be given this opportunity to continue the legacy of patient care, education and research that Dr. Fazio embodied during his very long tenure at Cleveland Clinic.”

As the clinic becomes more established, it will expand its focus to include blood cancer survivors who have not had a transplant.

Providing comprehensive clinical care and support for patients

Prior to the clinic’s opening, patients would continue follow-up treatment with their primary BMT physicians, who are generally more focused on addressing current acute issues, Dr. Hamilton says.

“Our main goal is not to replace the BMT physician, but rather to give the transplant recipient more education and empowerment to better understand their care and learn about potential complications that may occur,” she says. “We want the clinic to provide the resources for long-term care for these patients, as well as offer them more education and better screening for potential long-term complications and GvHD.”

Patients will initially be seen at the clinic at post-transplant Day 100. They will be scheduled for a one-hour appointment that will include time for completing questionnaires, a clinical visit with a nurse practitioner, social worker, and if necessary, clinical visits with other providers and medical consultants. Additional time may be required for laboratory and other testing.

The survivorship program includes:

• A clinical visit at Day 100 post-BMT to review patient history, provide a treatment summary and needs assessment.
• A clinical visit at one year post-BMT, with screening tests, education, appropriate referrals as needed and a follow-up care plan.
• Consultation regarding GvHD diagnosis and treatment, as well as long-term steroid use.

A commitment to long-term research

While GvHD is a common post-transplant complication, Dr. Hamilton notes that overall, it’s considered a rare disease and treatment options can be limited and challenging.

“It can be a difficult disease to study and do a lot of research in due to its heterogeneity and relatively overall incidence,” she says, adding that the survivorship clinic can better identify patients who may be suffering from chronic GvHD, enroll them in appropriate clinical trials and offer other potential treatment.

“In addition, the clinic can be a good mechanism to collect, not only patient data, but patient-reported outcomes,” she says. “We want to hear from patients on how they are doing, what they think about their quality of life and physical functioning, and how they’re coping with follow-up care. Through these patient-reported assessments, we can track a patient’s progress and correlate that with survival and outcomes.”

Qualitative research efforts will help physicians better understand the challenges facing BMT patients. Toward that end, patients may be invited to participate in clinical research trials. The aim is to combine patient care and research as part of a comprehensive platform for investigating novel ways to provide long-term care for patients who are far out from their leukemia/BMT treatments.

“This clinic is a great opportunity for patients and, in particular, their local oncologists or primary care physicians,” Dr. Hamilton says. “We want to work together to provide the best care we can for these patients, who often live far away and will go back to their local oncologist or primary care physician for follow-up care.”

She adds, “A main goal of the survivorship clinic is not only empowering these patients, but also potentially empowering physicians. We’re working on a website that will contain valuable resources for these physicians, especially those who aren’t BMT physicians or oncologists, so that they may feel more comfortable caring for these patients.”