Outpatient stem cell transplant: effectiveness and implications.
The aim of this mini-review (Griffiths, 2002) was to assess whether outpatient autologous haematopoietic stem cell transplant (AHSCT) is as effective as the traditional inpatient approach in terms of bed occupancy and morbidity. The Cochrane Library, Medline, Embase and CINAHL databases were searched for relevant studies. No systematic reviews or randomized control trials were found and after applying inclusion criteria, four non-randomized control trials were identified. The studies were conducted in North America, where high costs associated with AHSCT have led to the development of outpatient programmes designed specifically to reduce use of costly inpatient facilities. From the evidence available, it appears that outpatient AHSCT is not associated with increased morbidity and studies found either in favour of the intervention group or that there was no statistically significant difference between the two groups. The studies were unanimous in their findings that outpatient AHSCT is associated with a significantly reduced bed occupancy outcome. These findings may have a significant implication for the advancing practice and workload of community nurses. It is evident that good quality trials are needed in the UK to better and more relevantly address this question before implementing such programmes but it seems that outpatient AHSCT is achievable in carefully selected patients.
Ritchie
Louise
L
Department of Haematology, Royal Free Hospital, London, UK. louise.ritchie@kcl.ac.uk
D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002170:Canada; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D033581:Stem Cell Transplantation / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States