Barriers to Hematopoietic Cell Transplantation for Adults in the United States: A Systematic Review with a Focus on Age.
Barriers to Hematopoietic Cell Transplantation for Adults in the United States: A Systematic Review with a Focus on Age.
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DOI：
10.1016/j.bbmt.2020.09.013
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Loh KP
中科院分区：
文献类型：
--
作者：
Flannelly C;Tan BE;Tan JL;McHugh CM;Sanapala C;Lagu T;Liesveld JL;Aljitawi O;Becker MW;Mendler JH;Klepin HD;Stock W;Wildes TM;Artz A;Majhail NS;Loh KP
造血细胞移植（HCT）是许多血液恶性肿瘤的有效治疗方法，其利用率不断上升。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;这些障碍对于老年患者可能更大。虽然许多因素可能会影响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。我们根据系统性综述和荟萃分析的首选报告项目指南进行了一项系统性综述，以更好地对HCT的获取和转诊障碍进行分类，重点关注老年患者亚组。我们检索了PubMed、Embase、Cumulative Index for Nursing and Allied Health（CINAHL）和科克伦对照试验中心（CENTRAL）中从数据库建立到2020年1月31日期间以英文发表的文章。我们选择了符合以下纳入标准的文章：1）研究设计：定性、横断面、观察性队列或混合方法研究设计; 2）结局：与患者和医生获得HCT相关的障碍; 3）人群：美国境内年龄≥18岁的血液学恶性肿瘤成人。排除了没有全文的摘要。使用SYSTEMS方法确定文章质量。沿着其他研究特征，提取了关于HCT获取和转诊障碍的数据。我们使用描述性统计对研究结果进行了总结。我们纳入了3，859项筛选纳入标准的研究中的26项。二十项研究是回顾性队列研究，四项是横断面研究。有一项前瞻性队列研究和一项混合方法研究。只有一项研究被评为高质量，16项被评为一般。17项研究分析了年龄作为HCT转诊和访问的潜在障碍，其中16项研究发现年龄较大是一个障碍。HCT转诊和获得的其他一致障碍包括非白人（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。年龄较大和非白人种族始终与HCT获得减少相关。为了建立一个更加公正的医疗保健系统，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的教育，以及老年评估指导的护理模式，可以很容易地纳入临床实践。
Hematopoietic cell transplantation (HCT) is an effective treatment for many hematological 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 (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) between the database inception and January 31st, 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; 3) Population: adults aged ≥18 years with hematological malignancies within the US. 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 twenty-six of 3,859 studies screened for inclusion criteria. Twenty studies were retrospective cohorts and four were cross-sectional. There was one prospective cohort study and one mixed method study. Only one 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 sixteen finding older age to be a barrier. Other consistent barriers to HCT referral and access included non-white 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 non-white race were consistently linked to reduced access to HCT. To produce a more just healthcare 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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影响因子：
3.7
作者：
Jabo B;Morgan JW;Martinez ME;Ghamsary M;Wieduwilt MJ
通讯作者：
Wieduwilt MJ
DOI：
10.1016/j.bbmt.2019.02.004
发表时间：
2019-06
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Adrianzen Herrera D;Kornblum N;Acuna-Villaorduna A;Sica RA;Shah U;Butler M;Vishnuvardhan N;Shah N;Bachier-Rodriguez L;Derman O;Shastri A;Mantzaris I;Verma AK;Braunschweig I;Janakiram M
通讯作者：
Janakiram M
影响因子：
4.3
作者：
Barker, Juliet N.;Byam, Courtney E.;Kernan, Nancy A.;Lee, Sinda S.;Hawke, Rebecca M.;Doshi, Kathleen A.;Wells, Deborah S.;Heller, Glenn;Papadopoulos, Esperanza B.;Scaradavou, Andromachi;Young, James W.;van den Brink, Marcel R. M.
通讯作者：
van den Brink, Marcel R. M.
影响因子：
6.2
作者：
Fiala, Mark A.;Wildes, Tanya M.
通讯作者：
Wildes, Tanya M.
影响因子：
6.2
作者：
Joshua, Thomas V.;Rizzo, J. Douglas;Zhang, Mei-Jie;Hari, Parameswaran N.;Kurian, Seira;Pasquini, Marcelo;Majhail, Navneet S.;Lee, Stephanie J.;Horowitz, Mary M.
通讯作者：
Horowitz, Mary M.