A stem cell center consists of designated inpatient and outpatient treatment facilities with doctors and nurses experienced in stem cell transplantation. Three decades of continuous technological improvement have allowed high-dose chemotherapy and stem cell transplantation to become safe and widely available. There are currently over 200 centers that provide high-dose chemotherapy and stem cell transplantation services in the United States, including large cancer centers, community hospitals and physician practices. The increased availability of stem cell transplants to patients has allowed many patients to benefit from this treatment approach who otherwise could not have traveled away from their family and support system. When choosing where to be treated with high-dose chemotherapy and stem cell transplant, the following objective criteria may be useful in selecting a center:
Center Volume: The American Society of Blood and Marrow Transplant (ASBMT) recommends that a center perform at least 10 transplants in the previous year to maintain proficiency.
Quality of Staff: The ASBMT recommends that each center have a transplant team that includes a “program director” and at least one other physician experienced in transplant medicine. The director should be board certified and have 2 years experience or 1 year training in transplant medicine. You may also want to know which physician will actually provide your care. Will it be the program director, other physicians, or fellows (doctors in training)? The continuity of nursing care is also important, since the majority of care is actually delivered by the nurses. A single coordinating nurse can be invaluable. You may want to ask which nurses will be involved with your care and how frequently they will change.
Continuity of Care: Will a single or multiple doctors oversee your care during and after the high-dose chemotherapy treatment? If you are leaving your primary doctor to receive your care at a transplant center, it is important to know whether you can receive all your care and follow up at the transplant center. If not, then how well does that center communicate with your primary doctor concerning your long-term treatment plan and management of potential complications. Many patients prefer to receive their treatment close to home with a single doctor to ensure good continuity of care.
Outcomes: Evaluating the actual treatment results may be the most useful criteria when selecting where to receive treatment. The ASBMT recommends that each center keep accurate patient records that include specific treatment outcome information. Asking the following questions may help you choose one center over another.
What are the cure and survival rates for patients treated in the center with your specific cancer?
What is the average duration of hospital stay?
What are the mortality rates reported by the center?
Patient Satisfaction: Ask to talk with a patient who has been treated in the center, as well as to see the results of patient satisfaction surveys. All good centers can arrange for a new patient to talk to other patients that have been previously treated at the center.
Facility Infrastructure: The ASBMT recommends that facilities where high-dose chemotherapy is delivered have designated inpatient and outpatient areas, standard policies regarding infection control and the ability to evaluate patients on a 24-hour basis. Programs should also have a stem cell processing capability and 24-hour blood bank support. Accreditation of stem cell processing facilities began in 1997 and is currently being performed by the American Association of Blood Banks (AABB) and the Foundation for Accreditation of Hematopoietic Cell Therapy (FAHCT).
Allogeneic vs. Autologous: Lastly, the type of transplant being performed may also dictate where you choose to receive treatment. In general, an unrelated donor transplant requires more infrastructure and experience to perform than a matched sibling allogeneic transplant or an autologous transplant. Some of the largest centers performing unrelated donor transplants produce the best outcomes for patients. On the other hand, many small autologous transplant centers produce equal or better outcomes than large centers. Take the time to evaluate all potential centers and choose the center, physician, staff and environment where you feel most comfortable receiving your treatment.
For additional information, you may want to visit the American Society of Blood and Marrow Transplant Web site at www.asbmt.org, the American Association of Blood Banks at www.aabb.org, or the Foundation for the Accreditation of Cell Therapy at http://www.unmc.edu/Community/fahct/Default.htm.