Bringing a major medical treatment home. Patients once spent weeks in the hospital. Now they can get a stem cell transplant and go home. It means tackling a lot of hurdles, but this new idea is offering tremendous relief to patients.
She passes the time with a little knitting … and a visit with her doctor. Then there’s a quick flush of the central line in her chest, placed this past summer before Rebecca Zoltoski began a four-month course of chemotherapy to fight myeloma – cancer of her bone marrow.
Rebecca Zoltoski, stem cell transplant patient: “You do what you have to do.”
But this is not a doctor’s appointment. This is day three of Rebecca’s stem cell transplant. Her doctors are ready to infuse a batch of new cells – her own – with the hope they will grow into healthy bone marrow.
Dr Michael Bishop, University of Chicago Medicine, medical oncologist: “Think of the stem cells as the seeds of the bone marrow. It takes time to start growing and maturing and appearing in the peripheral blood, and that’s about a 10-day process.”
As the cells grow, patients wait. It’s an intense process that typically requires a 21-day stay in the hospital. But Rebecca is an outpatient. And after her daily check in – she’s ready to head out.
Dr Michael Bishop: “We would take her and monitor her blood counts, monitor her kidney and liver functions and make sure she’s doing ok. If everything looks cool, we send her on her merry way with very strict instructions that in that interim, before we would see her the next day, if she developed signs of infection, fever, cough, diarrhea, that she immediately gives us a phone call.”
It’s a new program at University of Chicago Medicine – the outpatient stem cell unit has been up and running for about three weeks.
Rebecca Zoltoski: “This afternoon I hope to get out and get a good walk in so I can try to get some of my energy back because I find that helps me a lot. I wouldn’t really be able to be outside if I were here as an inpatient.”
Dr Michael Bishop: “Knowing you are going home every day, that’s the psychological advantage. They have the comfort of their own home, own bed, foods they are used to and like.”
Rebecca Zoltoski: “I did have some concerns about things that could happen, negative things that could happen.”
And there are risks. Patients undergoing a stem cell transplant have weak immune systems and extremely low blood counts – their ability to fight infection is severely compromised.
Dr Michael Bishop: “Most of the time, 75% of the time the patient is going to be fine. One in four will have to be admitted to the hospital primarily for signs and symptoms of an infection.”
That’s why doctors place constraints on outpatients.
Dr Bishop: “Limited to no crowds, wear a mask, strict hand washing.”
Still, the outpatient process appealed to Rebecca.
Rebecca Zoltoski: “I have an 11-year-old at home, and it’s nice to be able to see her. And it’s nice for her to be able to see me, and know I’m doing ok. That’s been the positive of it.”