R-01. Clinical and pharmacoeconomic aspects of rehabilitation in oncohematology and the significance of non-profit organizations (NPO) in the development of rehabilitation

Summary

Due to permanently increased number of patients who completed the treatment of oncohematological diseases, including those who underwent HSCT, the issue of their follow-up and rehabilitation becomes relevant, considering their physical conditions, characteristics of previous treatment, existing and potential late complications. The purpose of the present study is a review of literature data and experience of the Rehabilitation Center “Russkoe Pole” with determination of clinical and pharmacoeconomic aspects of rehabilitation for the patients with oncohematological disorders and to evaluate the role of non-profit organizations (NPO) in the development of the rehabilitation activities in oncohematology.

Materials and methods

We performed the study of a group of HSCT recipients (167 children), including 113 boys and 54 girls, who underwent rehabilitation programs at the “Russkoe Pole” Center in 2017-2019 as part of the clinical trial protocol. The median time after HSCT was 150 days, and the median age of the patients was 11 years. HSCT was performed within treatment schedules for various disorders. Before rehabilitation, the patients underwent: follow-up examination, assessment of physical conditions. Based on the results, personalized rehabilitation programs were carried out. The median duration of rehabilitation was 28 days. Upon its completion, the patients underwent physical examination, and quality of life (QoL) was also assessed (PedsQL 4.0 poll). The obtained results concerning physical state were compared with the results of healthy children followed by evaluation of significant differences by the t-test (Student); QoL values were also compared with those of healthy children. The intergroup differences were considered statistically significant at p<0.05. The obtained results were extrapolated to international and domestic data and pharmacoeconomic results of a socioeconomic study performed by the Tinkov Family Charitable Foundation concerning posttransplant follow-up of oncohematological patients.

Results

The most common late posttransplant effects were as follows: polyneuropathies/myopathies, psychological/neurocognitive disorders, nutritional deficiency, functional and other disorders of the gastrointestinal tract, endocrinopathies. The quality of life is an integral index of the treatment effectiveness, and its improvement reflects the efficiency of rehabilitation measures. Pharmacoeconomic indicators reflecting the efficiency of medical technologies within the framework of the PPH are QALY (quality-adjusted life years) and DALY (disability-adjusted life years). The significance of NPOs activity is to initiate a dialogue between all stakeholders and help the regulator to develop an optimal strategy for the development of follow-up and rehabilitation through the development of educational technologies.

Conclusions

We have evaluated the incidence of the common late effects post-HSCT. Modern methods and approaches to treatment and HSCT are relatively sparing and allow maintaining high QoL in oncohematological patients after the end of treatment. For oncohematological patients, long-term follow-up and multidisciplinarity in lending the medical care at the posttransplant stage are important. Personalization of the rehabilitation plans, depending on the late effects in patients and their status, is the key to QoL improvement. Widespread implementation of tele-rehabilitation, introduction of care for oncohematological patients into rehabilitation practice in existing institutions by changes in clinical recommendations, creating the new types of medical and economic standards and pharmacoeconomically justified funding may be promising directions in future development of rehabilitation care. An alternative option is the development of paramedical services, e.g., by training in rehabilitation assistance for the specialists with secondary medical education, relatives of patients and the patients themselves (autorehabilitation).

Keywords

Hematopoietic stem cell transplantation, late effects, catamnesis, oncohematology, rehabilitation, non-profit organizations, education.