I see some accounts of inpatient vs. outpatient autologous stem cell transplant experiences on this weekly poll.
We just learned that while Stanford does autologous stem cell transplants as an outpatient procedure, UCSF does them as inpatient only.
Does anyone have any insights as to why that is the case? What is the rationale for why some institutions do outpatient by default while others do inpatient by default? Is it a difference in treatment philosophy? Space considerations? The type of cases / patients they typically get?
Thanks for any insights!
Forums
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Alizabeth - Name: Alizabeth
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 61
Re: Inpatient vs. outpatient stem cell transplants
Hi Alizabeth,
My husband's stem cell transplant at UCSF in June was outpatient. Daily visits for 3+ hours at the infusion center starting the Monday after stem cell infusion (done on a Friday) until he was ANC >5000 or >3000 for 2 consecutive days (in our case the latter). He had one platelet transfusion on day 11 but required no other blood products. Start to line removal was 16 harrowing, but blessedly uneventful, days.
Each center has criteria for their outpatient candidates. Proximity to the center is important - but we had friends at UCSF that did an inpatient transplant due to their young children and some pre-procedure complications.
You might want to ask the specialists at each why they are recommending inpatient or okay with outpatient.
In our case, I think proximity was the key feature (we live only 3 miles as the crow flies from the hospital).
When I was a resident MD at SUH, they had patient housing on Welch Rd for outpatient cases that was hospital controlled; I'm not sure if that is still the case, but it might factor in.
I also think that Stanford has a longer history with doing these as outpatient and does more as outpatient than most of the country.
Even some of the infusion staff at UCSF was surprised we were doing all outpatient. We had the same nurses daily during engraftment, there were very few new faces even on the weekends.
My husband's stem cell transplant at UCSF in June was outpatient. Daily visits for 3+ hours at the infusion center starting the Monday after stem cell infusion (done on a Friday) until he was ANC >5000 or >3000 for 2 consecutive days (in our case the latter). He had one platelet transfusion on day 11 but required no other blood products. Start to line removal was 16 harrowing, but blessedly uneventful, days.
Each center has criteria for their outpatient candidates. Proximity to the center is important - but we had friends at UCSF that did an inpatient transplant due to their young children and some pre-procedure complications.
You might want to ask the specialists at each why they are recommending inpatient or okay with outpatient.
In our case, I think proximity was the key feature (we live only 3 miles as the crow flies from the hospital).
When I was a resident MD at SUH, they had patient housing on Welch Rd for outpatient cases that was hospital controlled; I'm not sure if that is still the case, but it might factor in.
I also think that Stanford has a longer history with doing these as outpatient and does more as outpatient than most of the country.
Even some of the infusion staff at UCSF was surprised we were doing all outpatient. We had the same nurses daily during engraftment, there were very few new faces even on the weekends.
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rick - Name: rick
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: nov 2015
- Age at diagnosis: 50
Re: Inpatient vs. outpatient stem cell transplants
Hello Alizabeth,
I was an inpatient, but have been told that things move towards outpatient stem cell transplants at the hospital where I am treated, and if I had lived closer to the hospital I could have had my stem cell transplants as an outpatient.
I was told it has been shown that there usually is no need, from a medical point of view, to stay in the hospital, but on the contrary, sometimes it can be better to recover at home, where meals are not limited to the hospital's menu, and where we are more prone to get out of the bed, among other things.
Those institutions that still do inpatient by default probably do that (this is my guess) because it is how stem cell transplants were done to begin with, and it still works fine, while those doing outpatient by default, started out with inpatient treatment and decided to change that after discovering that it is safe for the patients.
I was an inpatient, but have been told that things move towards outpatient stem cell transplants at the hospital where I am treated, and if I had lived closer to the hospital I could have had my stem cell transplants as an outpatient.
I was told it has been shown that there usually is no need, from a medical point of view, to stay in the hospital, but on the contrary, sometimes it can be better to recover at home, where meals are not limited to the hospital's menu, and where we are more prone to get out of the bed, among other things.
Those institutions that still do inpatient by default probably do that (this is my guess) because it is how stem cell transplants were done to begin with, and it still works fine, while those doing outpatient by default, started out with inpatient treatment and decided to change that after discovering that it is safe for the patients.
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Myosotis - Who do you know with myeloma?: myself
- When were you/they diagnosed?: November 2015
- Age at diagnosis: 37
Re: Inpatient vs. outpatient stem cell transplants
I had my autologous stem cell transplant at UCSF in July 2016. We live about 45 miles away and would have to get to the hospital daily through north bay rush hour traffic. We decided that up to 4 hours a day on the road would be too stressful for me and my husband.
In retrospect, I'm glad I did inpatient simply because I had a lot of issues with nausea/vomiting and needed IV medications to control. There were a few days (+9-13) that I was very weak and needed transfusions. I think it was easier for my husband, too. There were plenty of food options for me, and I was able to ask for things not on the menu as well.
I'm glad I did it inpatient for myself and husband. The 14 days went by quickly, and as soon as my counts came up, I was released.
In retrospect, I'm glad I did inpatient simply because I had a lot of issues with nausea/vomiting and needed IV medications to control. There were a few days (+9-13) that I was very weak and needed transfusions. I think it was easier for my husband, too. There were plenty of food options for me, and I was able to ask for things not on the menu as well.
I'm glad I did it inpatient for myself and husband. The 14 days went by quickly, and as soon as my counts came up, I was released.
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Inpatient vs. outpatient stem cell transplants
Mine was done on an inpatient basis and at the time, I don't think I would have been comfortable doing it the other way.
Looking back, though, I think things probably would have gone fine if I'd been at home rather than in the hospital. I did need several bags of platelets over the course of the treatment, but that could have been done at the infusion center. I also had some nausea issues, which were handled with IV drugs but which may have been fine with oral versions of the same or similar anti-emetics (although it's hard to say for sure).
Best part of going outpatient would have been the food!
Looking back, though, I think things probably would have gone fine if I'd been at home rather than in the hospital. I did need several bags of platelets over the course of the treatment, but that could have been done at the infusion center. I also had some nausea issues, which were handled with IV drugs but which may have been fine with oral versions of the same or similar anti-emetics (although it's hard to say for sure).
Best part of going outpatient would have been the food!
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Mike F - Name: Mike F
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 18, 2012
- Age at diagnosis: 53
Re: Inpatient vs. outpatient stem cell transplants
I had my stem cell transplant as an inpatient (2013). I was glad to be in the hospital with nurses nearby to deal with any issues. I did have a fever most days and had a mild case of pneumonia. I got out of bed several times a day to walk the halls (recommended by medical team as the more you move, the faster you'll recover). I would have been very stressed doing it as an outpatient. I know that many patients like to recuperate at home.
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elizabethmwm - Name: Elizabeth M
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 8/20/2012
- Age at diagnosis: 57
Re: Inpatient vs. outpatient stem cell transplants
Thank you, everyone, for the great info and data points. This is all very helpful.
Thanks!
Thanks!
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Alizabeth - Name: Alizabeth
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 61
Re: Inpatient vs. outpatient stem cell transplants
I am a strong proponent of outpatient transplants. Proximity to the treatment center is a consideration but most centers have off-site options for those who live too far for a true outpatient experience. Being outside the hospital setting helps the patient to have a more "normal" life during recovery. Sleeping in your own bed and having the use of the other facilities at home makes it a more comfortable setting. The daily trips to be checked can be a bit challenging just because of fatigue but it's not an overwhelming burden.And you do avoid the drawbacks of the hospital: noise, greater exposure to germs generated by "sick" people, limited food options.
In my case, I live about 20 minutes from the center where I had my transplant. There were no significant complications so no need for traditional hospital services. It does put a bit more of a burden on the primary caregiver but it's worth it.
In my case, I live about 20 minutes from the center where I had my transplant. There were no significant complications so no need for traditional hospital services. It does put a bit more of a burden on the primary caregiver but it's worth it.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Inpatient vs. outpatient stem cell transplants
I agree with Andrew.
Both of my transplants were outpatient, and I won't say I wasn't apprehensive about that leading into the first one. The daily trips to the clinic were therapeutic, the rest was more comfortable, more food choices were available, the schedule was easier on my caregiver, and the risk of infection should be lower. I say 'should be lower' because I stayed in hospital-associated housing following previous transplant patients, so there was the risk the previous tenant 'may have' left infectious agents behind. A hotel may have been better.
Both of my transplants were outpatient, and I won't say I wasn't apprehensive about that leading into the first one. The daily trips to the clinic were therapeutic, the rest was more comfortable, more food choices were available, the schedule was easier on my caregiver, and the risk of infection should be lower. I say 'should be lower' because I stayed in hospital-associated housing following previous transplant patients, so there was the risk the previous tenant 'may have' left infectious agents behind. A hotel may have been better.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Inpatient vs. outpatient stem cell transplants
I totally agree with, Andrew. Obviously all of our opinions will be somewhat biased by whatever experience each patient had (inpatient or out).
I can't actually compare the experience since I was outpatient. But I think being in my own space, eating what I could when I could, walking to and from the clinic when I could, etc. all worked toward my fairly good and easy recovery.
I think if I had been mostly confined to a hospital room, walking the halls of the hospital, eating their food on their schedule would have been tough. I also wonder if there is a psychological impact. Do you feel "sicker" if you are in the hospital?
I know if I had to do it again and I had a choice I wouldn't take a second to decide on outpatient again.
I can't actually compare the experience since I was outpatient. But I think being in my own space, eating what I could when I could, walking to and from the clinic when I could, etc. all worked toward my fairly good and easy recovery.
I think if I had been mostly confined to a hospital room, walking the halls of the hospital, eating their food on their schedule would have been tough. I also wonder if there is a psychological impact. Do you feel "sicker" if you are in the hospital?
I know if I had to do it again and I had a choice I wouldn't take a second to decide on outpatient again.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
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