What is the role of a caregiver?

What is the importance of having a caretaker after infusion? We put a lot of emphasis on having a caregiver available. It is in fact most critical after the patient goes home. Some of the side effect profile of CAR T cells makes us advise patients not to drive or do any dangerous activities for about eight weeks after the infusion and therefore they would need a caregiver to bring them in for their appointments. We put a lot of emphasis on the availability of caregivers after CAR T cell therapy, pretty similar to the way we do with patients undergoing transplant for the same diseases. The importance of the caregiver is mostly after the discharge from the hospital. While the patient is in the hospital, they are under very, very close observation by the nursing team. We do all of the CAR T procedures on our transplant unit here at Columbia. They have a very high nursing to patient ratio, very, very frequent monitoring, and it also can serve as a step down unit, meaning that if someone does get issues with blood pressure or oxygen levels, we're capable of keeping them on the floor rather than taking them to a medical intensive care unit. The importance of the caregiver is still during that time frame to accompany the patient and to help them out with their needs while they're in the hospital. Being in the hospital is still a very isolating and frightening experience, so caregivers are of course welcome to come on board in our transplant unit, pre-COVID at least, even allowed sleepovers for patients undergoing CAR T or transplant. So I think that's very important. Following the discharge to the hospital, there's a period of about six to eight weeks where we advise patients not to drive or operate heavy machinery. This is related to some neurologic side effects that may arise after CAR T cell therapy, and we can talk about that a little bit. There definitely needs to be a caregiver who will be able to drive the patient in, support them, and of course report any symptoms or help them out with cooking, cleaning, and getting groceries. Those are, I think, the basic things. Patients generally don't need 24-7 surveillance at home unless they have specific ongoing symptoms, but it's always better to have a caregiver readily available at this time frame. Do patients require a caregiver when they are inpatient? We do not require a caregiver while they are inpatient. The level of monitoring is so good that the importance of a caregiver at that point is mostly to keep the patient company, and sometimes it helps with the nursing staff or if the patient does become sick with certain side effects, I think they can get through that better and more easily if they have a caregiver present. But we certainly don't mandate that while the patient is in the hospital.