What are the benefits and risks of inpatient versus outpatient transplant? The good news is the reason we can even contemplate an outpatient transplant is that these procedures are becoming so common and so safe that the patient doesn't have to be put in that bubble that we used to put people in and quarantine them throughout that neutropenic phase. So we have much better supportive care, much better antibiotics and other drugs to really help with the side effects of the transplant and support patients through that recovery. So a lot of times who gets an inpatient transplant and who gets an outpatient transplant often has to do more with the setup of the particular facility you're in and the resources that they have. There are centers that will do all of their transplants as outpatients because they have put in the personnel and the staffing to their outpatient facility so that they can see you every day 24-7 and be able to provide the same kind of care that you do as an inpatient. And then there are other centers that do not have those kind of setups and they feel it's safer to keep their patients in the hospital. But the majority of centers are actually probably doing some kind of hybrid model where you get admitted to the hospital for some of the initial treatments and then you're discharged before your recovery and followed as an outpatient for your recovery and only readmitted for any complications. I don't think there's any particular differences in outcomes because your particular center is doing what they feel is the safest. And so from you personally, you shouldn't have a fear whether it's done inpatient or outpatient. You should be more to social support and resources that you may have that might help you determine whether you want to do inpatient and outpatient. If you don't have a good caregiver or your caregiver can only help for a certain amount of time, it may help for you to stay inpatient where you have the staff as your caregiver for part of that to help you. If you have good caregivers, you live close to the center, it may be better for you to be home. You're not exposed to all those other patients who are in the hospital who may be there for infectious reasons. And so I think there's pluses and minuses to both. Does outpatient mean staying at home or at a hotel or other facility? Yeah, so I think every center feels the same way. When we talk about outpatient, it's not an easy, it's not like you just go home and come back next week. You're actually having to come into the clinic potentially every single day doing that recovery. And so to do so, you need to be a certain distance from the center. And so most of us have a radius of like perhaps 20 miles. If you live in New York City, for example, 20 miles could be five hours. So I think they have more of a time of how close you need to be to the center just to be safe that you will be able to get there quickly and that it will not be a roadblock to you getting to the treatment. But the reason we do that is because when you have no immune system, if you do have a fever, we assume it could be an infection, for example, and you know time is of the essence. And so you do need to get seen immediately and you don't want to be driving in for two or three hours.
HealthTree • March 26, 2020
