The Caregiver Paradigm in Hematopoietic Cell Transplant: Current and Future Directions

Many transplant centers (TCs) require a patient to have a caregiver 24 hours a day, 7 days a week for a minimum timeframe to proceed with an allogeneic hematopoietic cell transplant (alloHCT). However, this requirement varies across TCs, with timing of requirements varying from no requirements up to 180 days, and there is inconclusive evidence to support the need for this requirement. The current caregiver requirement paradigm can limit access for many patients, besides causing a significant physical, emotional, and financial burden on caregivers. This article reviews literature on the current alloHCT caregiver paradigm and identifies barriers to change. Lastly, it highlights alternative caregiving models that are currently being implemented, as well as opportunities for future directions to improve access, including the need for research on interventions such as remote monitoring, community partnerships, policy changes, and enhanced screening. There is a need for evidence-based patient-centered care models to transform the caregiver paradigm to ensure that all patients can receive the treatment they need, irrespective of whether they have a caregiver. The future of post-alloHCT care demands a shift towards patient-centered, flexible caregiving models that accommodate the diverse needs and circumstances of patients. Such evidence-based changes in the paradigm can help improve access to, and outcomes for, alloHCT.