Table 10.
Recommendation | Grade | Ref | Comments |
---|---|---|---|
• Clinical assessment for symptoms or signs of peripheral and CNS dysfunction at 6-12 months after HCT and at least yearly thereafter | 2A | • Earlier and more frequent evaluation to be considered in high-risk patients. • Careful history/examination/review of systems/medication history and assessment of time of onset of neurological signs and symptoms during survivorship visits. |
|
• Patients with exposures to head and neck irradiation, platinum chemotherapy, aminoglycosides, or an inherited condition associated with hearing disability, audiologic evaluation within 1st year post-HCT. • Council patients about hearing loss prevention and to seek assessment for new symptoms. |
2A | [408] | • Follow-up evaluations as clinically warranted. • Hearing loss may be present in ADA deficiency prior to HCT and require developmental support, regular otolaryngology, and audiologicassessment post-HCT |
• Perform Childhood cognitive developmental milestones ≥annually. • Neurocognitive testing and educational/vocational progress assessment in pediatric survivors |
2A | • Strongly consider before returning to work/school, major changes in school (ie, moving from elementary to middle school), or changes in school performance | |
• Query adults annually for cognitive function changes which may be subtle. • Neuropsychological testing and imaging should be considered in cases of reported functional impairment. |
2A | [302] | • Inquire about difficulties multitasking, attention, remembering things or whether thinking feels slow. • Exclude reversible causes of cognitive decline: depression, fatigue, insomnia, or medication toxicity. • SCD: offer neurocognitive testing, if available. |
• Perform CGA pre-HCT and at 6 months and 1 year post-HCT. | • To identify patients more likely to benefit from enhanced toxicity risk prediction and aid treatment decision making. | ||
• At each survivorship visit, review current symptom patterns, distress, medications, comorbidities, and physical activity. | 2A | • Minimum: days +100, +180, and +365, then annually. | |
• Discuss medication adherence and potential at each visit. | 2A | ||
• Set incremental goals for healthy diet, activity, weight management. • Encourage adequate sleep and age-appropriate preventative measures. • Assess those with significant physical, visual, or auditory disabilities for appropriate support services and medical equipment needs. |
2A | • ie, vegetables, fruits, whole grains, low in excess sugars, dried foods, red/processed meat, and dietary supplements. | |
• General screening of patient mental health, with standardized questionnaires (eg, NCCN distress thermometer, survivorship questionnaire). | 2A | [301,302] | • No gold standard for screening mental health after HCT; take care to not overburden patients with PRO tools. • To guide clinical investigations or behavioral or psychological support, particularly if multiple somatic complaints, new GVHD, major life events, or treatment changes. |
• Regularly inquire to level of spousal/caregiver psychological adjustment, family functioning, educational, vocational activities, and financial toxicity. | 2A | • Appropriate referral if necessary. • Offer peer support and return to work/school programs |
|
• For AYA, provide transition of care education and plans. | 2A |