Survivorship & Support

People who have undergone a stem cell transplant need to be assessed regularly by their physicians. The treatment team will closely monitor allogeneic transplant patients for signs of graft-versus-host disease (GvHD), and will monitor patients who have received either allogeneic or autologous transplants for immune system recovery, late complications arising from the agents used in the cytoreductive regimen, and any recurrence of cancer.

Physical Challenges

Patients may experience a range of physical symptoms while recovering from a marrow or stem cell transplant. These can include fatigue and weakness, distorted taste sensations, lingering nausea and diarrhea, hair loss or other changes in appearance, and loss of muscle tone. Because your immune system may not recover fully for some time, you will be at risk for infections and colds.

In some patients, cancer may recur following transplantation if the high-dose chemotherapy and radiation given before the transplant did not eliminate all the malignant cells, or if the autologous stem cells harvested before the cytotoxic therapy contained some cancer cells. In an allogeneic transplant, the graft-versus-leukemia process may not always protect the patient from relapse, especially if he or she had relapsed or advanced disease at the time of transplantation. When a patient's cancer recurs, physicians may shift their treatment strategy to a next-line therapy. In rare instances, patients may develop a secondary cancer or condition such as a myelodysplastic syndrome as a result of the high-dose treatment.

Our Allogeneic Stem Cell Transplant Survivorship Program

	Christine Iovino, NP

Memorial Sloan-Kettering Cancer Center has incorporated an Allogeneic Stem Cell Transplant Survivorship Program into the overall care plan for our patients. This program, part of Memorial Sloan-Kettering's institution-wide survivorship initiative, provides services that address the unique needs of survivors in the years following treatment, including:

• Review of recent medical history and physical examination
• Assessment to detect recurrence of cancer
• Identification and management of the effects of cancer and treatment
• Screening referrals for other cancers
• Health promotion recommendations, such as nutrition, exercise, and smoking cessation
• Development of treatment summary and follow-up care plan
• Communication with the primary care physician

Individuals in the Survivorship Program have regularly scheduled follow-up examinations with Christine Iovino, a nurse practitioner with special training in transplant survivorship issues. Ms. Iovino is a graduate of Columbia University's nurse practitioner program and has worked at Memorial Sloan-Kettering since 1998, including her five years as a nurse practitioner on the inpatient transplant service. She is a member of the Allogeneic Stem Cell Transplant Disease Management Team and leads our efforts to provide optimal care to patients following their treatment.

Emotional & Social Challenges

The period after a bone marrow or stem cell transplant can be a difficult and stressful time. To avoid infections, patients need to avoid crowds and people who are sick. They may feel somewhat isolated. Some people find it hard to get back to work. They may experience financial difficulties and may not be fully aware of their employment and insurance rights. Concerns about changes in their appearance and infertility may complicate social and sexual relationships and dating. These can all lead to depression and anger.

Our social workers counsel patients on how to cope with the stresses of illness and how to communicate with family members and children, and work with them on other fundamental concerns. During hospitalization, our inpatient bone marrow transplant social worker provides counseling for individuals, families, and couples, and facilitates a weekly support group for caregivers. During outpatient visits, a bone marrow transplant social worker can meet with you or your family members, or with everyone together in a family meeting. The outpatient social worker is also available to patients who have been discharged.

Other Aspects of Survivorship

To help patients manage some of the other issues that may come up in survivorship, Memorial Sloan-Kettering offers a wide range of programs for cancer survivors, including the following:

Memorial Sloan-Kettering Counseling Center

Our Counseling Center offers individual and family counseling sessions to help cancer survivors and their families address the problems they may encounter in adjusting to life after treatment.

Living Beyond Cancer

People facing the challenges of cancer survivorship can access a variety of support services through the Living Beyond Cancer section of our Web site. This section includes information about professionally led support groups and counseling; survivorship clinics to manage late effects of cancer and treatment; recommendations about screening and healthy living; and specialized services to address sexual health. We also offer a range of resources to help survivors, families, and friends better understand the complex emotional and social issues following treatment.

Additional services are offered through our Resources for Life After Cancer program, which provides a full range of educational support services, including individual and family counseling, periodic lectures or workshops to provide medical updates, and practical guidance on employment and insurance issues.

Integrative Medicine Service

Our Integrative Medicine Service is designed to enhance quality of life through healing regimens that address the body, mind, and spirit. Beneficial complementary therapies include various types of massage, acupuncture, hypnotherapy, meditation, visualization and other mind-body therapies, music therapy, and nutritional counseling, as well as classes such as yoga, t'ai chi, and chair aerobics. Patients may benefit from some of these services in the hospital, while others are better suited to recovering or recovered patients after discharge.