Objective

The objective of this study was to examine the relationship between adverse events (AEs) and critical events (CEs) during and following rehabilitation in cancer patients post hemopoietic stem cell transplant (HSCT) or bone marrow transplant (BMT) and to identify if particular lab values are associated with increased risk of AEs or CEs.

Design

A retrospective chart review (2012-2017) of hospitalized patients ages 18-75 years with cancer diagnosis and BMT or HSCT receiving rehabilitation services

Setting

Urban Midwest tertiary, research and academic hospital.

Participants

99 hospitalized adults with HSCT or BMT participated in 300 rehabilitation sessions.

Interventions

Physical or occupational therapy using a symptom-based approach where patient symptoms were monitored and therapy was adjusted in real time

Main Outcome Measures

Incidence of AEs or CEs occurring during or within 48 hours of rehabilitation.

Results

A total of 300 rehabilitation sessions were carried out where 99.7% had one or more laboratory values outside reference range. In only 3.3% of therapy sessions an AE occurred during or within 2 hours of rehabilitation. Within 48 hours post-rehabilitation, AEs occurred in 22.3% and CEs in 4%. No laboratory value was significantly associated with increased risk of AEs or CEs during rehabilitation. A hemoglobin <8.0 g/dL conferred an increased risk of AEs (OR 2.85-6.89) depending on timeframe analyzed and overall risk of CE (OR 3.75). Lower hemoglobin levels (<7.5 g/dL and <7.0 g/dL) did not increase this risk. Low platelets (<25 k/uL) increased the risk of AEs on day 1, 2 and overall (OR 2.5-2.72) and overall risk of CEs (OR 6.62).

Conclusion

Our research demonstrates a low rate of AEs and CEs during or within 2 hours of rehabilitation but supports the need to monitor patients when hemoglobin is <8 g/dL or platelets are <25 k/uL due to increased risk of events.