Just Reach Out and Touch Someone: QOL
A number of questions therefore arise. First, who should bear the onus for optimizing a patient’s QOL during the pretransplant waiting period? Can we do more than pulmonary rehabilitation alone? And last, what is the magnitude of this burden? With regard to the latter question, as of June 2000 there were 3,691 patients on the US waiting list for lung transplants. Most of these patients will have to wait up to 2 years before receiving an organ. Therefore, at any one time, there could be > 7,000 QALYs that could be impacted favorably by an additional effective support intervention. If QALY is to be the outcome measure by which the efficacy of lung transplantation is to be judged, then it is incumbent on us as physicians at transplant centers to raise the bar as high as possible with regard to pretransplant HRQOL. This is necessary to guarantee that any HRQOL improvements posttransplant are due to allograft function alone and not to a mechanism of support that could have been implemented in the pretransplant period.
The novel approach described in the article by Blumenthal et al in this issue of CHEST (see page 1176) involves a simple intervention, namely, telephone support. The authors demonstrate that the utilization of an existing simple technology can lead to improvements in the patient’s perceived level of support, general well-being, and general and disease-specific QOL. For many programs, the advantage of the telephone is that they can reach patients and impact their conditions, irrespective of their location. There are additional potential ancillary benefits of such close contact with pretransplant patients including the possibility that this will facilitate the identification of potential issues that may be manifested posttransplant. Sometimes, relatively simple, inexpensive interventions can have the most profound impacts. Without minimizing the expertise of the psychologist responsible for the telephone support, this appears to an example in which, calling rates aside, telephone support provided a significant “bang for the buck.”