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Electronic Symptom Assessment in Children and Adolescents with Advanced Cancer Undergoing Hematopoietic Stem Cell Transplantation
S270
Abstracts / Biol Blood Marrow Transplant 25 (2019) S100 S289
NPS, PAS ADVANCED PRACTICE PROFESSIONALS (FOR CLINICAL EDUCATION CONFERENCE)
385 A Pilot Study of Nutritional Tool Implementation during Autologous Transplant to Improve Caloric and Protein Intake Meaghan Ryan MSN, FNP-BC1, Kathleen Stockmann MS, RD, CSO, LD2. 1 Blood and Marrow Transplant, Washington University in St. Louis, Saint Louis, MO; 2 Barnes-Jewish Hospital, Saint Louis, MO Background: Patients receiving cytotoxic chemotherapy are at risk for gastrointestinal toxicities. Malnutrition is a common consequence of alteration in diet caused by chemotherapy. A review of the literature indicates that malnutrition plays an important role in cancer prognosis and outcomes, including contribution to longer hospitalizations. The few studies in which individualized, specialized nutritional interventions were implemented demonstrated a decrease in the frequency of malnourishment. Purpose: The purpose of this before and after interventional study was to determine if early intervention and provision of specialized menus regarding appropriate diet choices tailored for specific GI symptoms to autologous transplant patients would improve nutrition status (overall calorie and protein intake) throughout transplant process. This pilot interventional study was designed to provide baseline data for further research in this population. Methods: This study used sequential cohorts, with control group being enrolled first to reduce potential contamination with nursing staff as to which patient was receiving intervention. Calorie counts were completed on each patient per protocol. Worksheets were collected from each patient on selfreporting of GI symptoms. At end of data collection period, each patient completed a questionnaire on study experience. Results: 20 patients’ recorded nutritional intake measurements were analyzed with no significant differences found (reported in mean § SD). Total caloric intake in control group was 12106.93§ 6970.41, compared to intervention group of 9221.86§3219.63. Total protein intake in control group of 383.73§187.8, compared to intervention group of 349.6§128.66. Average daily caloric intake in control group of 1083.53§606.88, compared to intervention group of 811.11§288.04. Average daily protein intake in control group of 37.49§20.87, compared to intervention group of 30.68§120.87. Conclusion: Results indicated that there was no difference between the groups in respect to nutritional intake or patient experience. Possible explanation for this outcome includes a physical bed tower move during data collection, which affected menu item availability and contributed to changes in oral intake and patient dissatisfaction. Also, delivery of specialized menus in addition to standard hospital menu contributed to confusion in ordering. This outlined a need to incorporate information into existing menu. A larger, randomized trial with above modifications is necessary to determine impact of this intervention, with goal of providing this high risk oncologic population with a higher level of nutritional supportive care during transplant hospitalizations.
386 Electronic Symptom Assessment in Children and Adolescents with Advanced Cancer Undergoing Hematopoietic Stem Cell Transplantation Chelsea Balian MSN, RN, PHN, CNS, CPNP1, Jennifer Raybin MSN, RN, CPNP2, Elizabeth A Gilger MSN, APRN, PPCNP-BC, CPON3, Zhanhai Li PhD4, Kathleen E Montgomery PhD, RN, PCNS-BC, CPHON5, Jessica Ward PhD, cPNP, MPH, RN6. 1 Blood and Marrow Transplant
program, Childrens Center for Cancer and Blood diseases, Children's Hospital Los Angeles, Los Angeles, CA; 2 Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, CO; 3 Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 4 Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI; 5 University of Wisconsin School of Nursing, University of Wisconsin Health, American Family Children’s Hospital, Madison, WI; 6 Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA Background: Effective symptom assessment and management for children with advanced cancer undergoing hematopoietic stem cell transplantation (HSCT) is critical to minimize suffering. Most literature specific to children receiving HSCT is based upon medical record reviews and parent report, and to a lesser extent, patient self-report. Objectives: The purpose of this study was to describe symptom frequency, severity and level of distress in children and adolescents undergoing HSCT using patient self-report via electronic data collection. Methods: A modified Memorial Symptom Assessment Scale (MSAS) was electronically administered to children with advanced cancer every two weeks. Clinical data was collected at corresponding time points. A sub-analysis was conducted for the cohort of children with advanced cancer who received autologous or allogeneic HSCT. Results: Forty-seven children with advanced cancer were enrolled and completed 563 surveys during the course of the study. Eleven of these 47 children received HSCT and completed 201/563 surveys. The median age of children in the HSCT cohort was 12.7 years, 73% were female, and most children had a hematologic (45%) or solid tumor (45%) malignancy. Ninety-six percent of surveys administered to children receiving HSCT were completed, and 64% of surveys were completed at home. Pain (35%), nausea (30%), sleeping difficulty (29%) and fatigue (22%) were the most commonly reported symptoms in children receiving HSCT. Children in the HSCT cohort had higher total and physical subscale mean MSAS scores, and higher pain, nausea, fatigue, and lack of appetite mean scores compared to children with advanced cancer not receiving HSCT (p <.05). Children receiving HSCT experienced more distress from pain, fatigue, nausea, lack of appetite, diarrhea and constipation when these symptoms were present compared to children with advanced cancer not receiving HSCT (p <.05). Conclusion: Children with advanced cancer receiving HSCT may have increased symptom burden with higher levels of distress as compared to those who do not receive HSCT. Increased understanding of the symptom experience for children with advanced cancer undergoing HSCT may promote timely assessment and treatment of distressing symptoms.
387 Establishing a Post Pediatric Hematopoietic Stem Cell Transplant Immunization Clinic in a Specialty Care Center Anne Wohlschlaeger MSN, CRNP1, Ellen Levy MSN, CRNP2, Jason L Freedman MD, MSCE3. 1 Blood and Marrow Transplant, The Children's Hospital of Philadelphia, Philadelphia, PA; 2 Cellular Therapy and Transplantation, The Children's Hospital of Philadelphia, Philadelphia, PA; 3 Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA Intro: Vaccines have shown to significantly reduce the number of infections from vaccine preventable diseases. Children who undergo hematopoietic stem cell transplants (HSCT)
Abstracts / Biol Blood Marrow Transplant 25 (2019) S100 S289
NPS, PAS ADVANCED PRACTICE PROFESSIONALS (FOR CLINICAL EDUCATION CONFERENCE)
385 A Pilot Study of Nutritional Tool Implementation during Autologous Transplant to Improve Caloric and Protein Intake Meaghan Ryan MSN, FNP-BC1, Kathleen Stockmann MS, RD, CSO, LD2. 1 Blood and Marrow Transplant, Washington University in St. Louis, Saint Louis, MO; 2 Barnes-Jewish Hospital, Saint Louis, MO Background: Patients receiving cytotoxic chemotherapy are at risk for gastrointestinal toxicities. Malnutrition is a common consequence of alteration in diet caused by chemotherapy. A review of the literature indicates that malnutrition plays an important role in cancer prognosis and outcomes, including contribution to longer hospitalizations. The few studies in which individualized, specialized nutritional interventions were implemented demonstrated a decrease in the frequency of malnourishment. Purpose: The purpose of this before and after interventional study was to determine if early intervention and provision of specialized menus regarding appropriate diet choices tailored for specific GI symptoms to autologous transplant patients would improve nutrition status (overall calorie and protein intake) throughout transplant process. This pilot interventional study was designed to provide baseline data for further research in this population. Methods: This study used sequential cohorts, with control group being enrolled first to reduce potential contamination with nursing staff as to which patient was receiving intervention. Calorie counts were completed on each patient per protocol. Worksheets were collected from each patient on selfreporting of GI symptoms. At end of data collection period, each patient completed a questionnaire on study experience. Results: 20 patients’ recorded nutritional intake measurements were analyzed with no significant differences found (reported in mean § SD). Total caloric intake in control group was 12106.93§ 6970.41, compared to intervention group of 9221.86§3219.63. Total protein intake in control group of 383.73§187.8, compared to intervention group of 349.6§128.66. Average daily caloric intake in control group of 1083.53§606.88, compared to intervention group of 811.11§288.04. Average daily protein intake in control group of 37.49§20.87, compared to intervention group of 30.68§120.87. Conclusion: Results indicated that there was no difference between the groups in respect to nutritional intake or patient experience. Possible explanation for this outcome includes a physical bed tower move during data collection, which affected menu item availability and contributed to changes in oral intake and patient dissatisfaction. Also, delivery of specialized menus in addition to standard hospital menu contributed to confusion in ordering. This outlined a need to incorporate information into existing menu. A larger, randomized trial with above modifications is necessary to determine impact of this intervention, with goal of providing this high risk oncologic population with a higher level of nutritional supportive care during transplant hospitalizations.
386 Electronic Symptom Assessment in Children and Adolescents with Advanced Cancer Undergoing Hematopoietic Stem Cell Transplantation Chelsea Balian MSN, RN, PHN, CNS, CPNP1, Jennifer Raybin MSN, RN, CPNP2, Elizabeth A Gilger MSN, APRN, PPCNP-BC, CPON3, Zhanhai Li PhD4, Kathleen E Montgomery PhD, RN, PCNS-BC, CPHON5, Jessica Ward PhD, cPNP, MPH, RN6. 1 Blood and Marrow Transplant
program, Childrens Center for Cancer and Blood diseases, Children's Hospital Los Angeles, Los Angeles, CA; 2 Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, CO; 3 Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 4 Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI; 5 University of Wisconsin School of Nursing, University of Wisconsin Health, American Family Children’s Hospital, Madison, WI; 6 Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA Background: Effective symptom assessment and management for children with advanced cancer undergoing hematopoietic stem cell transplantation (HSCT) is critical to minimize suffering. Most literature specific to children receiving HSCT is based upon medical record reviews and parent report, and to a lesser extent, patient self-report. Objectives: The purpose of this study was to describe symptom frequency, severity and level of distress in children and adolescents undergoing HSCT using patient self-report via electronic data collection. Methods: A modified Memorial Symptom Assessment Scale (MSAS) was electronically administered to children with advanced cancer every two weeks. Clinical data was collected at corresponding time points. A sub-analysis was conducted for the cohort of children with advanced cancer who received autologous or allogeneic HSCT. Results: Forty-seven children with advanced cancer were enrolled and completed 563 surveys during the course of the study. Eleven of these 47 children received HSCT and completed 201/563 surveys. The median age of children in the HSCT cohort was 12.7 years, 73% were female, and most children had a hematologic (45%) or solid tumor (45%) malignancy. Ninety-six percent of surveys administered to children receiving HSCT were completed, and 64% of surveys were completed at home. Pain (35%), nausea (30%), sleeping difficulty (29%) and fatigue (22%) were the most commonly reported symptoms in children receiving HSCT. Children in the HSCT cohort had higher total and physical subscale mean MSAS scores, and higher pain, nausea, fatigue, and lack of appetite mean scores compared to children with advanced cancer not receiving HSCT (p <.05). Children receiving HSCT experienced more distress from pain, fatigue, nausea, lack of appetite, diarrhea and constipation when these symptoms were present compared to children with advanced cancer not receiving HSCT (p <.05). Conclusion: Children with advanced cancer receiving HSCT may have increased symptom burden with higher levels of distress as compared to those who do not receive HSCT. Increased understanding of the symptom experience for children with advanced cancer undergoing HSCT may promote timely assessment and treatment of distressing symptoms.
387 Establishing a Post Pediatric Hematopoietic Stem Cell Transplant Immunization Clinic in a Specialty Care Center Anne Wohlschlaeger MSN, CRNP1, Ellen Levy MSN, CRNP2, Jason L Freedman MD, MSCE3. 1 Blood and Marrow Transplant, The Children's Hospital of Philadelphia, Philadelphia, PA; 2 Cellular Therapy and Transplantation, The Children's Hospital of Philadelphia, Philadelphia, PA; 3 Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA Intro: Vaccines have shown to significantly reduce the number of infections from vaccine preventable diseases. Children who undergo hematopoietic stem cell transplants (HSCT)