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Reducing Oral Mucositis Using Cryotherapy and Near Infra-Red Light Emitting Diodes in Multiple Myeloma Patients Receiving Melphalan Chemotherapy Prior to Hematopoietic Stem Cell Transplant
Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481
stress may inform self-management strategies to improve survivorship. Methods, Intervention, & Analysis: This was a secondary analysis of a correlational study that enrolled 24 adults (>21 years) with cGVHD. After obtaining informed consent, data for this study (IRB# 201400992) was collected by medical record and validated self-report measures. Blood (3ml) was collected from a vein and stored in a -80o freezer until analysis. Inflammatory markers were analyzed using BioPlexÒ multiplex and enzyme-linked immunosorbent assays. Results were reported using descriptive statistics and Spearman’s rank correlations. All statistics were done using SAS version 9.3 with the level of significance set at .05. Findings & Interpretation: The mean age (years) was 53. Most (87.5%) were Caucasian and female (58.3%). Most (29.2%) had AML. Most (83.3%) had moderate to severe cGVHD (NIH criteria). Over half (62.5%) had involvement of 3-5 organs. Participants reported the lowest scores on nutrition, activity and stress management behavior subscales. Spiritual growth and perceived stress were significantly related (r¼ -.68, p< .01). Several behaviors and perceived stress items significantly correlated with markers of inflammation. Discussion & Implications: Associations were demonstrated among lifestyle behaviors, perceived stress and inflammation. Individuals did not routinely engage in healthpromoting lifestyle behaviors reported by the American Cancer Society as essential for cancer survivorship. Nurses are in the unique position to educate and assess transplant survivors with cGVHD on the importance of maintaining a healthy lifestyle. Future research to understand why these behaviors are neglected and nurse led interventions focusing on these quality of life indicators may increase longevity and quality of life for individuals with cGVHD.
743 Reducing Oral Mucositis Using Cryotherapy and Near Infra-Red Light Emitting Diodes in Multiple Myeloma Patients Receiving Melphalan Chemotherapy Prior to Hematopoietic Stem Cell Transplant Wendy Madden 1, Donna Salzman 2, Jeanne Dockery 1, Ayman Saad 3, Susanna Howell 4. 1 Bone Marrow Transplantation and Cell Therapy Program, University of Alabama at Birmingham Hospital, Birmingham, AL; 2 Bone Marrow Transplantation and Cell Therapy Program, The University of Alabama at Birmingham, Birmingham, AL; 3 Bone Marrow Transplant and Cellular Therapy, University of Alabama at Birmingham - UAB, Birmingham, AL; 4 Blood and Marrow Transplantation and Cellular Therapy Program, University of Alabama at Birmingham Hospital, Birmingham, AL Topic Significance & Study Purpose/Background/ Rationale: OM occurs 80% in patients receiving high dose melphalan prior to HSCT. OM causes severe pain and contributes to compromised nutrition while increasing healthcare costs, infection risks and risk of mortality for HSCT recipients. Both daily LED therapy and cryotherapy during melphalan infusion have shown effectiveness in reducing OM severity; however, little is known if OM is further reduced by combining both therapies. The aim of this study is to investigate Near Infra-Red Light emitting Diodes (LED) Therapy and Cryotherapy (Cryo) for oral mucositis (OM) prevention in multiple myeloma (MM) patients receiving high dose melphalan chemotherapy prior to Hematopoietic Stem Cell Transplant (HSCT).
S471
Methods, Intervention, & Analysis: March 2015, following IRB approval, seventy-five MM patients’ with OM were evaluated using National Cancer Institute (NCI) guidelines at UAB. Six melphalan 140mg/m2 and ten melphalan 200mg/ m2 patients received LED therapy only. Nine melphalan 140mg/m2 and 16 melphalan 200mg/m2 patients received a combination of LED therapy and cryotherapy. Eight melphalan 140mg/m2 and 26 melphalan 200mg/m2patients who received traditional post chemotherapy OM symptom relief and did not receive LED therapy or cryotherapy served as a historical control group. Findings & Interpretation: Median OM toxicity scores for Melphalan 140mg/m2 were 1.5 (control), 1 (LED only), and 1 (Melphalan/Cryo). Median scores for Melphalan 200mg/m2 were 2 (control), 2 (LED only), and 1 (Melphalan/Cryo). Mode OM toxicity scores for melphalan 140mg/m2 were 1 and 2 (control), 1 (LED only), and 0 (melphalan/Cryo). Mode scores for melphalan 200mg/m2were 2 (control), 2 (LED only), and 1 (melphalan/Cryo). Discussion & Implications: Utilizing cryotherapy and LED light therapy together reduces OM severity in HSCT patients receiving melphalan more than LED therapy alone. Cryotherapy with LED therapy safely reduces OM and associated symptoms for MM melphalan HSCT patients.
744 Adolescent/Young Adult Self-Management Framework: Preliminary Results and Practice Implications Caroline F. Morrison. Bone Marrow Transplantation and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; College of Nursing, University of Cincinnati, Cincinnati, OH Topic Significance & Study Purpose/Background/ Rationale: At least one quarter of Adolescents/young adult (AYA) oncology patients do not adhere to treatment protocols. Adolescents/young adults receiving a stem cell transplant (SCT) and their families face many challenges that make it difficult to effectively manage their care and medication regimens. Patients are prescribed complex medication regimens to prevent infection, graft versus host disease and disease relapse. Adherence is particularly difficult for AYA who are developmentally working to achieve independence from adults, seeking immediate rewards, and may be more likely to act in ways contrary to the recommendations of healthcare providers. Nurses as members of the healthcare team are poised to assist families in managing their care. Methods, Intervention, & Analysis: A grounded theory study is being conducted to better understand the process by which AYA and their caregivers manage the care regimen following transplant. The goal is to construct a framework on AYA self-management following SCT. Semi-structured interviews are being conducted with AYA, ages 13-25, and their caregivers. The Pediatric Self-Management Model guided development of the interview guide. The sample size is currently 10 AYA and 7 caregivers (n¼17) with a recruitment goal of 15 each (n¼ 30). Interviews were recorded and transcribed verbatim. Data were coded to consensus by members of the research team and memo writing was used as an audit trail of theoretical decision making. Constant comparison methods were used to analyze data for theoretical concepts and relationships. Findings & Interpretation: Preliminary results on the process by which AYA care is managed focused on “hunkering down” and “shifting gears,” putting life on hold by focusing
stress may inform self-management strategies to improve survivorship. Methods, Intervention, & Analysis: This was a secondary analysis of a correlational study that enrolled 24 adults (>21 years) with cGVHD. After obtaining informed consent, data for this study (IRB# 201400992) was collected by medical record and validated self-report measures. Blood (3ml) was collected from a vein and stored in a -80o freezer until analysis. Inflammatory markers were analyzed using BioPlexÒ multiplex and enzyme-linked immunosorbent assays. Results were reported using descriptive statistics and Spearman’s rank correlations. All statistics were done using SAS version 9.3 with the level of significance set at .05. Findings & Interpretation: The mean age (years) was 53. Most (87.5%) were Caucasian and female (58.3%). Most (29.2%) had AML. Most (83.3%) had moderate to severe cGVHD (NIH criteria). Over half (62.5%) had involvement of 3-5 organs. Participants reported the lowest scores on nutrition, activity and stress management behavior subscales. Spiritual growth and perceived stress were significantly related (r¼ -.68, p< .01). Several behaviors and perceived stress items significantly correlated with markers of inflammation. Discussion & Implications: Associations were demonstrated among lifestyle behaviors, perceived stress and inflammation. Individuals did not routinely engage in healthpromoting lifestyle behaviors reported by the American Cancer Society as essential for cancer survivorship. Nurses are in the unique position to educate and assess transplant survivors with cGVHD on the importance of maintaining a healthy lifestyle. Future research to understand why these behaviors are neglected and nurse led interventions focusing on these quality of life indicators may increase longevity and quality of life for individuals with cGVHD.
743 Reducing Oral Mucositis Using Cryotherapy and Near Infra-Red Light Emitting Diodes in Multiple Myeloma Patients Receiving Melphalan Chemotherapy Prior to Hematopoietic Stem Cell Transplant Wendy Madden 1, Donna Salzman 2, Jeanne Dockery 1, Ayman Saad 3, Susanna Howell 4. 1 Bone Marrow Transplantation and Cell Therapy Program, University of Alabama at Birmingham Hospital, Birmingham, AL; 2 Bone Marrow Transplantation and Cell Therapy Program, The University of Alabama at Birmingham, Birmingham, AL; 3 Bone Marrow Transplant and Cellular Therapy, University of Alabama at Birmingham - UAB, Birmingham, AL; 4 Blood and Marrow Transplantation and Cellular Therapy Program, University of Alabama at Birmingham Hospital, Birmingham, AL Topic Significance & Study Purpose/Background/ Rationale: OM occurs 80% in patients receiving high dose melphalan prior to HSCT. OM causes severe pain and contributes to compromised nutrition while increasing healthcare costs, infection risks and risk of mortality for HSCT recipients. Both daily LED therapy and cryotherapy during melphalan infusion have shown effectiveness in reducing OM severity; however, little is known if OM is further reduced by combining both therapies. The aim of this study is to investigate Near Infra-Red Light emitting Diodes (LED) Therapy and Cryotherapy (Cryo) for oral mucositis (OM) prevention in multiple myeloma (MM) patients receiving high dose melphalan chemotherapy prior to Hematopoietic Stem Cell Transplant (HSCT).
S471
Methods, Intervention, & Analysis: March 2015, following IRB approval, seventy-five MM patients’ with OM were evaluated using National Cancer Institute (NCI) guidelines at UAB. Six melphalan 140mg/m2 and ten melphalan 200mg/ m2 patients received LED therapy only. Nine melphalan 140mg/m2 and 16 melphalan 200mg/m2 patients received a combination of LED therapy and cryotherapy. Eight melphalan 140mg/m2 and 26 melphalan 200mg/m2patients who received traditional post chemotherapy OM symptom relief and did not receive LED therapy or cryotherapy served as a historical control group. Findings & Interpretation: Median OM toxicity scores for Melphalan 140mg/m2 were 1.5 (control), 1 (LED only), and 1 (Melphalan/Cryo). Median scores for Melphalan 200mg/m2 were 2 (control), 2 (LED only), and 1 (Melphalan/Cryo). Mode OM toxicity scores for melphalan 140mg/m2 were 1 and 2 (control), 1 (LED only), and 0 (melphalan/Cryo). Mode scores for melphalan 200mg/m2were 2 (control), 2 (LED only), and 1 (melphalan/Cryo). Discussion & Implications: Utilizing cryotherapy and LED light therapy together reduces OM severity in HSCT patients receiving melphalan more than LED therapy alone. Cryotherapy with LED therapy safely reduces OM and associated symptoms for MM melphalan HSCT patients.
744 Adolescent/Young Adult Self-Management Framework: Preliminary Results and Practice Implications Caroline F. Morrison. Bone Marrow Transplantation and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; College of Nursing, University of Cincinnati, Cincinnati, OH Topic Significance & Study Purpose/Background/ Rationale: At least one quarter of Adolescents/young adult (AYA) oncology patients do not adhere to treatment protocols. Adolescents/young adults receiving a stem cell transplant (SCT) and their families face many challenges that make it difficult to effectively manage their care and medication regimens. Patients are prescribed complex medication regimens to prevent infection, graft versus host disease and disease relapse. Adherence is particularly difficult for AYA who are developmentally working to achieve independence from adults, seeking immediate rewards, and may be more likely to act in ways contrary to the recommendations of healthcare providers. Nurses as members of the healthcare team are poised to assist families in managing their care. Methods, Intervention, & Analysis: A grounded theory study is being conducted to better understand the process by which AYA and their caregivers manage the care regimen following transplant. The goal is to construct a framework on AYA self-management following SCT. Semi-structured interviews are being conducted with AYA, ages 13-25, and their caregivers. The Pediatric Self-Management Model guided development of the interview guide. The sample size is currently 10 AYA and 7 caregivers (n¼17) with a recruitment goal of 15 each (n¼ 30). Interviews were recorded and transcribed verbatim. Data were coded to consensus by members of the research team and memo writing was used as an audit trail of theoretical decision making. Constant comparison methods were used to analyze data for theoretical concepts and relationships. Findings & Interpretation: Preliminary results on the process by which AYA care is managed focused on “hunkering down” and “shifting gears,” putting life on hold by focusing