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Jo and Kim: Incidence and Factors Influencing Oral Mucositis in Patients with Hematopoietic Stem Cell Transplantation
Original Article

Journal of Korean Academy of Nursing 2014; 44(5): 542-551.

Published online: 31 October 2014

DOI: https://doi.org/10.4040/jkan.2014.44.5.542

Incidence and Factors Influencing Oral Mucositis in Patients with Hematopoietic Stem Cell Transplantation

Kwan Suk Jo1, Nam Cho Kim2

1Graduate School, The Catholic University of Korea, Seoul, Korea.

2College of Nursing, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Kim, Nam Cho. College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-7405, Fax: +82-2-2258-7772, kncpjo@catholic.ac.kr

Received 9 May 2014       Revised 23 May 2014       Accepted 21 August 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity.

Methods

In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test.

Results

A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics.

Conclusion

The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.

Keywords: Hematopoietic stem cells, Transplantation, Mucositis

Figures and Tables

Table 1
Incidence of Oral Mucositis by Patients Characteristics (N=222)
jkan-44-542-i001

*p<.05; †Fisher exact test; AML=Acute myeloid leukemia; ALL=Acute lympnoblastic leukemia; MM=Multiple myeloma; SAA=Severe aplastic anemia; MDS=Myelodysplatsic syndrome; MAC=Myeloablative chemotherapy; RIST=Reduced instensified therapy; MPLV=Melphalan based chemotherapy; BMT=Busulfan-melphalan-thiothepa; TAM=Total body irradiation-cytoarabine-melphalan; HSCT=Hematopoietic stem cell transplantation; FMT=Familiar mismatched; CR=Complete remission; IR=Incomplete remission; SS/CP=Stable state/Chronic phase; TBI=Total body irradiation.

Table 2
Correlations of related Variables with Oral Mucositis Grade (N=222)
jkan-44-542-i002

*p<.05; HSCT=Hematopoietic stem cell transplantation; BMI=Body mass index; TBI=Total body irradatin.

Table 3
Factors Affecting Grade of Oral Mucositis by Ordinal Logistic Regression (N=222)
jkan-44-542-i003

*p<.05; ALL=Acute lymphoblastic leukemia; AML=Acute myeloid leukemia; MDS=Myelodysplatsic syndrome; MM=Multiple myeloma; SAA=Severe aplastic anemia; FMT=Familiar mismatched; IR=Incomplete remission; CR=Complete remission; TBI=Total body irradiation; HSCT=Hematopoietic stem cell transplantation.

Table 4
Patient Outcomes of HSCT Patients by Oral Mucositis Grade (N=222)
jkan-44-542-i004

*p<.05; †Kruskal-Wallis test; HSCT=Hematopoietic stem cell transplantation; NPO=Nothing per oral; TPN=Total parenteral nutrition.

Notes

This study was supported by the College of Nursing, The Catholic University of Korea in 2014.

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