The impact of education on patients' psycho-emotional status during allogeneic hematopoietic stem cell transplantation: a multicenter prospective study by thes Gruppo Italiano Trapianto di Midollo Osseo.

PURPOSE: Depressive disorders are the most common manifestation of psychological distress in allogenic hematopoietic stem cell transplantation. Few studies have yet investigated the relationship between therapeutic educational interventions and outcomes in these patients with specific attention to those related to mental health. Aim of this study was to understand how much educational intervention can represent a protective factor in preventing psycho-emotional distress-related issues in this setting. DESIGN: A prospective observational study of a multicenter cohort was conducted. PARTICIPANTS: Adult patients undergoing allogeneic hematopoietic stem cell transplantation. METHODS: A pre-transplant therapeutic educational programme was offered to a cohort of adult patients undergoing allo-HSCT recruited in ten transplant centers of the GITMO network between May 2018 and January 2019. Depression, Anxiety and Stress scale was used to collect data on psycho-emotional distress at admission (T0), at the day of transplant (T1) and at discharge (T2). Descriptive data were collected and reported, and comparative analyses were done among patients who were compliant with the pre-transplant educational intervention and those who did not (for any reason). FINDINGS: A cohort of 133 allo-HSCT patients was observed. In patients who did not receive pre-transplant educational intervention, higher levels of depression at admission (p = 0.01) and at the day of transplant (p = 0.03), higher levels of anxiety (p = 0.01 and p = 0.01 respectively) as well as higher levels of stress (p < 0.01 and p = 0.01) were observed. Problem solving and "face to face" interview were the best methods to provide education to patients. Those who received pre-transplant education through "face-to-face" interview reported significant low levels of depression during the whole hospital stay period (p < 0.01; p = 0.01; p = 0.01) and less anxiety and stress at admission (p < 0.05 and p = 0.01 respectively). Depression was more represented in female than male participants at T0 (16.5% vs 9.0%; p = 0.01), while among T0 and T2 the males had a significant higher increasing of depression than females (p = 0.03). CONCLUSION: Our study demonstrated that pretreatment therapeutic educational programs with specific learning modalities can be effective in limiting the potential risk of developing moderate-to-severe anxiety-depressive states and stress symptoms related to allo-HSCT. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Further studies are needed to confirm our results and to understand whether containing psycho-emotional distress can have any relationship with medium- and long-term post-transplant complications.

[Assessing the effectiveness of Gelclair® in the prevention and therapy of stomatitis in patients undergoing hematopoietic stem-cell transplantation: a randomized trial]. / Valutazione dell'efficacia del Gelclair® nella prevenzione e cura della stomatite nei pazienti sottoposti a trapianto di cellule staminali emopoietiche: Studio randomizzato.

INTRODUCTION: Chemotherapy-induced stomatitis is a major side effect of the treatment. Numerous approaches are described in the literature for the prevention and treatment of this complication. OBJECTIVE: the aim was assess the effectiveness of Gelclair® in patients undergoing hematopoietic stem-cell transplantation in terms of reducing the incidence of stomatitis, stomatitis-pain and the severity of stomatitis INTERVENTIONS/METHODS: Fifty-seven patients (28 control group and 29 experimental group) used a mouthwash 3 times a day and were evaluated by means of a specially-tailored form containing the following assessment items:stomatitis evaluation scale (WHO), VAS for pain and Likert-Scale for agreement. RESULTS: 61% of patients presented with stomatitis. No difference was observed between the two groups with regard to stomatitis grade throughout the observation period. Painful symptoms were observed in 54% subjects. No differences were observed in terms of average pain perception before the use of mouthwashes throughout the period of observation p=0.06. RESULTS showed a pain-relieving effect in the experimental group after using the mouthwash p=0.04. CONCLUSIONS: Although Gelclair® had no influence on the onset and severity of stomatitis in transplanted patients, a significant benefit was observed in terms of pain control. Our study suggest the possibility to implementation the use of Gelclair® in clinical practice. However, further multicenter trials are needed to provide stronger evidence on the real usefulness of this product.

[Acute graft versus host disease: a retrospective analysis of 55 bone marrow transplant patients]. / Acute graft versus host disease. Analisi retrospettiva in 55 pazienti sottoposti a trapianto di midollo osseo.

Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality in long-term survivors of allogenic stem cell transplantation. This retrospective study describes the problems occurring in stem cell transplanted patients. Data were collected from medical and nursing records of the 55 patients admitted to the Stem Cell transplant ward of Careggi Hospital, and affected by GVHD from December 1991 to October 2000. Fifty per cent of the patients had skin problems and 24 gastrointestinal problems. The mean duration of the GVHD is 19 days. Many patients exhibit behaviours of intense anxiety, depression and restlessness. The results are comparable with data published in the most recent literature and show the complexity and severity of the GVHD. The patients affected require high levels of care therefore the nurse performs a pivotal role in symptoms monitoring and care.