Paper
Sunday, November 4, 2007
160
Oral Symptom Experience and Health-Related Quality of Life of Adult Survivors of Hematopoietic Stem Cell Transplantation (HSCT) with Chronic Graft-Versus-Host-Disease (cGVHD)
Jane Fall-Dickson, RN, PhD1, Sandra Mitchell, MScN2, Susan Marden, RN, PhD3, Edward Ramsay, BS1, Matin Imanguli, DDS4, Jean-Pierre Guadagnini, DDS5, Jeanne Odom, BSN6, Niveen Atlam, BS7, and Steven Pavletic, MD4. (1) Laboratory of Symptom Management, National Institute of Nursing Research, Bethesda, MD, USA, (2) Research and Practice Development Service, National Institutes of Health, Bethesda, MD, USA, (3) Office of Clincial Research Training and Medical Education, National Institutes of Health, Bethesda, MD, USA, (4) Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD, USA, (5) DIR/CRC, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA, (6) Clinical Research Center, National Cancer Institute, Bethesda, MD, USA, (7) CRC, National Cancer Institute, Maryland, MD, USA
| Learning Objective #1: describe the stomatitis-related symptom experience and health-related quality of life of adult survivors of hematopoietic stem cell transplantation with oral chronic graft-versus-host-disease. |
| Learning Objective #2: state potential utility of salivary proinflammatory cytokines as correlates of stomatitis severity and related symptoms. |
Background: Oral cGVHD is a serious sequela of HSCT with optimal treatment unknown. This descriptive study assessed stomatitis, oral dryness and pain, HRQL and proinflammatory cytokines in patients with cGVHD enrolled in a NCI natural history protocol.
Methods:. Oral Mucositis Rating Scale (OMRS; 0-273) measured stomatitis. VAS (0-10) measured oral dryness and pain severity. Functional Assessment of Cancer Therapy-General (FACT-G) total and subscales (physical [PWB], emotional [EWB] social/family [SWB], and functional [FWB] well-being) assessed HRQL. TNFalpha, IL1alpha, and IL6 concentrations in stimulated submandibular saliva samples were measured by enzyme-linked immunosorbent assay (ELISA) (R & D Systems,
Minneapolis, MN). Saliva samples were collected on ice, stored at -80ºC, centrifuged at 4000xg 10 minutes at 4ºC and supernatant retained. Analyses included descriptive statistics (mean +/- SD) and Pearson correlation coefficients.
Results: Adult participants (N = 32) all had mild stomatitis (OMRS 17.8±13.4), erythema (91%), lichenoid (72%), ulceration (56%), mild oral dryness (2.2±3.1; 40%) and mild pain (0.1±0.41; 7%). HRQL was impaired (below General US population norms) except SWB: Total (75.1±21.2, norm=80); PWB (18.3±6.8, norm=22); EWB (18.0±4.9, norm=20); FWB (17.5±6.9, norm=18.5); and SWB (21.2±6.5, norm=19). TNFalpha 0.30pg/mL±0.6; IL1alpha 84.6pg/mL±67.51; and IL6 2.4pg/mL±2.95. Moderate correlations (p<0.05) seen between TNFalpha and erythema (r=.36), IL1alpha and oral dryness (r=.41), and IL6 and OMRS (r=.49), erythema (r=.63), and ulceration (r=.38). Oral dryness correlated (p<0.05) with PWB (r=-.42), SWB (r=-.40), and total FACT-G (r=-.41). OMRS correlated (p<0.05) with SWB (r=-.49). HRQL and cytokines showed no significant correlations.
Conclusions: Oral dryness was more prevalent than oral pain and significantly associated with salivary IL1alpha and poorer physical and social well-being. Moderate to strong associations between salivary TNFalpha and IL6 and oral cGVHD severity, and IL1alpha and oral dryness suggest utility as correlates of disease severity. Oral dryness deserves assessment in this population because it may adversely affect HRQL.