Role of nursing in the care of patient's skin with cutaneous chronic graft-versus-host disease after allogeneic haemopoietic stem cell transplantation: a questionnaire-based survey
Stringer, Jacqui Bakunina, K. Kozijn, A. Canesi, M. Liptrott, S. Kenyon, M Murray, John
Stringer, Jacqui
Bakunina, K.
Kozijn, A.
Canesi, M.
Liptrott, S.
Kenyon, M
Murray, John
Citations
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Abstract
Background: Chronic GvHD (cGvHD) is a common long term consequence of allogeneic haemopoietic stem cell
transplantation. As cutaneous chronic Graft versus Host
Disease (ccGvHD) can have a profound effect on quality of
life, supportive care is crucial for ccGvHD patients. We
aimed to gain an understanding of current practice in
ccGvHD management within EBMT member centres,
including level of access to extracorporeal photophoresis
(ECP) as a supportive therapy.
Methods: In this cross‐sectional survey, a self‐designed
online questionnaire on ccGvHD management and ECP was
distributed among all nurse representatives of EBMT
transplant member centres. The questionnaire included 41
questions, addressing: ccGvHD management policy, monitoring, patient education, treatments provided (with a special
focus on ECP), and referral. Participation was voluntary and
anonymous. The survey data were analyzed using descriptive
statistics. In case of non-response on a given question in the
questionnaire, the response was classified as ‘Don’t know’.
Results: A total of 110 questionnaires were returned, the
majority of respondents being nurses (92.7%) and having 15
or more years of relevant experience (53.6%). While most
centres reported to have a policy for monitoring a possible
ccGvHD patient (71.8%) and affiliation of a dermatologist for
referral (59.1%), few have access to a specialist nurse (e.g.,
tissue viability nurse) to support the transplant department
with the management of ccGvHD patients (21.8%). All
respondents indicated that assessment of ccGvHD is undertaken by the physicians, sometimes a nurse is involved
(39.1%). Education is routinely provided (80.9%) in the
majority of the centres, delivered mostly in a combination of
oral and written information by physicians (76.4%) as well as
nurses (68.2%). Topical management of ccGvHD skin is not
standardized in most centres (n = 58, 52.7%) and treatment is
increasingly tailored with worsening severity. Most centres
have ECP available for ccGvHD patients (65.5%) or can refer
to another centre for ECP treatment (10.0%). ECP is primarily
provided as a therapy to patients with moderate to severe
ccGvHD (40.0% and 66.4%, respectively) and is not routinely
used for management of patients with mild ccGvHD (8.2%).
QoL and/or emotional impact is assessed by most centres
(60.9%), usually by informal questioning (43.6%).
Conclusions: Our findings identify little standardization
in the topical management of ccGvHD, despite skin being
the most commonly cited organ affected by cGvHD.
Treatment is increasingly tailored with worsening severity
and ECP is reported to be used for moderate to severe
ccGvHD primarily. Our results indicate that additional
research into appropriate treatment of ccGvHD skin is
needed to establish guidelines for treatment selection.
Affiliation
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Stringer J, Bakunina K, Kozijn A, Canesi M, Liptrott S, Kenyon M, et al. Role of nursing in the care of patient's skin with cutaneous chronic graft-versus-host disease after allogeneic haemopoietic stem cell transplantation: a questionnaire-based survey. Bone Marrow Transplantation. 2021;56(SUPPL 1):359.