The aim of the study was to compare the differences in physical function and cancer-related symptoms before and after HSCT between adult patients with hematologic cancer who did and did not develop severe oral mucositis during their hospitalization.
A prospective longitudinal observational study was conducted at the Bone Marrow Transplant Unit of Clinica Dávila, Santiago, Chile, between September 2023 and March 2024. Patients with hematologic cancer undergoing allogeneic or autologous hematopoietic stem cell transplantation were consecutively included. All participants provided their written informed consent. A physiotherapist assessed physical function and symptoms at admission (T1) and discharge (T2). All participants received standard care for oral mucositis and physical therapy 1-2 times per day. The WHO scale assessed Oral mucositis severity daily during the hospital stay. Physical function was measured with the 30-second sit-to-stand test, handgrip strength, and the 2-minute step test. Symptom intensity was evaluated using the Edmonton Symptom Assessment Scale. Participants were grouped for comparison based on the presence or absence of severe oral mucositis. We used the Student T test or Mann-Whitney for group comparison and a survival curve to estimate onset and cessation.
Thirty-one participants were evaluated, with a mean age of 47.3 years (±12.6). The most frequent diagnosis was acute lymphoblastic leukemia (35.5%, n=11), and 19 participants (61.3%) received an allogenic transplant. The incidence of oral mucositis was 74.2%, and severe oral mucositis was 29%. Patients with severe oral mucositis had lower performance in the sit-to-stand test than those without severe oral mucositis (Mean Difference 1.5 repetitions, 95% CI 0.01 to 3.1, p= 0.048). In addition, they had more days with support parenteral nutrition (p= 0.001), more pain (p= 0.011), more loss of appetite (p= 0.036), and more nausea (p= 0.046) upon discharge from the hospital. The median onset of oral mucositis was day +8 after allogeneic HSCT (95% CI 6 to 12) and +10 (95% CI 8) after autologous HSCT.
Patients undergoing HSCT who develop severe oral mucositis experience greater deterioration in lower limb strength, more appetite loss, pain, and nausea upon discharge compared to those who do not develop severe oral mucositis.
These findings suggest the need to manage oral mucositis, as well as lower limb strength training, in patients undergoing HSCT. Patients who developed severe oral mucositis during their transplant may have greater rehabilitation needs after discharge compared to those who did not develop severe oral mucositis.
oral mucositis
physical function
