Chen, J., Seabrook, J., Fulford, A., & Rajakumar, I. (2015). Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant. Journal of Oncology Pharmacy Practice. Advance online publication.

DOI Link

Study Purpose

To evaluate the effectiveness of a cryotherapy protocol in patients undergoing hematopoietic cell transplantation (HCT)

Intervention Characteristics/Basic Study Process

Medical records of patients undergoing autologous HCT for multiple myeloma were used to obtain data. All received high-dose melphalan as part of the conditioning regimen. Patients who were treated prior to the implementation of the cryotherapy protocol were compared to those who received cryotherapy in terms of the incidence, severity, and duration of mucositis. Data were collected to also compare the use of parenteral narcotics, use of parenteral nutrition, and hospital stay.

Sample Characteristics

  • N = 140
  • MEAN AGE = 55 years
  • MALES: 44%, FEMALES: 56%
  • KEY DISEASE CHARACTERISTICS: All had multiple myeloma and received autologous HCT.

Setting

  • SITE: Single site  
  • SETTING TYPE: Inpatient  
  • LOCATION: Canada

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Retrospective cohort comparison

Measurement Instruments/Methods

  • World Health Organization (WHO) mucositis severity scale

Results

Overall incidence of oral mucositis was 95.7% of those with no cryotherapy compared to 71.4% of those who received cryotherapy (p < 0.001). Median severity without cryotherapy was 2.5 compared to 2 with cryotherapy (p = 0.03). More patients without cryotherapy needed parenteral narcotics for pain control (p = 0.02), and duration of mucositis was about two days less with cryotherapy (p = 0.02). No differences existed in parenteral nutrition use or length of hospital stay.

Conclusions

The use of cryotherapy was associated with lower incidence, severity, and duration of mucositis among patients undergoing HCT receiving high-dose melphalan.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)

Nursing Implications

Cryotherapy has been shown to be effective in reducing the severity of mucositis in patients receiving chemotherapeutic agents with a short half-life.