LAUSR

Topic Significance & Study Purpose/Background/Rationale Nursing care of BMT patients is complicated. Trends in BMT demonstrated improved survival with patients experiencing better quality of life (QOL) during treatment, early recovery and long term because of expanding pool of stem cell sources, more effective less toxic regimens, new supportive care drugs, maintenance therapy and specialized medical and nursing care. Nonetheless, disease recurrence, graft versus host disease (GVHD), organ failure and secondary cancer are common causes of late death. Nursing considerations of HSCT patients with GVHD requires an additional set of skills and knowledge that include side effects both expected and less common, assessment skills, treatment administration both standard and novel, and acute or intensive care. Nursing care of patients with acute and chronic GVHD also require symptom recognition and knowledge of treatment modalities, management and care of both physical and psychosocial elements, and requires consistent coordination of care for possible prolonged period of time. The nurses’ role is to advocate for the HSCT patient and that may include preparing for end of life if the patient's disease is refractory to treatment for GVHD. Methods, Intervention, & Analysis Specialized GVHD clinics have been set up at many larger centers. This is a multidisciplinary clinic that includes the clinic nurse, APP, BMT physician who specializes in GVHD, dermatologist and other experts in the field of gynecology, physical therapy, occupational therapy, GI medicine, pulmonary, pathology, symptom research, infectious disease, endocrinology, dental and ophthalmology. The patient is always in the central in the clinic focus. Findings & Interpretation Nursing care of BMT patients with skin GVHD will be determined by the degree of skin alteration with distinct decisions made about hygiene, both topical and systemic treatment, infection prevention, relief of discomfort, functional ability (ADL) and body image alteration. Care of the patient with chronic GVHD will also focus on prevention and early detection. Discussion & Implications Patient education about such aspects as sun protection, skin assessment, and recognition of risk for skin and oral cancer are important and covered in our survivorship program patient visit at or around day 100. A one-page handout on “Nursing Care Consideration of Skin GVHD” will be discussed.