The Effect of Continuous Nutritional Education and Oral Mucositis Management on Nutritional Status of Patients Undergoing Hematopoietic Stem Cell Transplantation

지속적인 식이교육과 구내점막염 관리가 조혈모세포이식(HSCT) 환자의 영양상태에 미치는 효과

  • Park, Kyoung-Soon (Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Byung-Hwa (Graduate School of Public Health, Yonsei University) ;
  • Park, Ho-Ran (College of Nursing, The Catholic University of Korea)
  • 박경 (가톨릭대학교 서울성모병원) ;
  • 이병화 (연세대학교 보건대학원) ;
  • 박호란 (가톨릭대학교 간호대학)
  • Received : 2010.01.27
  • Accepted : 2010.07.30
  • Published : 2010.08.31


Purpose: This study aimed to evaluate the effectiveness of continuous nutritional education and oral mucositis management on the nutritive status of patients who received hematopoietic stem cell transplantation (HSCT). Methods: After randomly allotting 72 patients who received HSCT to either an experimental group or a control group, intensive and continuous care for preventing malnutrition was conducted in the experimental group while usual routine care was conducted in the control group. The changes of the body scale, blood chemistry profile, oral intake calories, nausea and vomitus, and oral stomatitis scores were measured at three points during their hospitalization using a oral assessment guide and nutrition analysis program: admission, HSCT, and discharge day. The differences between the scores of two groups were analyzed by repeated measures analysis of covariance. Results: The number of total lymphocytes was significantly improved in the experimental group after transplantation (p<.001). Nausea and vomiting score was significantly decreased in the experimental group during the conditioning regimen (p<.001). Conclusion: It was found that continuous nutritional education and oral mucositis control is an effective intervention by improving immune condition. Further investigations concerning direct examination of oral intake with controlling the effect of the chemotherapy are needed to ultimately discern the impact of varying oral nutrition patterns during HSCT.


  1. Korean HSCT Nurses Association. Current status of HSCT in Korea. J Korean HSCT Nurs Society 2005;7:8-13.
  2. Pisachou E, Hann IM, Morgan G, Chessells JM. Early deaths in children under going marrow ablative therapy and bone marrow transplantation. Bone marrow transplantation 1994;14:975-80.
  3. Cunningham BA, Lenssen P, Aker SN, Gittere KM, Cheney CL, Hutchison MM. Nutritional consideration during marrow transplantaion. Nurs Clin North Am 1983;18:585-96.
  4. Carol PR. Nutrition Support of Blood or Marrow Transplant Recipients: How Much Do We Really Know? Nutritional Issues In Gastroenterology Series #26. Pract Gastroenterol 2005:84-97.
  5. Randolph S. Bone Marrow Transplant therapy in the home. Caring Magazine 1992;Sep:68-71.
  6. Koretz RL, Lipman TO, Klein S. AGA Technical Review on Parenteral Nutrition. Gastroenterology 2001;121:970-1001.
  7. Stern JM, Bruemmer B, Moinpour CM, Sullivan KM, Lenssen P, Aker SN. Impact of a randomized, cotrolled trial of liberal vs conservative hospital discharge criteria on energy, protein, and fluid intake in patients who received marrow transplants. J Am Diet Assoc 2000;100:1015-22.
  8. Smith LH, Besser SG. Dietary restrictions for patients with neutropenia: a survey of institutional practices. Onco Nurs Forum 2000;27:515-20.
  9. Bok JN, Kim GS, Choi SE, Song BE. Continuous telephone follow- up for HSCT patients. J Korean HSCT Nurs Society 2003; 5:55-61.7.
  10. Rosenberg SW. Oral Care of Chemotherapy Patients. Dtien-Clin North Am 1990;34:239-50.
  11. So HS. Assessment of appetite and nutritional status in cancer patients undergoing radiation therapy: a prospective study. J Koran acad nurs 2001;29:1179-91.
  12. Yang YH, Ghun SJ, Kim CI. The nutritional status of the patients with cancer during the chemotherapies. J Koran Acad Nurs 2001;31:978-87.
  13. Graham KM, Pecoraro DA, Vontura M, Meyer CC. Reducing the incidence of Stomatitis using a quality assessment and improvement approach. Cancer Nurs 1993;16:117-22.
  14. Cho GJ. The nutritional evaluation of Oncology Inpatients receiving chemotherapy[dissertation]. Chung Nam Univ.;1993.
  15. Hong JI, Jang UJ. The relationship between the period of engraftment and the nutritional status in patients undergoing allogenic bone marrow transplantation for acute myelogenous leukemia (AML). Korean J Community Nutr 2002;7:578-84.
  16. Ernest JS, Rosenbaum H, Andrews A, Dollbaum CM, Ignoffo RJ. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Int Society for Oral Onco 2004;100(9 Suppl):2026-46. Available at
  17. Nutrition Department. Clinical manuals for nutrition part. 3rd ed. Seoul: Saint Mary's Hospital, Catholic University of Korea; 2000.
  18. Andersson PR, Lena RH, Ingalill R. Steran R, Testing an oral assessment guide during chemotherapy treatment in a Swedish care setting: a pilot study. J Clin Nurs 1999;8:150-8.
  19. Shin KY, Song MS. Efficacy progressive muscle relaxation training reducing nausea and vomiting, anxiety and symptom distress of cancer chemotherapy. J Korean Acad Nurs 1987;17:195-204.
  20. Brodie DA, Eston RG. Body fat estimations by Electrical impedance and infrared interaction. Int J Sports Med 1992;13:319-25.
  21. Kim SH, Shin HS, Im WK. A Study on the dietary nutrient intakes and blood profiles of smoking teenage girls living in a rural community in Korea. Korean J Nutr 2001;34:338-47.
  22. McWhirter JP, Penningtion CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945-8.
  23. Lipkin EW, Bell S. Assessment of nutritional status: the clinician's perspective. Clin Lab Med 1993;13:329-52.
  24. Papas AS, RE Clark, Martuscelli G, O'Loughlin KT, Johansen E, Miller KB. A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplantation 2003:31:705-12.
  25. Lee RD, Nieman DC. Nutritional Assessment. 2nd ed. Chicago: Mosby Press;1996.
  26. Park HJ. Nutritional Status of Patients undergoing Hematopoietic Stem Cell Transplantation[dissertation]. Graduate School of Public Health, Catholic Univ.; 2000.
  27. Nieweg R, Poelhuis EK, Abraham IL. Nursing care for oral complication ompociated with chemotherapy. Cancer Nurs 1992; 15:313-21.
  28. Yang YH, Lee DS. The relationship of anorexia, nausea, vomiting, oral intake and nutritional status in patients receiving chemotherapy. J Korean acad nurs 2000;30:720-30.
  29. Picou D, Waterlow JC. The effect of malnutrition on the metabolism of plasma albumin. Clin Sci 1962;22:459-68.
  30. Hermann VM, Petruska P. Nutrition support in bone marrow transplant recipients. Nutr Clin Pract 1993;8:19-27.