The resurgence of granulocyte transfusions.

Granulocyte transfusion can be used as supportive therapy in patients with life-threatening neutropenia caused by bone marrow failure or in patients with neutrophil dysfunction. Emerging evidence demonstrates the benefits of granulocyte transfusions to treat infections in patients after treatment with high-dose chemotherapy, particularly the chemotherapy associated with conditioning for hematopoietic stem cell transplant. There has been an increased interest in the use of therapeutic granulocyte transfusion in recent years due to the ability to use granulocyte colony-stimulated factors to produce higher doses of granulocytes for transfusion. Other factors that influence the outcome of transfusion include the type of infection being treated, the likelihood of recipient marrow recovery, and recipient alloimmunization. This article provides a historical perspective on granulocyte transfusion and an overview of its clinical use.

Putting evidence into practice: evidence-based interventions for the management of oral mucositis.

Mucositis, an inflammation of the mucous membranes, is a commonly occurring side effect of chemotherapy and radiation. Oral mucositis can cause significant clinical consequences, such as pain, malnutrition, and local and systemic infections. Nurses have a critical role in all aspects of managing mucositis, including assessing it, teaching oral care, administering pharmacologic interventions, and helping patients cope with symptom distress. Mucositis can have a negative impact on the overall treatment experience, especially when severe pain or infections occur. Many interventions for managing mucositis exist; however, some are based in tradition or expert opinion and have not been studied in large, randomized, controlled trials. In addition, a variety of assessment tools are available, which creates confusion and difficulties when comparing interventions across studies. This article reviews empirical evidence related to interventions for oral mucositis. Oral care and rinses, pharmacologic interventions, and other techniques are evaluated. Gaps in the literature and opportunities for research, education, and practice changes are discussed.

Cancer treatment-induced mucositis pain: strategies for assessment and management.

Mucositis pain is a major clinical problem associated with cancer treatment. Mucosal tissue injury is a dose-limiting side effect and also limits nutritional intake and oral function, resulting in weight loss and nutritional deficits for many patients. The pathophysiology of mucositis is thought to be a complex array of cytokine-mediated events, which begins with mucosal atrophy and eventually leads to the painful ulceration of the mucosa. This article reviews current research related to pain management for mucositis. Effective treatment for mucositis pain must be targeted at the various factors involved in the pain experience. Although a number of interventions aimed to prevent and treat mucositis have been studied, there is little evidence to recommend any one treatment modality. While current strategies for pain management rely on general treatment for acute pain, research developments are aimed at targeting the specific receptors and enzymes involved in mucositis. As these breakthroughs become available clinically, thorough assessment and timely directed interventions must be implemented in order to limit patient distress from mucositis. This article presents an assessment tool specific to mucositis pain, including physical, functional, and pain parameters.

Assessing and managing chemotherapy-induced mucositis pain.

Acute pain is the major clinical problem associated with mucositis. Mucosal tissue injury is a dose-limiting toxicity of many cancer therapies. Because the number of patients treated with combinations of high-dose chemotherapy agents is likely to increase, more patients are at risk for mucositis. Currently, no consensus exists regarding mucositis prevention, assessment, or treatment. Similarly, research is needed in methods to accurately assess and manage pain for mucositis. Multiple interventional approaches are needed to decrease the emotional and physical distress caused by acute oral pain and mucositis. An assessment tool that includes physical, functional, and pain parameters is presented. Although approaches to prevent and treat mucositis are increasing, appropriate assessment and timely directed interventions can minimize patient distress.