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Background: As early as 1997 it was stated that the outpatient model when patients are cared for in their homes (outpatient care) in connectionwith hematopoietic stemcell transplantation (hSCT), gave positive results regarding safety and effectiveness. But in the year of 2022, in manycountries, it is still an offer and not a standard treatment. Despite long international and national experience of outpatient treatment at hSCT, manypatients are still fully cared for in hospitals. Purpose: To describe the patients’ subjective experiences of outpatient (OP)- and inpatient (IP) care during autologous hematopoietic stem celltransplantation and to ensure the quality of care outside hospital environment as a form of care in order to improve the patient's experience ofsafety and security at autologous hematopoietic stem cell transplantation at a University Hospital in Sweden. And, to evaluate physicians' andnurses’ assessment using a standardized assessment form of the patient's self-care ability when cared for outside the hospital. Methods: A quantitative questionnaire study with pre-selected response alternatives and open-ended questions. Results: Most patients, regardless of the form of care, OP or IP care, felt satisfied with the information given by the care provider. Nearly all ofthe patients who were cared for in hospital and who responded to the questionnaire, experienced anxiety during the care period compared withpatients who were cared for in a home environment responding to the questionnaire, where the vast majority did not experience any anxiety duringthe care period. Conclusion: Most patients indicate, as shown in other studies, that they felt satisfied with the care and information they received in connectionwith hematopoietic stem cell transplantation but patients in IP care felt more anxiety than patients in OP care. Regarding evaluating physicians'and nurses’ assessment using a standardized assessment form of the patient's self-care ability when cared for outside the hospital, there wereno notable differences in the assessment. Clinical relevance: A questionnaire provides the healthcare provider with a basis for developing and improving in clinical care for patientsreceiving hSCT. Regarding attention to the mental well-being equated with the physical well-being it is a clinical task for healthcare providers. Awell-developed basis for assessing the patient's level of care can ensure the best care.

INTRODUCTION: A majority of patients who receive myeloablative therapy prior to hematopoetic stem cell transplantation develop oral mucositis (OM). This adverse cytotoxic effect manifests as oral mucosal erythema and ulcerations and frequently necessitates high doses of morphine for pain alleviation. OM may also interfere with food intake and result in parenteral nutrition, weight loss and impaired quality of life. To date, there have been a few studies of evidence-based interventions for prevention of OM. Cooling the oral mucosa using ice chips in conjunction with chemotherapy is known to reduce the severity of OM although clinical application is still limited due to several disadvantages. The primary endpoint of this study is therefore to evaluate the efficacy of an innovative intraoral cooling device (Cooral) compared with ice cooling in reducing the degree of OM, in patients with myeloma or lymphoma. METHOD AND ANALYSIS: A total of 180 patients from four different university hospitals in Sweden will be randomised to ice or Cooral in a proportion of 1:1. The degree of OM will be assessed at eight intraoral locations, in accordance with the Oral Mucositis Assessment Scale and WHO scale. Patients will be registered beginning at admission and will continue until discharge or until day +28. The primary variable is analysed in a multiple linear regression model. The significance level used is 5%. ETHICS AND DISSEMINATION: The study protocol, questionnaire, diaries and letter of invitation to participants have been reviewed by the local ethical board in Göteborg. The trial results will be published in a peer-reviewed journal and disseminated to participants. TRIAL REGISTRATION NUMBER: NCT03203733; Pre-results. PROTOCOL VERSION: Version 4, 2017-06-05. CC BY-NC 4.0This article has a correction:Correction: Protocol for a randomised controlled trial to study cryoprevention of chemotherapy-induced oral mucositis after autologous stem cell transplantationhttp://dx.doi.org/10.1136/bmjopen-2018-021993corr1

Background: Chemotherapy in connecting with autologous stem cell transplantation (SCT) is an established treatment for patients diagnosed with myeloma and lymphoma. Chemotherapy has side effects nausea/vomiting, infection, diarrhoea, fatigue and oral mucositis. SCT often requires hospitalization for weeks. Today it is common to treat patients in an outpatient care in combination with visits at the clinic/ward. Despite experience about outpatient care in connection with SCT, it is still a small proportion of patients who are treated on an outpatient basis. Reasons to readmit unplanned from homecare to hospital are mainly incidence of infection. Purpose: To investigate in what extend patients undergoing autologous SCT, received an outpatient care or care at a University hospital in Sweden during transplant period and if the treatment at outpatient care was interrupted to study the reason for readmitting to hospital care, also to compare intra venous (iv) treatment with antibiotics or total parenteral nutrition and length of hospital stay. Methods: The study was a quantitative, retrospective, descriptive design. A review from medical and nursing records of 88 adult patients who underwent autologous SCT in 2013-2014 and treated at a University Hospital in Sweden. Results: Thirty-nine patients were cared for outside hospital at home/home-like environment and 28 of them were readmitted to hospital. Forty-nine was cared for at hospital ward. The results showed that the main reason of readmission to hospital was related to nausea/vomiting, oral mucositis, stomach problem or other reason. No patients treated outside the hospital in the home/home-like environment the entire post-transplant period (n=11) needed total parenteral nutrition in contrast to patients readmitted to hospital (n=28) where 7 patients needed total parenteral nutrition. Among patients cared for at hospital ward during the entire post- transplant period (n=49), 17 patients needed total parenteral nutrition. Conclusion: Staying at home during the transplant period leads to less total parenteral nutrition, iv antibiotics and fewer days in the hospital.

The aim of this thesis was to investigate oral cryotherapy (OC) as prophy-laxis against oral mucositis (OM) in patients given high-dose chemotherapy for stem cell transplantation (SCT). A new mouth rinse device was tested for possible additive effect to OC. For study I-III, 78 patients were randomised to OC or standard oral care (SOC). Papers I and II showed that OC patients had significantly less severe mucositis, pain, opioid use, lower C-reactive protein and less parenteral nutrition treatment (TPN). There was no difference in relapse rate, and 5-year survival was unexpectedly significantly better in the OC group (Paper III). In paper IV, the local effect of OC on the mucosa of the mouth was investigated by the use of an infrared thermograph. Change in surface temperature in eight areas of the mouth cavity was measured after cooling of the mouth in healthy volunteers. A substantial lowering of the temperature (-12.9 °C, mean) was seen which could explain the efficacy of OC. To exclude that acute cooling in itself is traumatic, the proinflammatory cytokine IL-6 was measured in saliva and showed no increase after cooling. Paper V reported a study in 40 allogeneic SCT patients. 20 were given SOC including OC and 20 in addition received Caphosol®, a calcium phosphate mouth rinse, during chemotherapy and until day 21. Severity of mucositis, use of opioids and TPN, effects on nutrition and CRP levels were measured. No significant difference was found between the groups in any of these variables, but a non-significant trend for an advantage for the combination could be seen. IL-6 saliva levels were measured. There was a substantial increase (more than 10-fold), in mean IL-6 levels from baseline to beginning of mucositis and a weak correlation between increased IL-6 levels and severity of OM, suggesting that IL-6 in saliva may be a useful marker of the inflammatory mucosal process. This thesis demonstrates that OC is effective as prophylaxis against chemotherapy-induced OM. As a consequence of this work, OC has been introduced as the standard of care in all SCT patients in our institution.