3 Key Oncology Nursing Strategies to Help Combat GVHD Frailty

By Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - September 7, 2023

Oncology nurses can help patients with graft-versus-host disease (GVHD) build frailty resistance. Rashid and colleagues define frailty in chronic GVHD (cGVHD) using 5 criteria, but little research has evaluated the impact of different interventions. Prevention, early identification, and prompt interventions may help counteract frailty—reversing or slowing development. Interventions to improve frailty status must focus on 3 critical areas: exercise (or activity), diet, and stress.

3 Ways to Potentially Improve Frailty Status

Oncology nurses can apply 3 critical interventions from the geriatric literature to the care of patients with GVHD.

  1. Exercise. Patients who exercise are less likely to become frail or more likely to improve when they are frail. Many patients dislike “exercise,” so consider changing your terminology to “activity.” Explain that addressing major muscle groups is essential to improve endurance and balance.

According to the American Cancer Society, patients need aerobic and muscle-strengthening exercises for the best results. Walking is an excellent movement—even just 5 minutes at a time, aiming for 150 minutes per week. Muscle-strengthening activities, such as stretch bands, must be done 2 or more days per week.

Collaborate with physical therapy to suggest education on stretch band exercises or chair yoga routines for cancer survivors. Check out these videos on YouTube:

  1. Diet. Eating a balanced diet can prevent and treat frailty. For patients with gut GVHD, this can be challenging. However, their gut GVHD diet is hopefully temporary. Be sure to follow your institutional guidelines and dietitian recommendations. Encourage patients to eat more of a Mediterranean diet with plenty of fruits, vegetables, protein, good fats, and low-fat dairy products whenever possible.
  1. Stress reduction. Research shows a clear link between stress and inflammation. Physiologically, ongoing stress causes the continuous dysfunction of the normal stress response (eg, nervous and endocrine systems). Patients need strategies such as regular exercise and mindfulness to maintain mental fitness.
    • Regular exercise helps manage stress by reducing adrenaline and cortisol, the body’s stress hormones. It also enhances mood by stimulating endorphins and boosting serotonin. Exercise can help to improve mental fitness, including self-esteem. In addition, it can help reduce brain fog and alleviate anxiety and depression.
    • Mindfulness, relaxation techniques, and chair yoga can decrease stress and inflammation by helping the autonomic nervous system. Check out the CNT article, “Mindfulness Meditation for Survivors of Lung Cancer,” which offers many resources for all survivors, including those living with GVHD.

Essential Role of Oncology Nurses

Researchers reported in “Frailty in Patients With Chronic Graft-Versus-Host Disease” that frail patients were more likely to have increased morbidity and impaired quality of life. In “The Frail Factor: Quantifying a Familiar Foe in Chronic GVHD,” DeFilipp’s editorial of the study poses 2 considerations:

  • cGVHD frailty is likely rising because patients who receive allogeneic SCT are typically older in this study.
  • Interventions are needed to improve clinical outcomes for frail patients with cGVHD.

DeFilipp asks, “What can be done to improve clinical outcomes for frail [patients with] chronic GVHD?”

Oncology nurses can offer a holistic patient approach to frailty—physical, emotional, psychosocial, financial, and spiritual quality of life. They can facilitate collaboration between the SCT team and the referring oncologist’s office to individualize strategies to reverse or slow down frailty.

Overall, oncology nurses can encourage patients to increase activity, focus on a healthy diet within their gut GVHD limitations, and suggest resources to decrease stress. Only with a comprehensive plan can patients focus on building resilience against frailty.


Frailty in Patients With Chronic Graft-Versus-Host Disease

Frailty: A New Predictor of Outcome as We Age

How to Use Resistance Bands: Best Beginner Guide

Movement for Cancer: Chair Yoga

Stay Strong: Four Ways to Beat the Frailty Risk

Exercising to Relax

Mindfulness Meditation for Survivors of Lung Cancer