Most participants viewed nutrition as relevant to strength, treatment tolerance and recovery. Thirteen of 16 described eating as a way to support the body and prevent further decline, with some linking adequate intake to the regeneration of cells and the restoration of energy. Yet 12 held low expectations for meaningful nutritional improvement while hospitalized, and 11 treated reduced intake as an expected part of the transplant-unit experience. Patients often described their immediate objective as enduring the period until appetite and gastrointestinal function improved after discharge, rather than meeting an ideal intake target. This gap between recognizing nutrition’s importance and believing that eating could be improved in the unit points to a mismatch between protocol-style nutritional goals and the capacities of patients undergoing intensive treatment.

The transplant-unit environment directly limited patients’ control over what and when they could eat. Nine participants described constant clinical interruptions, continuous intravenous infusions, frequent toileting and poor sleep as leaving them exhausted and without the energy to prepare for or complete meals. Multiple intravenous lines also limited mobility for some patients. The exhaustion was not presented as a direct cause of malnutrition in the statistical sense, but it weakened their ability to act on nutritional advice: one participant said they were too tired to read educational materials or concentrate on eating, while another described being unable to manage ordinary meals. Their accounts show how the physical demands embedded in inpatient transplantation can make even willing patients unable to meet recommendations centered on eating enough.

Dietary restrictions narrowed choice for all 16 participants. Patients described restrictions on rich or strongly tonic foods, including eel, soft-shelled turtle and ginseng, as well as limitations on particular fish, seafood and spicy dishes. Some complied because doctors or nurses advised them not to eat these foods, but the restrictions could leave them with meals that differed markedly from their usual preferences. Eight participants also described a mismatch between home eating patterns and the unit’s fixed schedule. Some had small appetites and became hungry long before the next official meal, yet there was no food between the three main meals. Others ate alone rather than with family, making meals feel cold and task-like. Reheating family-cooked food for delivery to the unit could also reduce its texture, while transport over long distances left some meals soggy and less appealing.

Nutrition-impact symptoms affected not only the quantity consumed but also the meaning of food. Eleven participants reported nausea, vomiting or taste changes that made previously familiar foods repulsive or difficult to distinguish. The smell of meat, for example, could provoke vomiting, while chemotherapy-related changes made meals taste bitter or bland. Oral mucositis created another gap: 12 participants described painful mouths, ulcers and swallowing difficulty that sometimes left them unable to consume even water despite feeling hungry. Gastrointestinal symptoms were still more widespread, with 14 reporting diarrhea, bloating, impaired digestion or concern about poor absorption. Some feared that eating would trigger vomiting or abdominal pain, and one patient said oral nutritional supplement powder caused diarrhea. In these accounts, food ceased to function consistently as something nourishing or comforting; it could instead become painful, uncertain or futile.

Patients nevertheless tried to reclaim limited control over eating. Ten prioritized foods they could tolerate, even when those choices did not match ideal nutritional targets. Common choices included rice-water congee, millet congee, potato noodles, soft starch sheets, winter melon and steamed egg custard. Nine adjusted the pace, amount and expectations of eating to maintain a minimal intake. Some ate tiny bites while watching television or scrolling through a phone to divert attention from nausea; others stopped before reaching a point that would provoke vomiting. Seven also sought changes through conversations with family or clinical staff, including substitutions in food preparation or advice about whether a particular food was permitted. These behaviors indicate adaptation, but the study did not test whether they improved nutritional status or clinical outcomes.

When asked what form of nutritional support would be more useful, 13 of 16 participants wanted guidance that was practical and adapted to their current symptoms. Broad encouragement to “eat more” did not answer practical questions such as which food might be gentle on an unsettled stomach or when meat might be reintroduced after diarrhea. Patients wanted recommendations to change as nausea, oral pain, bloating and appetite fluctuated. Eight also wanted some autonomy over food-related decisions within the unit’s safety requirements, while 11 preferred realistic timelines for recovery over optimistic predictions. Several reported being told that weight or appetite could take months to improve, and one said that advice about rapid dietary restoration was discouraging when symptoms remained severe.

Family participation was central to these preferences: 14 of 16 participants regarded relatives as important participants in nutritional care. Family members prepared food, monitored restrictions, helped decide what could safely be brought into the unit and encouraged patients to continue eating. Their involvement was practical but also relational. For some, eating represented a collective family responsibility rather than an isolated act of self-management. Eight participants additionally said that advice was more acceptable when it aligned with culturally familiar ideas about nourishment and recovery. Their examples included congee for a sensitive stomach, mild foods such as pumpkin and taro, and the belief that nutritional restoration should proceed gradually. The researchers cautioned that food preferences and beliefs are not uniform across China; regional cuisine, local customs and stage-specific recovery beliefs may shape what different patients consider appropriate.

The study provides a patient-centered account of a difficult clinical period, but its evidence is preliminary. It included only 16 participants from one institution, all interviewed three to 21 months after transplantation, so recall bias is possible. The interviews averaged 27 minutes, which may have limited the depth of some accounts, and social-desirability bias could have influenced discussion of food, family support and treatment cooperation. The researchers did not compare patients’ accounts with those of nurses, physicians, dietitians or family caregivers, and patients with the most severe symptoms or those receiving enteral or parenteral nutrition may have been underrepresented. Accordingly, the findings describe how these participants experienced nutrition management rather than demonstrating that a particular nutritional intervention improves outcomes. Their central message is that transplant-unit nutrition is embodied and relational: successful support may need to account for symptoms, institutional constraints, family roles, cultural understandings of food and realistic recovery timelines, not merely prescribe intake targets.

Subject of Research: Patient experiences of nutrition management during hematopoietic stem cell transplantation hospitalization

Article Title: Chinese HSCT patients' perceptions and experiences of nutrition management during transplant-unit hospitalization: a qualitative study

Article References: Wang, Y., Cheng, Q., Zhu, M., Xu, H., Tu, N., Zhu, J., & Zhang, X. (2026). Chinese HSCT patients' perceptions and experiences of nutrition management during transplant-unit hospitalization: a qualitative study. Frontiers in Nutrition, 13, Article 1970435. https://doi.org/10.3389/fnut.2026.1970435

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1970435

Keywords: hematopoietic stem cell transplantation, nutrition management, nutrition-impact symptoms, transplant unit, qualitative study, Chinese patients, food preferences, family caregiving, mucositis, nutritional recovery, Chinese, HSCT

The research, published in Supportive Care in Cancer, examined 65 patients with non-keratinizing nasopharyngeal carcinoma receiving curative-intent chemoradiotherapy at a single center. Thirty-four of these patients had documented use of ozonated water mouthrinses during their radiation course, while 31 served as controls receiving standard oral care alone. The primary endpoint was the time to first development of WHO grade 2 or worse oral mucositis, measured on a fraction-based time scale that tracked each radiation session individually.

The results were striking. In a time-dependent Cox model that treated ozonated water exposure as a time-varying covariate, documented use was associated with a 65 percent lower hazard of developing moderate-to-severe oral mucositis, with a hazard ratio of 0.35 and a confidence interval of 0.20 to 0.63, reaching statistical significance at P less than 0.001. A 10-fraction landmark analysis, which restricted the cohort to patients who remained event-free at fraction 10 and started follow-up from that point, showed a directionally consistent association with a hazard ratio of 0.47. By fraction 30—the end of the planned 33-fraction course—only 50 percent of ozonated water users had developed grade 2 or worse mucositis, compared with 90.3 percent of controls.

Beyond the mucositis endpoint itself, the ozonated water group reported significantly lower peak oral pain scores on a 0-to-10 visual analogue scale, with a Cliff’s delta of −0.39 indicating a clinically relevant reduction. The study also found a nonsignificant trend toward a shorter post-radiotherapy mucosal healing interval, with a median difference of 3.9 days favoring the ozonated water group. The number needed to treat decreased from approximately 4 at fraction 15 to approximately 2 at fraction 30, suggesting increasingly meaningful absolute benefits as treatment progressed.

The preparation protocol behind these results was anything but casual. Medical oxygen served as the feed gas, and ozone was generated at a concentration of 10 micrograms per normal milliliter using a German medical ozone therapy device. The ozone was bubbled through 250 milliliters of double-distilled water for 5 minutes, yielding a dissolved-ozone concentration of 2.5 micrograms per normal milliliter. Solutions were stored in sealed glass bottles with silicone stoppers at 4 to 6 degrees Celsius and used within 30 minutes of preparation, with any solution exceeding this limit or stored above 8 degrees Celsius discarded.

Patients performed one rinse 15 to 30 minutes before and one 15 to 30 minutes after each radiation fraction, with additional rinses upon waking, after each of three meals, and at bedtime while on the ward—amounting to at least five sessions per day. Each session used 20 to 30 milliliters with repeated swishes to cover the entire oral cavity, lasting 5 minutes per session. Patients were advised to avoid swallowing and to maintain at least a 15-minute interval between toothbrushing and rinsing. Once initiated, the ozonated water course continued through the end of radiotherapy, with possible extension for 7 to 14 days if mucositis or pain persisted.

The biological rationale for these findings rests on several converging mechanisms. Dissolved ozone can rapidly reduce oral microbial and biofilm burdens, a property that matters because the oral mucosal microenvironment in radiation patients is often characterized by dysbiosis, chronic inflammation, and impaired repair capacity. Ozone also attenuates mucosal inflammation by activating the Nrf2 pathway and inhibiting NF-κB, while promoting epithelial repair and microcirculatory perfusion—thereby dampening the inflammatory cascade and ulcer progression that drive mucositis severity.

The study team was careful to address the methodological pitfalls inherent in observational research. Because ozonated water initiation occurred after radiotherapy had started in some patients, fixed exposure classification by ever-use could introduce immortal time bias. The researchers therefore emphasized time-aware analyses, including the time-dependent Cox model and the landmark analysis, while retaining propensity score-based models as supportive analyses. Stabilized inverse-probability-of-treatment weighting produced a hazard ratio of 0.48, and additional sensitivity analyses—including propensity score matching, weight truncation, overlap weighting, and a stage-based specification—showed directionally consistent estimates throughout.

Yet the authors are unequivocal that these findings cannot be interpreted as proof of causal efficacy. The retrospective design, modest sample size, optional and time-varying ozonated water uptake, residual confounding, and chart-based exposure and outcome ascertainment all limit the strength of the conclusions. E-values quantifying the potential impact of unmeasured confounding ranged from 3.54 to 5.38, suggesting that a hypothetical unmeasured factor would need to be associated with both ozonated water use and mucositis outcomes by substantial margins to explain away the observed associations. The researchers also noted that abstraction and verification were not blinded to exposure status, and undocumented ozonated water use among controls cannot be excluded.

Against the backdrop of existing supportive interventions—photobiomodulation with its higher-level evidence but significant equipment and training costs, cryotherapy with restricted applicability in concurrent chemoradiotherapy, and heterogeneous conclusions for glutamine and zinc—ozonated water emerges as a candidate adjunctive approach that could be readily embedded into routine care pathways. The authors call for prospective multicenter studies with standardized protocols, objective adherence monitoring, and blinded outcome assessment to determine whether this simple rinse can deliver on the promise suggested by these exploratory real-world associations.

Subject of Research: Oncology

Article Title: Ozonated water mouthrinse for radiation-induced oral mucositis in non-keratinizing nasopharyngeal carcinoma: a retrospective cohort study

Article References: Yu, J., Ou, X., Tong, F., Su, Q., Zeng, W., Wang, Z., & Li, X. (2026). Ozonated water mouthrinse for radiation-induced oral mucositis in non-keratinizing nasopharyngeal carcinoma: a retrospective cohort study. Supportive Care in Cancer, 34(11), Article 1111. https://doi.org/10.1007/s00520-026-11343-0

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11343-0

Keywords: oral mucositis, nasopharyngeal carcinoma, ozonated water, radiotherapy, supportive care, head and neck cancer, Ozonated, water, mouthrinse, radiation-induced, oral, mucositis

The biological rationale for this call is straightforward once the mechanics of CAR-T therapy are understood. Before engineered T-cells are infused, patients typically receive lymphodepleting chemotherapy, a regimen designed to suppress their existing immune system so that the infused cells can expand without being rejected. This creates a window of profound immunosuppression, often compounded by severe neutropenia, in which the body’s defenses against bacteria, fungi, and viruses are dramatically weakened. At the same time, many candidates for CAR-T have already been through multiple lines of chemotherapy, which damages the oral mucosa, alters saliva production, and disrupts the delicate microbial ecosystem of the mouth. The result is that even a routine dental infection or an untreated cavity can become a serious systemic threat precisely when the patient is most vulnerable.

The oral cavity is, in fact, one of the most microbiologically dense environments in the human body, harboring hundreds of bacterial species alongside fungi such as Candida albicans. When mucosal barriers break down, as they commonly do during intensive cancer therapy, these microorganisms can translocate into the bloodstream. Recent research on Candida has shown how fungal cells can cross the intestinal epithelial barrier, and the same principle applies to oral tissues. In a patient recovering from lymphodepletion and facing the inflammatory storm of cytokine release syndrome, a dental abscess or fungal overgrowth is not a minor inconvenience; it is a potential source of sepsis, treatment delay, or even failure of the CAR-T product itself. Niscola and Del Principe emphasize that oral infectious complications are among the avoidable hazards that a structured dental evaluation could help prevent.

Evidence supporting this concern is accumulating. A retrospective observational study published in the same journal examined oral manifestations and dental management in patients undergoing CAR-T cell therapy and documented a range of problems, including mucositis, infections, and xerostomia, the distressing dryness of the mouth that follows damage to salivary glands. Related work in patients who have undergone allogeneic hematopoietic stem cell transplantation, a closely related form of cellular therapy, has measured long-term changes in the immunological components of saliva, suggesting that glandular function and mucosal immunity may take months or years to recover, if they recover at all. These findings paint a picture of the mouth as a barometer of systemic vulnerability, one that changes measurably during and after aggressive immunotherapy.

The functional consequences extend beyond infection. New clinical data on swallowing outcomes after CAR-T treatment in patients with non-Hodgkin lymphoma have documented dysphagia, or difficulty swallowing, as a real and underappreciated complication of the therapy pathway. Taste disturbances, or dysgeusia, have also been reported in association with immunotherapy, and recent translational work has explored microbiome-aware nutritional strategies to address them. When eating becomes painful, difficult, or unappetizing, patients lose weight, malnutrition sets in, and recovery slows. Oral health, in other words, is not a cosmetic concern but a determinant of whether a patient can maintain the nutritional and physical resilience needed to weather the acute phase of CAR-T therapy and benefit from it in the long run.

Recognizing these risks, the international supportive care community has begun to respond. In 2025, the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology issued a joint clinical practice statement recommending dental evaluation and management before treatment for hematologic malignancies and before CAR-T cell therapy. The statement, authored by an expert panel including Zadik, Raber-Durlacher, Epstein, and colleagues, essentially formalizes what dental oncologists have long practiced: that patients scheduled for intensive immunotherapy should undergo a thorough oral examination, radiographic assessment, and stabilization of active disease before their immune system is deliberately dismantled. Niscola and Del Principe’s commentary can be read as both an endorsement of that guidance and a call to close the gap between recommendation and routine practice.

What would such integration look like in practice? The authors sketch a pathway that begins at patient selection, when a candidate for CAR-T is first identified. At that point, ideally weeks before lymphodepletion begins, a dentist or oral medicine specialist would assess caries risk, screen for periodontal disease and non-vital teeth, evaluate the condition of dentures and oral prostheses, and treat any source of potential infection. Preventive measures would include professional cleaning, fluoride application, and patient education on meticulous oral hygiene. During the hospital admission for infusion, the focus shifts to monitoring for mucositis, managing xerostomia with salivary substitutes or stimulants, and watching for early signs of oral candidiasis or herpes simplex reactivation. After discharge, follow-up dental visits would track healing, address persistent dry mouth or taste changes, and restore function as immune reconstitution proceeds.

The commentary also situates oral care within the broader architecture of CAR-T supportive management, which has grown increasingly sophisticated around toxicities such as cytokine release syndrome and immune effector cell-associated neurotoxicity. Guidelines for managing these systemic toxicities are now well established, and the authors suggest that oral supportive care deserves the same systematic attention. They point to their own prior work on mucosal toxicity in hematological malignancies, which reviewed prevention and management strategies across the spectrum of intensive therapies, as part of a growing literature arguing that the mucosal surfaces of the body are a frontline in cancer supportive care. The mouth, being simultaneously a sensory organ, a digestive gateway, and a microbial reservoir, sits at the intersection of several of these concerns.

There are practical challenges to implementing the vision. CAR-T therapy is delivered in a relatively small number of specialized centers, and patients often travel long distances for treatment, which complicates coordination with community dental providers. Many patients arrive with years of neglected dental care, particularly those whose cancer diagnosis interrupted routine checkups, and complete dental rehabilitation can take longer than the clinical window allows. Prioritization therefore becomes essential: treating active infection and removing unstable teeth take precedence over elective work, and the MASCC/ISOO statement offers a framework for triage. The authors argue that embedding a dental assessment checklist into the standard CAR-T workup, much as cardiac and infectious disease evaluations are already routine, would require modest resources but could prevent disproportionate harm.

Ultimately, the message of the commentary is one of integration rather than novelty. CAR-T cell therapy represents one of the most striking achievements of modern medicine, and its expanding applications across hematological malignancies continue to grow, as recent reviews of the field document. But the technology’s promise can only be realized if patients survive and thrive through the treatment window, and that depends on the unglamorous details of supportive care. Oral health, the authors contend, should no longer be an afterthought delegated to chance. By bringing dentists into the multidisciplinary team that plans and delivers CAR-T therapy, centers can reduce infectious complications, preserve nutrition and quality of life, and give patients the best possible chance of enjoying the remissions that this remarkable therapy can deliver.

Subject of Research: Integrating oral health and preventive dental care into CAR-T cell therapy supportive care

Article Title: Integrating oral health and preventive dental care into CAR-T cell therapy

Article References: Niscola, P., & Del Principe, M. I. (2026). Integrating oral health and preventive dental care into CAR-T cell therapy. Supportive Care in Cancer, 34(10), Article 1012. https://doi.org/10.1007/s00520-026-11268-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11268-8

Keywords: CAR-T cell therapy, oral health, preventive dental care, supportive care, hematologic malignancies, mucositis, immunosuppression, dysgeusia, dysphagia, oral infections, immunotherapy, MASCC/ISOO guidelines