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Nutrition support during allogeneic stem cell transplantation: evidence versus practice

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Abstract

Purpose

Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haematopoietic progenitor cell transplantation (HPCT), however there is limited consensus on the appropriate mode and timing of nutrition support commencement. This study aimed to investigate current nutrition support practices in Australian allogeneic transplant units and explore barriers and enablers to the use of EN and PN.

Methods

All Australian adult allogeneic HPCT units were eligible to participate. A survey tool was developed, and phone interview with each unit dietitian was completed to explore current nutrition support and perceived barriers and enablers to provision of nutrition care.

Results

A total of 12 (100%) units agreed to participate. Six (50%) units reported using PN as standard care and six use EN routinely for one or more conditioning regimens. All units using EN place feeding tubes proactively with tolerance of EN reported at 50–95%. The most frequently reported barriers to the use of EN include perception of poor EN tolerance, medical team preference for PN, gastrointestinal symptoms and thrombocytopenia. Reported barriers to the use of PN include fluid overload, elevated liver enzymes, patient apprehension about PN commencement, medical team uncertainty if PN is required and patients approaching engraftment.

Conclusion

There is wide variation in the mode and timing of nutrition support provided to patients undergoing allogeneic HPCT. Clinical guidelines should be updated to reflect recent findings on EN use and incorporate strategies to optimise EN tolerance. This will assist in standardising practice and facilitate evidence-based nutrition care.

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Funding

This research was supported by grants from the Royal Brisbane & Women’s Hospital Research Foundation.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

    Sarah Andersen, Merrilyn Banks & Teresa Brown

  2. School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia

    Sarah Andersen, Merrilyn Banks, Teresa Brown & Judy Bauer

  3. Department of Clinical Haematology, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

    Nicholas Weber & Glen Kennedy

Authors
  1. Sarah Andersen
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  2. Merrilyn Banks
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  3. Teresa Brown
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  4. Nicholas Weber
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  5. Glen Kennedy
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  6. Judy Bauer
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Contributions

SA carried out the study design, data collection, data analysis, interpretation and manuscript drafting. MB, TB, NW, GK and JB assisted with study design, data analysis and interpretation and critical revision of the manuscript. All authors have read and approved the final manuscript. The authors have full control of the primary data.

Corresponding author

Correspondence to Sarah Andersen.

Ethics declarations

Ethical approval was received from the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (reference HREC/18/QRBW/320) and the University of Queensland Human Research Ethics Board approval number 2018001549.

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The authors declare that they have no conflict of interest.

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Andersen, S., Banks, M., Brown, T. et al. Nutrition support during allogeneic stem cell transplantation: evidence versus practice. Support Care Cancer 28, 5441–5447 (2020). https://doi.org/10.1007/s00520-020-05397-x

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