Nutrition support during allogeneic stem cell transplantation: evidence versus practice
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ORIGINAL ARTICLE
Nutrition support during allogeneic stem cell transplantation: evidence versus practice Sarah Andersen 1,2
&
Merrilyn Banks 1,2 & Teresa Brown 1,2 & Nicholas Weber 3 & Glen Kennedy 3 & Judy Bauer 2
Received: 15 December 2019 / Accepted: 4 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Enteral nutrition . Parenteral nutrition . Nutrition support . Allogeneic stem cell transplant
Introduction Allogeneic haematopoietic progenitor cell transplantation (HPCT) is frequently used in the treatment of haematological malignancies. Due to the intensive conditioning regimen Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05397-x) contains supplementary material, which is available to authorized users. * Sarah Andersen [email protected] 1
Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
2
School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
3
Department of Clinical Haematology, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
given prior to transplant, gastrointestinal side effects such as anorexia, nausea, vomiting, diarrhoea and mucositis are common post-HPCT resulting in prolonged poor oral intake [1]. Patients are at hi
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