Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison

Annic Baumgartner; Mario Bargetzi; Annika Bargetzi; Noemi Zueger; Micheal Medinger; Jakob Passweg; Urs Schanz; Panagiotis Samaras; Yves Chalandon; Claude Pichard; Alessandro Limonta; Luciano Wannesson; Thomas Pabst; Michel A Duchosal; Urs Hess; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.nut.2016.10.007

Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison

Nutrition. 2017 Mar:35:43-50. doi: 10.1016/j.nut.2016.10.007. Epub 2016 Oct 15.

Authors

Annic Baumgartner¹, Mario Bargetzi², Annika Bargetzi¹, Noemi Zueger¹, Micheal Medinger³, Jakob Passweg³, Urs Schanz⁴, Panagiotis Samaras⁴, Yves Chalandon⁵, Claude Pichard⁶, Alessandro Limonta⁶, Luciano Wannesson⁷, Thomas Pabst⁸, Michel A Duchosal⁹, Urs Hess¹⁰, Zeno Stanga¹¹, Beat Mueller¹, Philipp Schuetz¹²

Affiliations

¹ Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland.
² Clinic for Hematology and Oncology, Kantonsspital Aarau, Aarau, Switzerland.
³ Clinic for Hematology, University Hospital Basel, Basel, Switzerland.
⁴ Clinic for Hematology and Clinic for Oncology, University Hospital Zürich, Zürich, Switzerland.
⁵ Clinic for Hematology, University Hospital Geneva, Geneva, Switzerland.
⁶ Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
⁷ Instituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
⁸ Clinic for Hematology and Oncology, University Hospital Bern, Bern, Switzerland.
⁹ Service and Central Laboratory of Hematology, University Hospital of Lausanne, Lausanne, Switzerland.
¹⁰ Clinic for Hematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹¹ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Bern, Switzerland.
¹² Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: Schuetzph@gmail.com.

PMID: 28241989
DOI: 10.1016/j.nut.2016.10.007

Abstract

Objective: In 2009, international nutritional societies published practice guidelines on screening and nutritional support for patients undergoing stem cell transplantation. Little is known about how these guidelines are implemented in clinical practice. We performed a nationwide survey with the aim of understanding current practice patterns, differences between clinical practice, and international recommendations as well as barriers to the use of nutritional therapy.

Methods: We performed a qualitative survey including all centers across Switzerland offering allogeneic (n = 3) or autologous (n = 7) stem cell transplantation. We focused on in-house protocols pertaining to malnutrition screening, indications for nutritional support, types of nutritional therapy available and provided, and recommendations regarding neutropenic diets.

Results: All centers offering allogeneic, and most of the centers offering autologous transplantation, had a malnutrition screening tool, mainly the nutritional risk score (NRS 2002) method. Only one center does not provide nutritional support. There is wide variation regarding start and stop of nutritional therapy as well as route of delivery, with five centers recommending parenteral nutrition and five centers recommending enteral nutrition as a first step. Although all centers offering allogeneic transplantation, and approximately every other autologous transplant center, used a neutropenic diet, specific recommendations regarding the type of food and food handling showed significant variation.

Conclusion: This Swiss survey found wide variation in the use of nutritional therapy in patients undergoing stem cell transplantation, with low adherence overall to current practice guidelines. Understanding and reducing barriers to guideline implementation in clinical practice may improve clinical outcomes. Close collaboration of centers will facilitate future research needed to improve current practice and ensure high quality of treatment.

Keywords: Guidelines; Hematopoietic stem cell transplantation; Nutrition; Survey.

Publication types

Multicenter Study

MeSH terms

Diet
Evaluation Studies as Topic
Hematopoietic Stem Cell Transplantation*
Humans
Malnutrition / diagnosis
Nutrition Assessment
Nutrition Policy
Nutritional Support / methods*
Nutritional Support / standards*
Patient Compliance
Surveys and Questionnaires
Switzerland
Transplantation, Autologous