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. 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.
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.
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.
Authors: Viviane C Pereira; Sarah N Silva; Viviane K S Carvalho; Fernando Zanghelini; Jorge O M Barreto Journal: Health Res Policy Syst Date: 2022-01-24