A Pilot Study of Nutritional Tool Implementation during Autologous Transplant to Improve Caloric and Protein Intake

Abstract

Background Patients receiving cytotoxic chemotherapy are at risk for gastrointestinal toxicities. Malnutrition is a common consequence of alteration in diet caused by chemotherapy. A review of the literature indicates that malnutrition plays an important role in cancer prognosis and outcomes, including contribution to longer hospitalizations. The few studies in which individualized, specialized nutritional interventions were implemented demonstrated a decrease in the frequency of malnourishment. Purpose The purpose of this before and after interventional study was to determine if early intervention and provision of specialized menus regarding appropriate diet choices tailored for specific GI symptoms to autologous transplant patients would improve nutrition status (overall calorie and protein intake) throughout transplant process. This pilot interventional study was designed to provide baseline data for further research in this population. Methods This study used sequential cohorts, with control group being enrolled first to reduce potential contamination with nursing staff as to which patient was receiving intervention. Calorie counts were completed on each patient per protocol. Worksheets were collected from each patient on self-reporting of GI symptoms. At end of data collection period, each patient completed a questionnaire on study experience. Results 20 patients' recorded nutritional intake measurements were analyzed with no significant differences found (reported in mean ± SD). Total caloric intake in control group was 12106.93±6970.41, compared to intervention group of 9221.86±3219.63. Total protein intake in control group of 383.73±187.8, compared to intervention group of 349.6±128.66. Average daily caloric intake in control group of 1083.53±606.88, compared to intervention group of 811.11±288.04. Average daily protein intake in control group of 37.49±20.87, compared to intervention group of 30.68±120.87. Conclusion Results indicated that there was no difference between the groups in respect to nutritional intake or patient experience. Possible explanation for this outcome includes a physical bed tower move during data collection, which affected menu item availability and contributed to changes in oral intake and patient dissatisfaction. Also, delivery of specialized menus in addition to standard hospital menu contributed to confusion in ordering. This outlined a need to incorporate information into existing menu. A larger, randomized trial with above modifications is necessary to determine impact of this intervention, with goal of providing this high risk oncologic population with a higher level of nutritional supportive care during transplant hospitalizations.