Abstract
Patients undergoing myeloablative conditioning regimens and autologous stem-cell transplantation (asct) are at high risk of malnutrition. This randomized study aimed to determine if early nutrition support (commenced when oral intake is less than 80% of estimated requirements) compared with usual care (commenced when oral intake is less than 50% of estimated requirements) reduces weight loss in well-nourished patients undergoing high-nutritional-risk conditioning chemotherapy and asct. In the 50 well-nourished patients who were randomized, the outcomes evaluated included changes in weight and lean body mass (mid-upper arm circumference), length of stay, time to hemopoietic engraftment, and quality of life (Memorial Symptom Assessment Scale - Short Form). On secondary analysis, after exclusion of a single extreme outlier, both groups demonstrated significant weight loss over time (p = 0.0005). Weight loss was less in the early nutrition support group at time of discharge (mean: -0.4% ± 2.9% vs. -3.4% ± 2.6% in the usual care group, p = 0.001). This difference in weight was no longer observed at 6 months after discharge (mean: -1.0% ± 6.8% vs. 1.4% ± 6.1%, p = 0.29). In practice, an early start to nutrition support proved difficult because of patient resistance and physician preference, with 8 patients (33%) in the control group and 4 (15%) in the intervention group not commencing nutrition support when stipulated by the study protocol. No significant differences between the groups were found for other outcomes. In well-nourished patients receiving asct, early nutrition support maintained weight during admission, but did not affect other outcomes. Interpretation of results should take into consideration the difficulties encountered with intervention implementation.
Highlights
Malnutrition is common in cancer patients and is associated with poorer patient and treatment outcomes[1,2]
Nutrition intervention studies undertaken in the asct population have focused on enteral compared with parenteral nutrition; predictors of mucositis; and the use of oral, enteral, or parenteral glutamine[8,9]
Nutrition research in stem-cell transplantation has focused largely on three areas: the feasibility of enteral compared with parenteral nutrition[8], predictors of mucositis[4,7,11], and the role of glutamine[8]
Summary
Malnutrition is common in cancer patients and is associated with poorer patient and treatment outcomes[1,2]. Nutrition support is required to prevent malnutrition as a consequence of treatment toxicities and has been established as a standard of care in many myeloablative conditioning regimens[6]. The conditioning regimens associated with the greatest gastrointestinal toxicity are those containing melphalan or busulphan and those incorporating total body irradiation (tbi)[4,7]. Evidence for nutrition interventions that are optimal in preventing malnutrition in patients undergoing asct is currently limited and largely based on expert opinion[6]. No studies have examined whether commencing nutrition support in advance of a large deficit in oral intake improves patient outcomes
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