Abstract
A survey within Italian haematopoietic stem cell transplant (HSCT) programmes was performed, in order to obtain a snapshot of nutritional support (NS) in patients undergoing HSCT. The primary objective was to verify whether an evidence-based practice (EBP) approach to NS was implemented in HSCT centres. A multicentre survey was performed by questionnaire, covering the main areas of NS (screening, treatment planning, monitoring, nutritional counselling, and methods of nutritional support). The results indicated a significant variation between clinical practice and evidence-based guidelines in terms of clinical pathways, decision-making, and care provision regarding NS. Further research is required to identify reasons for the limited application of EBP and measures that may be undertaken to address such issues. Development of a multidisciplinary educational programme in order to raise awareness of the issue should be undertaken.
Highlights
Malnutrition in patients undergoing haematopoietic stem cell transplant (HSCT) is related to a series of factors including the underlying disease, nutritional state pre-transplant, conditioning regimen used, and complications such as graft versus host disease (GvHD) [1]
We report the results of a national survey of transplant centres looking at nutritional care for HSCT patients, in which a notable variation in practice was observed
One reason may be related to the weighing of the recommendations, as these are the result of complex analyses, which are often poorly supported by the presence of high quality evidence
Summary
Malnutrition in patients undergoing HSCT is related to a series of factors including the underlying disease, nutritional state pre-transplant, conditioning regimen used, and complications such as graft versus host disease (GvHD) [1]. A nutritional intervention is appropriate in HSCT patients who are malnourished, or expected to have a reduced intake or reduced absorption of nutrients for a prolonged period of time, or have developed moderate or severe GvHD accompanied by a reduced oral intake and/or significant malabsorption [1]. HSCT patients are poorly compliant to all that is nutrition and NS [2], and the use of artificial nutritional interventions incur numerous side effects and significantly affect costs [21, 22]. These types of factors including others such as social, psychological, and ethical, can impact on decisions regarding NS provision. Despite suggestions from the literature, which aim to orient, coordinate, and guide healthcare professionals in providing optimal care, the actual translation from the literature into clinical practice remains challenging, and this may be compounded by a lack of clear evidence for some of the NS methods, where clinical results are often influenced by the complexity of the clinical context
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