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Kujawska J, Zeiser R, Gil L. Recent advances in acute gastrointestinal graft versus host disease (aGvHD): aspects of steroid-resistant disease. Ann Hematol 2024:10.1007/s00277-024-05952-0. [PMID: 39207560 DOI: 10.1007/s00277-024-05952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Acute Graft versus Host Disease (aGvHD) is a common immunological complication occurring in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Moreover, aGvHD is associated with a higher risk of infections and metabolic complications, affecting non-relapse mortality. Progress in transplantation has changed the prophylactic and therapeutic strategies of aGvHD and improved patient outcomes. The standard first-line therapy remains steroids, with a response rate of about 50%. The Janus Kinase 2 (JAK2) inhibitor, ruxolitinib, is an effective second-line therapy. The management of patients who developed a disease that is refractory to steroids and ruxolitinib, especially in the severe gastrointestinal forms of aGvHD, is not validated and remains an unmet medical need. In the article, we present the current clinical practice, as well as the latest advances targeting pathophysiological pathways of GvHD and gut microbiota, which may be a potential future of aGvHD therapy.
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Affiliation(s)
- Joanna Kujawska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland.
| | - Robert Zeiser
- Department of Internal Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
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Valdés Boccardo S, Sarmiento Maldonado M, Velasco Fuentes N. [Nutritional evolution during the early stages of hematopoietic stem cell transplantation: importance of the phase angle]. NUTR HOSP 2023. [PMID: 37929830 DOI: 10.20960/nh.04732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION the aim of this study is to compare the changes in anthropometry, dynamometry and bioelectrical impedance analysis (BIA) of patients undergoing autologous and allogeneic hematopoietic stem cell transplantation (HSCT) after the conditioning period and one-week post-transplantation, and to assess whether these early changes are associated with the development of later complications. METHODS prospective cohort study. Nutritional status was assessed by anthropometry, dynamometry and BIA at three different defined times: T1, time of admission; T2, after the myeloablative conditioning period; and T3, day + 8 post-HSCT. RESULTS forty patients were evaluated, 17 received autologous HSCT (TAU) and 23 received allogeneic HSCT (TAL). Patients with TAL had higher mortality and hospital stay compared to patients with TAU. Those who developed graft versus host disease (GVHD) presented a lower phase angle (PA) than those who did not develop this complication (T2: TAL PA with GVHD 4.8° vs TAL PA without GVHD 5.5°, p = 0.007). The patients who died during the hospital stay are all from the TAL group and had PA less than 5° at T3. Weight, body mass index (BMI) and fat-free mass index (FMI) did not show a significant impact, and all of them were influenced by total body water. CONCLUSIONS early nutritional evaluation of these patients by phase angle seems promising, since it is not altered by water retention and can be evaluated before anthropometric changes occur.
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Affiliation(s)
- Silvana Valdés Boccardo
- Departamento de Nutrición, Diabetes y Metabolismo. Escuela de Medicina. Facultad de Medicina. Pontificia Universidad Católica de Chile
| | - Mauricio Sarmiento Maldonado
- Departamento de Hematología y Oncología. Escuela de Medicina. Facultad de Medicina. Pontificia Universidad Católica de Chile
| | - Nicolás Velasco Fuentes
- Departamento de Nutrición, Diabetes y Metabolismo. Escuela de Medicina. Facultad de Medicina. Pontificia Universidad Católica de Chile
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Andersen S, Xu J, Llewellyn S, Kennedy G, Bauer J. Nutrition support and clinical outcomes following allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58:1137-1142. [PMID: 37542189 DOI: 10.1038/s41409-023-02080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
Nutrition support is frequently required post allogeneic stem cell transplantation (SCT) and while there is some evidence on the benefits of enteral nutrition (EN), parenteral nutrition (PN) is widely used in practice. The study aimed to examine the impact of EN versus PN on early outcomes following SCT. All patients who underwent allogeneic SCT over 2.5 years were included in the analysis. Data was retrospectively collected on mode of nutrition support with clinical outcome data obtained from an existing database. Clinical outcomes were compared between groups by logistic, poisson and negative binomial regression, with adjustment for baseline confounders as appropriate. Patients who received EN then changed to PN had a longer length of hospital stay compared to those who received EN only (IR 1.24, 95% CI: 1.11-1.38, p < 0.001). Compared to those who received EN only, patients who received EN that changed to PN or PN only had a longer time to neutrophil engraftment (IR 1.11, 95% CI: 1.02-1.20, p = 0.016 and IR 1.16, 95% CI: 1.03-1.30, p = 0.017) and platelet engraftment (IR 1.20, 95% CI 1.08-1.33, p < 0.001 and IR 1.24, 95% CI 1.08-1.42, p = 0.002). Enteral nutrition should be first line nutritional support for patients undergoing allogeneic SCT.
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Affiliation(s)
- Sarah Andersen
- Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Jiani Xu
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Stacey Llewellyn
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Glen Kennedy
- Department of Haematology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
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van Lieshout R, Tick LW, de Beer F, Koene HR, Regelink JC, Westerweel PE, de Witte MA, Beckers EAM, Schouten HC, Beijer S. Medical nutrition therapy during intensive remission-induction treatment and hematopoietic stem cell transplantation in acute myeloid leukemia patients: Hematologists' experiences and perspectives. Clin Nutr ESPEN 2023; 57:399-409. [PMID: 37739686 DOI: 10.1016/j.clnesp.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS The European Societies for Clinical Nutrition and Metabolism (ESPEN) and Blood and Marrow Transplantation (EBMT) recommend enteral nutrition (EN) as the first-choice medical nutrition therapy in acute myeloid leukemia (AML) patients undergoing intensive treatments, including high-dose remission-induction chemotherapy and hematopoietic stem cell transplantation (HSCT). However, parenteral nutrition (PN) remains the preferred method of nutrition support in current clinical practice. The aim of this qualitative study was to gain insight into hematologists' experiences and perspectives regarding the choice and ESPEN/EBMT recommendations on EN versus PN. METHODS Online semi-structured interviews were conducted with one hematologist from each of the 21 hospitals offering intensive AML treatments in the Netherlands, using Microsoft Teams. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using Atlas. ti. One hundred nineteen hematologists working in the same hospitals were invited to complete a short online questionnaire survey (SurveyMonkey®) regarding their knowledge and opinion on the ESPEN/EBMT guidelines recommending EN over PN during intensive AML treatments. The results of this survey are presented in a descriptive way. RESULTS Fifty-nine hematologists participated in this study (42% overall response rate), of which 21 in the semi-structured interviews (response rate 100%) and 38 in the online survey (response rate 32%). Hematologists considered medical nutrition therapy important for prevention and treatment of malnutrition and associated adverse outcomes in AML patients undergoing intensive remission-induction treatment and HSCT. However, opposed to the ESPEN/EBMT guidelines, the vast majority of hematologists were hesitant or reluctant to use EN instead of PN as the first-choice medical nutrition therapy in these patients. The most frequently cited barriers to use EN were the expected low feasibility and tolerance of EN, feeding tube-related discomfort and bleeding risk, and patient refusal. Other barriers to follow the guidelines on EN were related to personal factors, including hematologists' knowledge (lack of awareness and familiarity) and attitude (lack of agreement, outcome expectancy, experience, success, motivation, and learning culture), guideline-related factors (lack of evidence and applicability), and external factors (lack of collaboration and resources). Facilitators included strategies for nutrition education and dissemination of nutritional guidelines, interprofessional and patient collaboration, availability of feeding tubes that can be inserted without endoscopy and stronger scientific evidence. CONCLUSIONS Hematologists recognized the importance of medical nutrition therapy for reducing malnutrition and related negative outcomes during intensive AML treatments. However, contrary to the ESPEN/EBMT guidelines, they preferred PN instead of EN as the medical nutrition therapy of first choice. To reduce compliance barriers, interventions should focus on improving hematologists' knowledge of medical nutrition therapy and dietary guidelines, enhancing success rates of EN by adequately triaging patients eligible for EN and inserting duodenal feeding tubes using an electromagnetic sensing device without endoscopy, developing decision aids and multidisciplinary guidelines and care pathways. Furthermore, future trials should focus on the feasibility and benefits of EN versus PN both during remission-induction treatment and HSCT.
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Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Fenne de Beer
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, Veldhoven, 5504 DB, The Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands
| | - Josien C Regelink
- Department of Internal Medicine, Meander Medical Center, Maatweg 3, Amersfoort, 3813 TZ, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands
| | - Moniek A de Witte
- Department of Internal Medicine, University Medical Center Utrecht, Division Hematology, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands
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Casirati A, Salcedo I, Cereda E, Chabannon C, Ruggeri A, Kuball J, Clout R, Mooyaart JE, Kenyon M, Caccialanza R, Pedrazzoli P, Kisch AM. The European Society for Blood and Marrow Transplantation (EBMT) roadmap and perspectives to improve nutritional care in patients undergoing hematopoietic stem cell transplantation on behalf of the Cellular Therapy and Immunobiology Working Party (CTIWP) and the Nurses Group (NG) of the EBMT. Bone Marrow Transplant 2023; 58:965-972. [PMID: 37407728 DOI: 10.1038/s41409-023-02018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023]
Abstract
Malnutrition is the most common comorbidity during the continuum of hematopoietic stem cell transplant (HSCT) and negatively impacts clinical outcomes, response to therapy, quality of life, and costs. The intensive conditioning regimen administered before transplant causes inflammatory damages to the gastrointestinal system, which themselves contribute to trigger graft versus host disease (GvHD) in the allogeneic setting. GvHD and other post-transplant complications such as infections adversely affect food intake and gut absorption of nutrients. Consequently, patients exhibit signs of malnutrition such as weight loss and muscle wasting, thus triggering a "vicious circle" that favours additional complications. Among HSCT centres, there is marked variability in nutritional care, from screening for malnutrition to nutritional intervention. The present paper, elaborated by the Cellular Therapy and Immunobiology Working Party and the Nurses Group of the European Society for Blood and Marrow Transplantation, aims at defining a roadmap that identifies the main nutritional critical issues in the field of HSCT. This document will be propaedeutic to the development of clinical algorithms to counteract risk factors of malnutrition, based on scientific evidence and shared among HSCT centres, and thus maximize transplant outcomes.
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Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Isabel Salcedo
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian Chabannon
- Centre de Thérapie Cellulaire & Centre d'Investigations Cliniques en Biothérapies Inserm CBT-1409, Institut Paoli-Calmettes, Marseille, France
| | - Annalisa Ruggeri
- Hematology and BMT Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Jurgen Kuball
- Department of Hematology and Center for Translational Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Ruth Clout
- Department of Haematology and Transplant Unit, The Christie Hospital, Manchester, United Kingdom
| | | | - Michelle Kenyon
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
- Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Annika M Kisch
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden and Institute of Health Sciences, Lund University, Lund, Sweden
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Limpert R, Pan P, Wang LS, Chen X. From support to therapy: rethinking the role of nutrition in acute graft-versus-host disease. Front Immunol 2023; 14:1192084. [PMID: 37359550 PMCID: PMC10285162 DOI: 10.3389/fimmu.2023.1192084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Allogeneic Hematopoietic stem cell transplantation (HSCT) offers a potential cure for patients with hematologic malignancies. Unfortunately, graft-versus-host disease (GVHD) remains a major obstacle to the greater success of this treatment. Despite intensive research efforts over the past several decades, GVHD is still a major cause of morbidity and mortality in patients receiving allogeneic HSCT. The genetic disparity between donor and recipient is the primary factor that dictates the extent of alloimmune response and the severity of acute GVHD (aGVHD). However, some nongenetic factors are also actively involved in GVHD pathogenesis. Thus, identifying host factors that can be readily modified to reduce GVHD risk is of important clinical significance. We are particularly interested in the potential role of nutrition, as a nongenetic factor, in the etiology and management of aGVHD. In this article, we summarize recent findings regarding how different routes of nutritional support and various dietary factors affect aGVHD. Since diet is one of the most important factors that shape gut microbiota, we also provide evidence for a potential link between certain nutrients and gut microbiota in recipients of allogeneic HSCT. We propose a shifting role of nutrition from support to therapy in GVHD by targeting gut microbiota.
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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van Lieshout R, Lize N, Tick LW, van Deursen J, Driessen E, Janssen T, Custers S, Kranenburg S, van der Lee D, Koene HR, Beckers EAM, Schouten HC, Beijer S. Nutrition-related problems, nutritional support practices and barriers to adherence to nutritional guidelines during intensive treatment for acute myeloid leukemia: Patients' and hematology nurses' perspectives and experiences. Clin Nutr ESPEN 2022; 48:446-455. [PMID: 35331527 DOI: 10.1016/j.clnesp.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS The updated guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) and for Blood and Marrow Transplantation (EBMT) on nutrition in intensively treated acute myeloid leukemia (AML) patients recommend enteral nutrition (EN) instead of parenteral nutrition (PN) as the first-choice medical nutrition therapy. Despite this, PN remains the preferred route of nutrition administration in daily practice. The aim of this qualitative study was to gain insight into the patients' and hematology nurses' experiences and perceptions regarding nutritional problems and nutritional support and the reasons for the low adherence to the ESPEN/EBMT guidelines. METHODS Semi-structured interviews were conducted in 23 patients from various Dutch hospitals who had completed intensive AML treatment. Interviews with 22 patients were audio-recorded and transcribed, one interview was summarized. The transcripts and summary were thematically analyzed using Atlas.ti. From each of the 22 Dutch hospitals providing intensive AML treatment, one hematology nurse participated in a telephone questionnaire survey. The results of this survey are presented in a descriptive way. RESULTS Nutritional problems were a major source of distress in most participating patients. Nutritional support often led to peace of mind and less concerns, provided that there were no conflicting nutritional support practices among treating hospitals. Patients perceived PN and EN as a life-line and necessary for the prevention of or recovery from physical decline, but they also experienced loss of independence, limited mobility, fear of unwanted body weight gain and problems related to the feeding equipment. Both patients and hematology nurses regarded PN as an easy method of nutrition administration, while EN was often seen as a necessary evil or was even refused by patients, owing to tube-related physical discomfort and EN intolerance. Both patients' and hematology nurses' reluctance to administer EN proved to be barriers to the ESPEN/EBMT nutritional guideline adherence. Among the surveyed hematology nurses, barriers to adherence included personal factors related to their knowledge (lack of awareness) and attitudes (negative outcome expectancy and lack of agreement), guideline-related factors (lack of evidence) and external factors (lack of collaboration). CONCLUSION Individualized nutritional support, including EN and PN, may reduce nutrition-related distress in intensively treated AML patients, provided that conflicting nutritional support practices among hospitals are avoided or explained. The barriers to adherence to the ESPEN/EBMT guidelines on EN and PN in this patient group may be reduced by enhancing hematology nurses' awareness and knowledge of the guidelines, incorporating the guidelines into multidisciplinary clinical pathways, improving outcome of EN by proper triage of patients eligible for EN and increasing the level of evidence of the guidelines.
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Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Nora Lize
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Judith van Deursen
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Eline Driessen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Tina Janssen
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Harry R Koene
- Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Division Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
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Pereira VC, Silva SN, Carvalho VKS, Zanghelini F, Barreto JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst 2022; 20:13. [PMID: 35073897 PMCID: PMC8785489 DOI: 10.1186/s12961-022-00815-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.
Methods
This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).
Results
This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
Conclusion
This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.
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Valenta S, Ribaut J, Leppla L, Mielke J, Teynor A, Koehly K, Gerull S, Grossmann F, Witzig-Brändli V, De Geest S. Context-specific adaptation of an eHealth-facilitated, integrated care model and tailoring its implementation strategies-A mixed-methods study as a part of the SMILe implementation science project. FRONTIERS IN HEALTH SERVICES 2022; 2:977564. [PMID: 36925799 PMCID: PMC10012712 DOI: 10.3389/frhs.2022.977564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023]
Abstract
Background Contextually adapting complex interventions and tailoring their implementation strategies is key to a successful and sustainable implementation. While reporting guidelines for adaptations and tailoring exist, less is known about how to conduct context-specific adaptations of complex health care interventions. Aims To describe in methodological terms how the merging of contextual analysis results (step 1) with stakeholder involvement, and considering overarching regulations (step 2) informed our adaptation of an Integrated Care Model (ICM) for SteM cell transplantatIon faciLitated by eHealth (SMILe) and the tailoring of its implementation strategies (step 3). Methods Step 1: We used a mixed-methods design at University Hospital Basel, guided by the Basel Approach for coNtextual ANAlysis (BANANA). Step 2: Adaptations of the SMILe-ICM and tailoring of implementation strategies were discussed with an interdisciplinary team (n = 28) by considering setting specific and higher-level regulatory scenarios. Usability tests were conducted with patients (n = 5) and clinicians (n = 4). Step 3: Adaptations were conducted by merging our results from steps 1 and 2 using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). We tailored implementation strategies according to the Expert Recommendations for Implementing Change (ERIC) compilation. Results Step 1: Current clinical practice was mostly acute-care-driven. Patients and clinicians valued eHealth-facilitated ICMs to support trustful patient-clinician relationships and the fitting of eHealth components to context-specific needs. Step 2: Based on information from project group meetings, adaptations were necessary on the organizational level (e.g., delivery of self-management information). Regulations informed the tailoring of SMILe-ICM`s visit timepoints and content; data protection management was adapted following Swiss regulations; and steering group meetings supported infrastructure access. The usability tests informed further adaptation of technology components. Step 3: Following FRAME and ERIC, SMILe-ICM and its implementation strategies were contextually adapted and tailored to setting-specific needs. Discussion This study provides a context-driven methodological approach on how to conduct intervention adaptation including the tailoring of its implementation strategies. The revealed meso-, and macro-level differences of the contextual analysis suggest a more targeted approach to enable an in-depth adaptation process. A theory-guided adaptation phase is an important first step and should be sufficiently incorporated and budgeted in implementation science projects.
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Affiliation(s)
- Sabine Valenta
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Janette Ribaut
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Lynn Leppla
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Juliane Mielke
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Alexandra Teynor
- Faculty of Computer Science, University of Applied Sciences Augsburg, Augsburg, Germany
| | - Katharina Koehly
- Department of Acute Medicine, Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabine Gerull
- Department of Hematology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Florian Grossmann
- Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Verena Witzig-Brändli
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Clinic for Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Sabina De Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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11
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Nabarrete JM, Pereira AZ, Garófolo A, Seber A, Venancio AM, Grecco CES, Bonfim CMS, Nakamura CH, Fernandes D, Campos DJ, Oliveira FLC, Cousseiro FK, Rossi FFP, Gurmini J, Viani KHC, Guterres LF, Mantovani LFAL, Darrigo LG, Albuquerque MIBPE, Brumatti M, Neves MA, Duran N, Villela NC, Zecchin VG, Fernandes JF. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents. EINSTEIN-SAO PAULO 2021; 19:eAE5254. [PMID: 34909973 PMCID: PMC8664291 DOI: 10.31744/einstein_journal/2021ae5254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
- Juliana Moura Nabarrete
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Garófolo
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Adriana Seber
- Universidade Federal de São PauloSão PauloSPBrazilUniversidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Angela Mandelli Venancio
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Carlos Eduardo Setanni Grecco
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Carmem Maria Sales Bonfim
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Claudia Harumi Nakamura
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Daieni Fernandes
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Denise Johnsson Campos
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Fernanda Luisa Ceragioli Oliveira
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Flávia Krüger Cousseiro
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Flávia Feijó Panico Rossi
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Jocemara Gurmini
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Karina Helena Canton Viani
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Luciana Fernandes Guterres
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Luiz Guilherme Darrigo
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Maria Isabel Brandão Pires e Albuquerque
- Instituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazilInstituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Melina Brumatti
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mirella Aparecida Neves
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Natália Duran
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Neysimelia Costa Villela
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Victor Gottardello Zecchin
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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12
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Nutritional support practices and opinions toward gastrostomy use in pediatric bone marrow transplant centers: A national survey. Nutrition 2021; 95:111556. [PMID: 34998029 PMCID: PMC8830357 DOI: 10.1016/j.nut.2021.111556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Previous surveys have shown deviations in nutritional practices from international guidelines during bone marrow transplant (BMT). Guidelines recommend enteral nutrition first-line and nasogastric tubes are the mainstay for its provision. Gastrostomies provide an alternative, yet their use is less common. This national survey investigated nutrition support practices in pediatric allogeneic BMT centers and compared clinicians' opinions on gastrostomy use. The aim of this study was to identify the national picture of nutritional support practices across pediatric allogeneic BMT centers, including use and opinions of dietitians, clinical nurse specialists, and physicians, toward gastrostomy feeding. METHODS An online survey was administered to 12 centers. The lead dietitian answered questions regarding nutritional counseling, screening, assessment, and interventions. Questions regarding current use, perceived advantages, and problems of gastrostomies were answered by the dietitian, lead clinical nurse specialist, and physician. RESULTS A 100% response rate was achieved from 12 centers (N = 36 clinicians). Nutritional counseling was provided in 92% of centers before and routinely throughout admission, 83% screened on and regularly throughout admission, 83% assessed nutritional status before transplant, and 92% used enteral nutrition first-line. Forty-two percent of the centers used gastrostomies. In those not using gastrostomies, 76% of clinicians felt some children should be offered a gastrostomy. Clinicians perceived less displacements (78%) and cosmetic appearance (69%) as the most common advantages of gastrostomies over nasogastric tubes. Risks associated with surgery (92%) and tube/stoma complications (58%) were the most common perceived problems. CONCLUSIONS A similar approach was shown on many aspects of nutritional support. Gastrostomy use divided opinion with differences in use and perceived advantages, but agreement on potential complications. Despite their risks, clinicians wanted to use gastrostomies more. Placement requires careful consideration of the risks, benefits, and family preferences.
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13
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Malnutrition risk prior to hematopoietic stem cell transplantation predicts mortality in adults. Bone Marrow Transplant 2021; 56:2268-2271. [PMID: 33846560 DOI: 10.1038/s41409-021-01292-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023]
Abstract
Patients with hematological malignancies have a high risk of developing malnutrition. Few data are currently available that illustrate the impact of the patients' nutritional status prior to HSCT on their outcome. The aim of this study was to investigate the association between the patients' malnutrition status prior to receiving autologous or allogeneic HSCT and mortality in adults with hematological malignancies. We conducted a retrospective cohort study including 341 patients. Survival curves and Cox proportional-hazards models were used to reveal whether malnutrition risk served as a predictor for the overall mortality and non-relapse mortality. The survival curves revealed that patients with malnutrition risk prior to HSCT had an increased risk of death during the 1-year follow-up period (overall mortality as well as non-relapse mortality). This result was confirmed by the Cox regression models, which showed a mortality risk that is more than two times higher in patients at risk of malnutrition. In allogeneic transplant patients, the impact of malnutrition risk on mortality was even higher. Our conclusions presuppose that nutrition is an important factor during the holistic treatment of HSCT patients by all healthcare professionals involved in the care of this patient group. Future studies should be carried out to examine how and whether different nutritional interventions effectively improve the nutritional status of this patient group.
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14
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Toenges R, Greinix H, Lawitschka A, Halter J, Baumgartner A, Simon A, Arends J, Jäger P, Middeke M, Hilgendorf I, Klein S, Wagner-Drouet EM, Schmid C, Bug G, Wolff D. Current practice in nutrition after allogeneic hematopoietic stem cell transplantation - Results from a survey among hematopoietic stem cell transplant centers. Clin Nutr 2021; 40:1571-1577. [PMID: 33744601 DOI: 10.1016/j.clnu.2021.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (alloHSCT) is frequently associated with impaired oral intake and malnutrition, which potentially increases morbidity and mortality. Therefore, nutrition is one of the major challenges in the post-transplant period. METHODS To document the current clinical approach in nutritional treatment, we designed a questionnaire concerning the current practice in nutrition after alloHSCT and distributed it to German speaking centers performing alloHSCT in Germany, Austria and Switzerland between November 2018 and March 2020. Twenty-eight (39%) of 72 contacted centers completed the survey, 23 from Germany, two from Austria and three from Switzerland, representing 50% of alloHSCT activity within the participating countries in 2018. RESULTS All centers reported having nutritional guidelines for patients undergoing alloHSCT, whereby 86% (n = 24) provided a low-microbial diet during the neutropenic phase. The criteria to start parenteral nutrition (PN) directly after alloHSCT seemed to be consistent, 75% (n = 21) of the corresponding centers started PN if the oral nutritional intake or the bodyweight dropped below a certain limit. In the setting of intestinal graft-versus-host disease (GvHD) the current practice appeared to be more heterogenous. About 64% (n = 18) of the centers followed a special diet, added food stepwise modulated by GvHD symptoms, while only four centers regularly stopped oral intake completely (intestinal GvHD grade >1). Half of the centers (54%, n = 15) applied a lactose-free diet, followed by 43% (n = 12) which provided fat- and 18% (n = 5) gluten-free food in patients with intestinal GvHD. Supplementation of micronutrients in acute intestinal GvHD patients was performed by 54% (n = 15) of the centers, whereas vitamin D (89%, n = 25) and vitamin B12 (68%, n = 19) was added regularly independently of the presence of GvHD. Only 5 (18%) participating centers ever observed a food-associated infection during hospitalization, whereas food-associated infections were reported to occur more often in the outpatient setting (64%, n = 18). CONCLUSION The survey documented a general consensus about the need for nutritional guidelines for patients undergoing alloHSCT. However, the nutritional treatment in clinical practice (i.e. lactose-, gluten- or fat-free in intestinal GvHD) as well as the use of food supplements was very heterogeneous. In line with current general recommendations the centers seemed to focus on safe food handling practice rather than providing a strict neutropenic diet. More high-quality data are required to provide evidence-based nutrition to patients during and after alloHSCT.
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Affiliation(s)
- R Toenges
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt, Germany.
| | - H Greinix
- Division of Hematology, Medical University of Graz, Austria.
| | | | - J Halter
- Dept. of Hematology, University Hospital Basel, Switzerland.
| | - A Baumgartner
- Dept. of Endocrinology, Medical University Klinik Kantonsspital Aarau, Aarau, Switzerland.
| | - A Simon
- Pediatric Oncology and Hematology, Saarland University Hospital, Saar, Homburg, Germany.
| | - J Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - P Jäger
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Medical Faculty, Duesseldorf, Germany.
| | - M Middeke
- Dept. of Internal Medicine I, University Hospital Dresden, Dresden, Germany.
| | - I Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Germany.
| | - S Klein
- III. Medizinische Klinik Hämatologie und Onkologie Universitätsmedizin Mannheim, Mannheim, Germany.
| | - E M Wagner-Drouet
- 3rd Medical Dept., Hematology, Oncology and Pneumology, University Medical Center Mainz, Germany.
| | - C Schmid
- Department of Hematology and Oncology, Universitätsklinikum Augsburg, Augsburg, Germany.
| | - G Bug
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt, Germany.
| | - D Wolff
- Dept. of Internal Medicine III, University Hospital, Regensburg, Germany.
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15
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Cancer-related malnutrition management: A survey among Italian Oncology Units and Patients’ Associations. Curr Probl Cancer 2020; 44:100554. [DOI: 10.1016/j.currproblcancer.2020.100554] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/24/2019] [Accepted: 01/15/2020] [Indexed: 12/14/2022]
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16
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Fang Y, Liu MJ, Zhang WW, Xie C, Liu ZZ. Nutrition Support Practices of Hematopoietic Stem Cell Transplantation Centers in Mainland China. Curr Med Sci 2020; 40:691-698. [PMID: 32862380 DOI: 10.1007/s11596-020-2231-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/22/2020] [Indexed: 01/10/2023]
Abstract
It has been identified that malnutrition can influence the immune system and time of engraftment, and it's also associated with increased incidence of complications, prolonged length of hospital stays, and transplant mortality and morbidity in patients undergoing hematopoietic stem cell transplantation (HSCT), so dynamic nutrition care is highly important. The aim of this study was to better understand the differences between clinical nutrition practices and international recommendations as well as possible barriers to the use of nutrition support in HSCT patients. An evidence-based nutrition support pathway was constructed through a systematic literature review to identify evidence and recommendations relating to the relevant issues. Then, a questionnaire consisting of 28 questions that focused on the 4 topics, namely, assessment and screening for malnutrition, nutrition support interventions, nutrition support in gastrointestinal graft-versus-host disease (GVHD) and neutropenic diet was developed by the study authors and used for data collection. Responses of 18 HSCT centers from 17 provinces were received. General assessment for malnutrition was performed at 72% (13/18) centers. Parenteral nutrition (PN) was given as the first option to HSCT patients in the majority of centers, despite the fact that current guidelines recommend enteral nutrition (EN) over PN. As many as 72% (13/18) of the centers considered a neutropenic diet in the management of HSCT patients, but only one center had a formal neutropenic diet protocol in place for transplant recipients. Criteria for initiating nutrition support in patients with gastrointestinal GVHD were heterogeneous among the centers, and PN was the most widely used technique. The survey results revealed significant heterogeneity with regard to nutrition support practices among the centers, as well as between the practices and the guidelines. Standard nutrition support guidelines or protocols for nutrition support practices were absent in most of the centers.
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Affiliation(s)
- Yun Fang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Min-Jie Liu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Wei-Wei Zhang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chen Xie
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhun-Zhun Liu
- Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
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17
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Botti S, van der Werf S, Stringer J, Eeltink C, Murray J, Ciceri F, Babic A, Duarte RF, Labopin M, Peczynski C, Basak GW, Liptrott SJ. Nutritional support in stem cell transplantation programs: Results from a multicenter survey of nurses on behalf of the Nurses Group and Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation and the Gruppo Italiano Trapianto di Midollo Osseo. Nutrition 2020; 79-80:110998. [PMID: 32987334 DOI: 10.1016/j.nut.2020.110998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/08/2020] [Accepted: 08/15/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Malnutrition in patients undergoing hematopoietic stem cell transplant (HSCT) can develop rapidly without appropriate nutritional support and affect morbidity and mortality. Guidance to monitor and manage nutrition status is described within the literature; however, whether this is applied in clinical practice is unclear. METHODS This paper describes a cross-sectional survey to explore current practice approaches in nutrition support management and adherence to international guidelines. RESULTS A total of 108 nurses from 108 centers across 16 countries replied to the questionnaire. A significant variation was observed regarding the availability of documents supporting the monitoring and management of nutrition status, application of recommendations, and nutritional practices. DISCUSSION The findings revealed that country was the most important factor influencing the differences in practice; however, significant differences were also observed based on patient age group (pediatrics vs. adults), department composition (hematology + HSCT unit vs. HSCT unit alone), and availability of nutrition health care professionals. Behavioral differences regarding nutritional practice approaches could be indicative of differences in knowledge or subject awareness, as well as a reflection of diversity across health care system policies. CONCLUSIONS Guideline dissemination and raising awareness through educational campaigns are suggested approaches to improve health care professionals' knowledge and sensitivity to this important topic.
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Affiliation(s)
- Stefano Botti
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy.
| | | | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Corien Eeltink
- Cancer Center Amsterdam, Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Aleksandra Babic
- Hemato-Oncology Unit, IOSI-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Rafael F Duarte
- Hematopoietic Transplantation and Hemato-Oncology Section, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Myriam Labopin
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Christophe Peczynski
- Department of Hematology and Cell Therapy and EBMT Paris Office, Hôpital Saint-Antoine APHP, Saint Antoine, France
| | - Grzegorz Wladyslaw Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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van Lieshout R, Tick LW, de Laat D, Custers S, Dekker IM, Douma MD, Kalter D, Kranenburg S, van der Lee D, Rhoon-Bruijnzeel P, Schlösser I, Somer M, van Tilborg CJ, Visser WK, Schouten HC, Beijer S. Adherence to guidelines on nutrition support during intensive treatment of acute myeloid leukemia patients: A nationwide comparison. Clin Nutr ESPEN 2020; 39:242-250. [PMID: 32859324 DOI: 10.1016/j.clnesp.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The level of adherence to the updated guidelines of The European Societies for Clinical Nutrition and Metabolism (ESPEN) and for Blood and Marrow Transplantation (EBMT) on nutrition in intensively treated adult acute myeloid leukemia (AML) patients in clinical practice is unknown. The aim of this nationwide survey was to investigate ESPEN/EBMT nutritional guideline adherence during intensive AML treatment, variation in nutrition support practices among hospitals and whether these practices changed after guideline publication. METHODS All 22 Dutch hospitals providing (aftercare following) high-dose chemotherapy and/or hematopoietic stem cell transplantation for adult AML patients were surveyed on nutrition support practices during these intensive AML treatments. We used an online questionnaire in 2015 and semi-structured telephone interviews in 2018-2019. Both surveys were completed by registered dieticians and addressed the use of enteral (EN) and parenteral (PN) nutrition. The ESPEN/EBMT nutritional guideline adherence was investigated through the telephone interviews. RESULTS High-level ESPEN/EBMT guideline adherence and/or uniformity among hospitals regarding nutrition support practices during intensive AML treatment were observed for nutritional screening, -aims, safe food handling and exercise training. Adherence to ESPEN/EBMT recommendations that were not implemented into national guidelines, including nutritional assessment and use of medical nutrition, was poor. All hospitals assessed nutritional intake, -impact symptoms and body weight, but muscle mass, physical performance and degree of systemic inflammation were rarely and variably monitored. Although the number of hospitals using EN as first-choice nutritional intervention increased from 3 hospitals in 2015 to 8 in 2019, PN remained the preferred method of nutrition support. Furthermore, the timing of medical nutrition varied. CONCLUSIONS Although the use of EN increased after publication of the updated ESPEN/EBMT nutritional guidelines, adherence to these standards was limited and there was heterogeneity in nutrition support practices during intensive AML treatment among hospitals. Incorporating international nutritional standards into national guidelines by nutrition expert groups immediately upon publication may improve adherence.
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Affiliation(s)
- Rianne van Lieshout
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Daphne de Laat
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Stephanie Custers
- Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Ingeborg M Dekker
- Department of Dietetics and Nutrition, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Madieke D Douma
- Department of Dietetics and Nutrition, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Doris Kalter
- Department of Gastroenterology and Hepatology - Dietetics and Intestinal Failure, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Suzanne Kranenburg
- Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Debbie van der Lee
- Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Patricia Rhoon-Bruijnzeel
- Department of Dietetics and Nutrition, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Ien Schlösser
- Department of Dietetics and Nutrition, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Maaike Somer
- Department of Dietetics and Nutrition, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Claudia J van Tilborg
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Willy K Visser
- Department of Dietetics and Nutrition, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Section Hematology, P. Debyelaan 25, 6229 HX, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandra Beijer
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands
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Mikkelsen S, Østergaard T, Zacher N, Holst M. Unintended weight loss in hematology outpatients - Work to do. Clin Nutr ESPEN 2020; 37:202-206. [PMID: 32359744 DOI: 10.1016/j.clnesp.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after. AIMS The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool. METHODS All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi2 test and simple logistic regression analyses were performed. RESULTS Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629]. CONCLUSIONS Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.
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Affiliation(s)
- Sabina Mikkelsen
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Trine Østergaard
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Nina Zacher
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
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Nutrition support during allogeneic stem cell transplantation: evidence versus practice. Support Care Cancer 2020; 28:5441-5447. [DOI: 10.1007/s00520-020-05397-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
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21
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Barban JB, Simões BP, Moraes BDGDC, da Anunciação CR, da Rocha CS, Pintor DCQ, Guerra DC, Silva DA, Brandão EDCM, Kerbauy F, Pires FRDO, Morais GL, Schmidt J, Sicchieri JMF, Barroso KSN, Viana LV, da Rocha MHM, Guimarães MP, Lazzari NLC, Hamerschlak N, Ramos PP, Gomes PN, Mendonça PDS, de Oliveira RC, Scomparim RC, Chiattone R, Diez-Garcia RW, Cardenas TDC, Miola TM, Costa TCDM, Rocha V, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults. EINSTEIN-SAO PAULO 2020; 18:AE4530. [PMID: 32049129 PMCID: PMC6999189 DOI: 10.31744/einstein_journal/2020ae4530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.
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Affiliation(s)
- Juliana Bernardo Barban
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazil Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Belinda Pinto Simões
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Bruna Del Guerra de Carvalho Moraes
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Daniela Cristina Querino Pintor
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daiane Cristina Guerra
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | | | - Edith de Castro Martins Brandão
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Fábio Kerbauy
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Jayr Schmidt
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Maria Faccioli Sicchieri
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Karine Sampaio Nunes Barroso
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | - Luciana Verçoza Viana
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrazilHospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Mariana Hollanda Martins da Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Nelson Hamerschlak
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Plinio Patricia Ramos
- Hospital Leforte LiberdadeSão PauloSPBrazil Hospital Leforte Liberdade, São Paulo, SP, Brazil.
| | - Plinio Nascimento Gomes
- Centro de Transplante de Medula ÓsseaInstituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazil Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Priscila da Silva Mendonça
- Universidade Federal do CearáHospital Universitário Walter CantídioFortalezaCEBrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | | | - Renata Corrêa Scomparim
- Universidade Estadual de CampinasCampinasSPBrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil.
| | - Ricardo Chiattone
- Hospital SamaritanoSão PauloSPBrazilHospital Samaritano, São Paulo, SP, Brazil.
| | - Rosa Wanda Diez-Garcia
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Thais Manfrinato Miola
- A.C.Camargo Cancer CenterSão PauloSPBrazil A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
| | - Thalita Cristina de Mello Costa
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Vanderson Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Changes in body weight and serum liver tests associated with parenteral nutrition compared with no parenteral nutrition in patients with acute myeloid leukemia during remission induction treatment. Support Care Cancer 2020; 28:4381-4393. [DOI: 10.1007/s00520-019-05251-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
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23
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Evans JC, Hirani SP, Needle JJ. Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies. Biol Blood Marrow Transplant 2019; 25:e252-e259. [DOI: 10.1016/j.bbmt.2019.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/23/2019] [Indexed: 12/12/2022]
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Sonbol MB, Jain T, Firwana B, Hilal T, Deleon T, Murad A, Murad MH, Khera N. Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis. BMJ Support Palliat Care 2019; 9:425-433. [PMID: 30948447 DOI: 10.1136/bmjspcare-2018-001742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Multiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review. MATERIALS AND METHODS We searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random-effects meta-analyses using the Der-Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection. RESULTS We included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50). CONCLUSION There is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.
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Affiliation(s)
| | - Tania Jain
- Adult Bone Marrow Transplant Service, New York City, Manhattan, USA
| | - Belal Firwana
- Heartland Cancer Research NCORP, Missouri Baptist Medical Center, St Louis, Missouri, USA
| | - Talal Hilal
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Thomas Deleon
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Angela Murad
- Healthy Living Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA
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Faucher C, Adam C, Bancillon N, Bertrand E, Colledani F, de Berranger E, Denis V, Girard I, Hamzy F, Loukili N, Mannone L, Mercier L, Perrin A, Vasseur A, Asma Q, Bompoint C, Yafour N, Yakoub-Agha I, Jost E. [Stem cell transplantation unit: Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. Bull Cancer 2018; 106:S1-S9. [PMID: 30580913 DOI: 10.1016/j.bulcan.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic HCT leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of HCT are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for human resources, construction and layout of a unit treating patients during the transplantation procedure and for different complications are not well defined. Here, we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of personnel and infrastructural requirements for hospitals caring for people with severe immunosuppression.
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Affiliation(s)
- Catherine Faucher
- Unité d'hématologie, institut Paoli Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France
| | - Catherine Adam
- Hématologie pôle IUC oncopole CHU, institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Nelly Bancillon
- CHU d'Angers, service d'hématologie, 4, rue Larrey, 49933 Angers, France
| | - Elisabeth Bertrand
- Centre Henri Becquerel, cadre du département d'hématologie, rue d'Amiens, CS11516, 76038 Rouen cedex 1, France
| | - Fabienne Colledani
- Service d'hématologie greffe de l'hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - Eva de Berranger
- CHRU Lille, service d'hématologie pédiatrique, avenue Eugene Avinee, 59037 Lille, France
| | - Virginie Denis
- Centre Henri Becquerel, département hématologie, rue d'Amiens, CS11516, 76038 Rouen cedex 1, France
| | - Isabelle Girard
- CHU Rennes, service hématologie pédiatrique, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Fati Hamzy
- Service d'hématologie greffe de l'hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - Noureddine Loukili
- CHRU de Lille, service de gestion risque infectieux et des vigilances, 2, avenue Oscar Lambret, 59037 Lille cedex, France
| | - Lionel Mannone
- CHU de Nice, hôpital l'Archet 1, service d'hématologie clinique unité de greffe, 151, route Saint-Antoine Ginestière, 06202 Nice, France
| | - Lara Mercier
- Hématologie pôle IUC oncopole CHU, institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Agnes Perrin
- CHRU de Lille, service de gestion risque infectieux et des vigilances, 2, avenue Oscar Lambret, 59037 Lille cedex, France; CHRU de Lille, service des maladies du sang, 2, avenue Oscar Lambret, 59037 Lille cedex, France
| | - Alyette Vasseur
- CHRU de Lille, service des maladies du sang, 2, avenue Oscar Lambret, 59037 Lille cedex, France
| | - Quessar Asma
- Hôpital 20-Août de Casablanca, 6, rue Lahssen Elaarjoun, Casablanca 20250, Maroc
| | - Caroline Bompoint
- CHU Montpellier, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - Nabil Yafour
- Service d'hematologie et de therapie cellulaire, établissement hospitalier et universitaire 1(er)-Novembre 1954, BP 4166, 31000 Ibn Rochd, Oran, Algérie; Université d'Oran 1, Ahmed Ben Bella, faculté de médecine, Oran, Algérie
| | - Ibrahim Yakoub-Agha
- CHRU de Lille, service des maladies du sang, 2, avenue Oscar Lambret, 59037 Lille cedex, France; LIRIC, Université de Lille2, Inserm U995, 59000 Lille, France
| | - Edgar Jost
- University Hospital RWTH Aachen, medical faculty, department of hematology, oncology, hemostaseology and stem cell transplantation, Pauwelsstraße 30, 52074 Aachen, Allemagne.
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Baumgartner A, Hoskin K, Schuetz P. Optimization of nutrition during allogeneic hematologic stem cell transplantation. Curr Opin Clin Nutr Metab Care 2018; 21:152-158. [PMID: 29465425 DOI: 10.1097/mco.0000000000000461] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Malnutrition before and during hematopoietic stem cell transplantation (HSCT) is an independent risk factor for mortality in patients undergoing hematopoietic stem cell transplantation. Yet, optimal use of nutritional support to improve outcomes remains controversial. Our aim was to do an up-to-date literature review regarding nutritional therapy in allogeneic HSCT, the neutropenic diet and the use of immunonutrients. RECENT FINDINGS Several observational studies find malnutrition to be associated with poor outcome, increased complications and lower overall survival. There are, however, few interventional trials proving the benefits of nutritional therapy in this population compared with no nutritional treatment. Regarding routes of treatment, studies suggested that parenteral nutrition is associated with higher risk for complications compared with enteral nutrition. Whether the use of specific formulas, such as immunonutrition, has a beneficial effect on clinical outcome is not established yet. Strict use of neutropenic diets did not show a reduction in infection risk and clinical outcome, and can no longer be recommended. SUMMARY Our updated search confirms that malnutrition is a strong negative predictor for outcome, yet optimal use of nutritional interventions to prevent or treat malnutrition remains ill-defined. There is need for larger randomized trials to better address these issues in the future.
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Peric Z, Botti S, Stringer J, Krawczyk J, van der Werf S, van Biezen A, Aljurf M, Murray J, Liptrott S, Greenfield DM, Duarte RF, Ruutu T, Basak GW. Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the Complications and Quality of Life Working Party of the EBMT. Bone Marrow Transplant 2018. [PMID: 29515252 DOI: 10.1038/s41409-018-0137-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recommendations on screening and nutritional support for patients undergoing hematopoietic stem cell transplantation (HSCT) have been presented by international nutritional societies, but nutritional practices remain poorly standardized. Following the general policy of the European Society for Blood and Marrow Transplantation (EBMT) to standardize transplantation procedures, the Complications and Quality of Life Working Party and Nursing Research Group carried out a survey among all EBMT centers about their current nutritional practices. The aim of this study was to better understand current practices, differences from available guidelines, and possible barriers for recommended nutritional therapy. Responses from 90 centers (19%) from 23 countries were received. We observed a marked variability in nutritional care between EBMT centers and a substantial lack of standardized operating procedures in screening patients for malnutrition and management of gastrointestinal GVHD. Furthermore, our study confirmed neutropenic diet as standard of care in most centers as well a preference for parenteral nutritional support over enteral. On the basis of these findings, future EBMT efforts will focus on better implementation of international nutritional guidelines into clinical practice.
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Affiliation(s)
- Zinaida Peric
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Stefano Botti
- Hematology Unit, Oncology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Joanna Krawczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Crysandt M, Yakoub-Agha I, Reiß P, Theisen S, Silling G, Glatte P, Nelles E, Lemmen S, Brümmendorf TH, Kontny U, Jost E. How to build an allogeneic hematopoietic cell transplant unit in 2016: Proposal for a practical framework. Curr Res Transl Med 2017; 65:149-154. [PMID: 29122584 DOI: 10.1016/j.retram.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
Allogeneic hematopoietic cell transplantation is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic hematopoietic cell transplantation leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of hematopoietic cell transplantation are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for the construction and layout of a unit treating patients during the acute phase of the transplantation procedure or at readmission for different complications are not well defined. In addition, the infrastructure of such a unit may be decisive for optimized care of these fragile patients. Here we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of infrastructural requirements for hospitals caring for people with severe immunosuppression.
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Affiliation(s)
- M Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - I Yakoub-Agha
- CHU de Lille, LIRIC, INSERM U995, University of Lille 2, France
| | - P Reiß
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - S Theisen
- Project Management, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - G Silling
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - P Glatte
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - E Nelles
- Medfacilities, GmbH, Cologne, Germany
| | - S Lemmen
- Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - U Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
| | - E Jost
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany.
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