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Paviglianiti A, Bianchessi A, Avenoso D, Radici V, Domingo MP, Pozzilli P, Sureda A. Modern views of nutritional support in patients undergoing allogeneic stem cell transplantation. Clin Nutr ESPEN 2024; 63:400-408. [PMID: 38971406 DOI: 10.1016/j.clnesp.2024.07.002] [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: 02/26/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Patients undergoing allogeneic stem cell transplant (HSCT) have a higher risk of developing malnutrition. The aetiology is multifactorial and complex: the conditioning regimen causes damages to the gastrointestinal tract that can contribute to trigger graft-versus-host disease and/or infectious complications that adversely affect food intake and the gut absorption of nutrients in transplant recipients. Consequently, patients might develop weight loss and muscle wasting. There is mounting evidence that insufficient muscle mass increases the risk of toxicity to many chemotherapy drugs. Furthermore, the screening for malnutrition, assessment and intervention can vary among HSCT centers. Hereby, we report the main nutritional clinical issues in the field of HSCT and the main nutritional tools used in this setting. Future clinical trials investigating nutritional tools and dose-escalating studies based on pre-treatment body composition assessment may help having the potential to alter cancer treatment paradigms.
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Affiliation(s)
- Annalisa Paviglianiti
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy; Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
| | - Antonio Bianchessi
- Department of Molecular Medicine, University of Pavia and Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Avenoso
- Department of Hematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Vera Radici
- Unit of Blood Diseases and Stem Cell Transplantation, ASST-Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marta Peña Domingo
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
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Gandossi C, Jessop H, Hahn A, Heininger L, Henes J, Radaelli AM, Carmagnola A, Morello E, Renica C, Bertulli A, Lazzari L, Kenyon M, Alexander T, Domenech A, Greco R. Nutritional aspects in autoimmune diseases undergoing hematopoietic stem cell transplantation: overview and recommendations on behalf of the EBMT ADWP and Nurses Group. Front Nutr 2024; 11:1394518. [PMID: 38784130 PMCID: PMC11111942 DOI: 10.3389/fnut.2024.1394518] [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: 03/01/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Autoimmune diseases (ADs) represent a heterogeneous group of conditions affecting 5-10% of the global population. In recent decades, hematopoietic stem cell transplant (HSCT), mainly autologous, has been successfully adopted to treat patients affected by severe/refractory ADs. In this context malnutrition has a detrimental impact on relapse, mortality, infection rate, engraftment, long-term survival, and prolongation of hospitalization. However, in this population, the management of nutrition should be improved since nutritional assessment is partially performed in routine clinical practice. A panel of nurses and physicians from the European Society for Blood and Marrow Transplantation (EBMT) reviewed all available evidence based on current literature and expert practices from centers with extensive experience in HSCT for ADs, on the nutritional management of ADs patients during HSCT procedure. In this context, adequate nutritional status predicts a better response to treatment and improves quality of life. Herein, a systematic and comprehensive monitoring of nutritional status before, during and after HSCT, with adequate nutritional support in the case of ADs patients, in addition to assessing the dietary requirements associated with HSCT has been covered. Moreover, given the singularity of each AD, the underlying disease should be considered for an appropriate approach. The management and evaluation of nutritional status must be carried out by a multidisciplinary team to assess the needs, monitor the effectiveness of each intervention, and prevent complications, especially in complex situations as patients affected by ADs.
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Affiliation(s)
- Chiara Gandossi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Helen Jessop
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Anne Hahn
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa Heininger
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Henes
- Department of Internal Medicine II (Hematology, Oncology, Clinical Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Alexia Marina Radaelli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Carmagnola
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Morello
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Renica
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Bertulli
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit" ASST-Spedali Civili" Hospital of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Lazzari
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, United Kingdom
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ariadna Domenech
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Peled JU, Markey KA. The sweet taste of liberalizing dietary restrictions in HCT. Blood Adv 2023; 7:6005-6007. [PMID: 37815817 PMCID: PMC10580263 DOI: 10.1182/bloodadvances.2023011125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Affiliation(s)
- Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Kate A Markey
- Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medicine, University of Washington, Seattle, WA
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Matteucci S, De Pasquale G, Pastore M, Morenghi E, Pipitone V, Soekeland F, Caccialanza R, Mazzoleni B, Mancin S. Low-Bacterial Diet in Cancer Patients: A Systematic Review. Nutrients 2023; 15:3171. [PMID: 37513590 PMCID: PMC10385845 DOI: 10.3390/nu15143171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
The low-bacterial diet (LBD) is a widely used dietary regimen to reduce the risk of food-borne infections in patients with neutropenic cancer, but its role is controversial due to its unclear benefits. The purpose of this study was to provide an updated analysis of the available evidence on the efficacy of the LBD to reduce the risk of infections, mortality rates, and quality of life (QoL) in neutropenic patients with cancer. A systematic literature search was conducted in the biomedical databases Cochrane Library, PubMed, CINHAL, and EMBASE. The process of the screening, selection, inclusion of articles, and assessment of risk of bias and methodological quality was conducted by two reviewers. Of the 1985 records identified, 12 were included. The LBD demonstrated heterogeneity in definition, composition, and initiation timing; moreover, the LBD did not demonstrate a reduction in infection and mortality rates compared to a free diet, showing a negative correlation with quality of life. The LBD, in addition to not bringing benefits in terms of reductions in infection and mortality rates, has been shown to worsen the quality of life due to the reduced palatability and limited variety of the food supply, negatively impacting nutritional status.
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Affiliation(s)
- Sofia Matteucci
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Veronica Pipitone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, Schwarztorstrasse 48, 3007 Bern, Switzerland
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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GOMEZ CARLYB, MITCHELL JADE, RYSER ELLIOTT, MARKS BRADLEYP. Listeriosis Risk Model for Cancer Patients Who Consume Ready-to-Eat Salad. J Food Prot 2023; 86:100087. [PMID: 37004807 DOI: 10.1016/j.jfp.2023.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
The foodborne pathogen Listeria monocytogenes generally infects immunocompromised individuals, such as cancer patients, more frequently and with higher morbidity and mortality than the general population. Because of the anticipated risk associated with L. monocytogenes and other pathogens in produce, immunocompromised individuals are often placed on neutropenic diets that exclude fresh produce, though these risks have not been quantified. Therefore, this study developed a data-driven risk model for listeriosis in cancer patients who consume ready-to-eat (RTE) salads, consisting of leafy greens, cucumbers, and tomatoes, as influenced by kitchen-scale treatments and storage practices. Monte Carlo simulations were used to model the risk of invasive listeriosis during one chemotherapy cycle. Refrigerating all salad components decreased median risk by approximately one-half log. For refrigerated salads with no treatment, the predicted median risk was ≤ 4.3 × 10-08. When salad ingredients were surface blanched with greens rinsed, the predicted risk decreased to 5.4 × 10-10. Predicted risk was lowest (1.4 × 10-13) for a blanched "salad" consisting of solely cucumbers and tomatoes. Interestingly, rinsing, as recommended by FDA only decreased median risk by 1 log. A sensitivity analysis revealed that the highly variable dose-response parameter k strongly influenced risk, indicating that reducing uncertainty in this variable may improve model accuracy. Overall, this study demonstrates that kitchen-scale pathogen reduction approaches have high risk-reduction efficacy and could be considered as an alternative to diets that exclude produce when making risk management decisions.
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Role of Nutrition in Pediatric Patients with Cancer. Nutrients 2023; 15:nu15030710. [PMID: 36771416 PMCID: PMC9920596 DOI: 10.3390/nu15030710] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Children with cancer are at high risk for developing short-term and long-term nutritional problems related to their underlying disease and side effects of multimodal treatments. Nutritional status (NS) can influence several clinical outcomes, such as overall survival (OS) and event-free survival (EFS), treatment tolerance, risk of developing infections and quality of life (QoL). However, the importance of nutrition in children with cancer is still underestimated. This review focuses on alterations of NS that occurs in children during cancer treatment. In particular, we reviewed the pathogenesis of undernutrition in oncological children, as well as how NS affects treatment tolerance and response, the immune system and the risk of infections of children with cancer. Thanks to recent advances in all types of supportive therapy and to the progress of knowledge on this topic, it has been realized that NS is a modifiable prognostic factor that can be intervened upon to improve the outcome of these patients. Currently, there is a lack of a systematic approach and standard recommendations for nutritional care in the pediatric cancer population. Literature analysis showed that it is essential to define the NS and treat any alterations in a timely manner ensuring proper growth and development. Nutritional follow-up should become an integral part of the care pathway. Regular nutritional monitoring should be performed at diagnosis, during treatment and during follow-up. A close collaboration and sharing of expertise between pediatric oncologists and nutrition specialists, combined with careful and participatory sharing of the feeding experience with the family and the child (after age 6 years), is strongly required.
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Fakier K, Xu W. Development, Validation, and Testing of a Self-Assessment Tool to Measure Food Safety Beliefs, Attitudes, and Behaviors in Health Care Food Service Operations. J Food Prot 2022; 85:607-614. [PMID: 34914827 DOI: 10.4315/jfp-21-375] [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: 10/05/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT The neutropenic diet has long been a dietary prescription for immunocompromised patients. However, its effectiveness and consistency have been constantly challenged. Researchers and health care policymakers call for liberalization of the neutropenic diet, which shifts risk management strategies from excluding "high-risk" food items to focus on safe food handling. The responsibility of food safety falls on food service workers in a health care setting. The objective of the present study was to develop and conduct psychometric testing to determine the validity and reliability of a self-assessment survey instrument tool targeting beliefs, attitudes, and behaviors of health care food service workers regarding safe food handling practices. This survey validation study was conducted in four phases. First, the tool was developed based on the Theory of Planned Behavior. After the initial draft, the survey was tested to establish face validity and test-retest reliability to measure temporal stability. The 40-item survey was then pilot tested to assess internal consistency and construct validity. Pilot testing was conducted over a 16-month period on 211 health care food service workers across six acute care hospitals that serve immunocompromised people. The original survey comprised 46 items. Six items were removed due to low content validity scores and temporal instability. Pilot testing revealed acceptable internal consistency (Cronbach's alpha = 0.79). The linear regression model was a good fit (P ≤ 0.0001) after assumptions were tested and met to predict behavior from attitude. A reliable and valid self-assessment survey instrument tool was developed for use in a health care food service operation. Results of this tool can help organizations pinpoint areas in which they can improve food safety practices of food service workers who serve immunocompromised people. HIGHLIGHTS
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Affiliation(s)
- Kathryn Fakier
- School of Health Professions, Franciscan Missionaries of Our Lady University, 5414 Brittany Drive, Baton Rouge, Louisiana 70808.,School of Nutrition and Food Sciences, Louisiana State University Agricultural Center, Baton Rouge, Louisiana 70803, USA
| | - Wenqing Xu
- School of Nutrition and Food Sciences, Louisiana State University Agricultural Center, Baton Rouge, Louisiana 70803, USA
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Gomez CB, Ryser ET, Marks BP. Kitchen-Scale Treatments for Reduction of Listeria monocytogenes in Prepared Produce. J Food Prot 2021; 84:1603-1609. [PMID: 34047798 DOI: 10.4315/jfp-21-019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/20/2021] [Indexed: 12/31/2022]
Abstract
ABSTRACT Listeriosis, a foodborne illness caused by Listeria monocytogenes, has relatively low incidence, but a substantial mortality rate, particularly in immunocompromised populations. Because of the known risk of L. monocytogenes and other pathogens in produce, immunocompromised individuals are often placed on neutropenic diets that exclude fresh produce. Therefore, this study aimed to evaluate several kitchen-scale treatments as potential interventions to reduce L. monocytogenes in prepared produce. Cucumbers, apples, and celery were dip inoculated with a three-strain cocktail of L. monocytogenes and dried for 24 h. Inoculated products were subjected to the following treatments as applicable: commercial sanitizer soak (90 s, with agitation), tap water rinse (15 s), tap water soak (90 s, with agitation), surface blanching (25 s), tap water rinse (15 s) followed by peeling, and surface blanching (25 s) followed by peeling. In addition, inoculum uptake in celery and the impact of two types of peelers (mechanical crank and manual) were assessed. Treated samples were plated on differential media and incubated for 48 h at 37°C. L. monocytogenes populations were then enumerated and compared with the untreated control (in log CFUs per gram). All treatments lacked efficacy for celery, with reductions significantly less (P < 0.05) than in other products, likely because of inoculum internalization. The sanitizer soak, tap water rinse, and tap water soak did not differ in efficacy (P > 0.05), which was low for cucumbers (<1.5 log CFU/g), apples (<1.3 log CFU/g), and celery (<0.7 log CFU/g). The two types of apple peelers did not differ in efficacy (P > 0.05). Surface blanching and surface blanching followed by peeling were the most effective treatments for both cucumbers and apples (P < 0.05), with average reductions of 4.2 to 5.1 and 3.5 to 5.9 log CFU/g, respectively. HIGHLIGHTS
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Affiliation(s)
- Carly B Gomez
- Department of Biosystems and Agricultural Engineering, Michigan State University, 524 South Shaw Lane, East Lansing, Michigan 48824
| | - Elliot T Ryser
- Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road #204, East Lansing, Michigan 48824, USA
| | - Bradley P Marks
- Department of Biosystems and Agricultural Engineering, Michigan State University, 524 South Shaw Lane, East Lansing, Michigan 48824
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Patois C, Chen Y, Meiselman HL, Barraco F, Giboreau A. Designing food and meals for bone marrow transplant patients with compromised immunity. INTERNATIONAL JOURNAL OF FOOD DESIGN 2021. [DOI: 10.1386/ijfd_00023_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Immunocompromised post-bone marrow transplant patients must follow a restrictive diet after discharge to avoid microbiological risks in food. Despite the apparent health considerations, these restrictions can sometimes create confusion and apprehension during home meal preparation which has a negative impact on patients’ social dining experiences with families and friends and ultimately leads to adverse health effects such as appetite and weight loss. A user-friendly meal guidebook, specifically designed to fit patient’s needs, was developed to ensure a smooth transition from controlled hospital food to home-cooked meals without compromises in food safety and pleasure. With this guidebook, the objective of this uncommon collaboration between chefs and health professionals was to provide clear instructions to the patients on their diet and adapted recipes (six starters, eight main dishes and eight desserts) easy to do and share with the whole family. This design project represents a unique approach to addressing the food and nutrition needs of these transplant patients. Thus, this article presents an example of a multi-actor collaboration between health and culinary professionals who combined their expertise to help the patients feel less marginalized after their hospitalization and to support their recovery by providing adapted recipes that they can share with their family.
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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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Otten KR, Staffileno BA, Mozer M, Maidlow C. Mediterranean Diet: Outcomes from an Education Session Among Patients With Cancer and Nursing Staff. Clin J Oncol Nurs 2020; 24:177-185. [PMID: 32196010 DOI: 10.1188/20.cjon.177-185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Strong evidence supports the benefits of the Mediterranean diet, but little is reported among patients and nurses regarding knowledge about the diet and its health benefits. OBJECTIVES A pre-/post-test practice initiative was implemented to identify level of knowledge about the Mediterranean diet in patients with cancer and nursing staff and to provide education about the diet's health benefits. METHODS A 17-item survey was developed to assess knowledge and willingness to try or recommend the Mediterranean diet, current practices, and general nutrition knowledge. A 10-minute education session was provided to patients and nursing staff. Descriptive statistics were used. FINDINGS The majority of patients reported eating from one to four servings of fruits and vegetables daily. For patients and nursing staff, post-education session scores demonstrated increased knowledge, willingness to try the diet, and perceived effectiveness of the diet.
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13
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Ball S, Brown TJ, Das A, Khera R, Khanna S, Gupta A. Effect of Neutropenic Diet on Infection Rates in Cancer Patients With Neutropenia: A Meta-analysis of Randomized Controlled Trials. Am J Clin Oncol 2019; 42:270-274. [PMID: 30628912 DOI: 10.1097/coc.0000000000000514] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Neutropenic diets are commonly prescribed to cancer patients with neutropenia with the intention of reducing rates of infection. These diets are restrictive and are associated with lower patient satisfaction and possibly malnutrition. Further, it is unclear if these restrictive diets are effective in reducing infection. We performed a meta-analysis on the rates of infection reported in trials comparing the neutropenic diet to unrestricted diets in cancer patients with neutropenia. METHODS AND MATERIALS A comprehensive database search for all published randomized controlled trials comparing infection rates in cancer patients receiving a neutropenic diet versus an unrestricted diet was performed for all publications in English language from database's inception until September 12, 2017. The search strategy, study selection, and subsequent analysis adhered to PRISMA guidelines. Random effects modeling was used to obtain pooled relative risks. The primary outcome measure was the rate of infection. RESULTS Five randomized controlled trials with a total of 388 patients were included in the final analysis. Patients mostly had acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or sarcoma. Infection was noted in 53.7% patients in the neutropenic diet group, as compared with 50% in the unrestricted diet group. No significant difference in infection rate was observed between the neutropenic diet versus unrestricted diet groups, pooled risk ratio (RR) 1.13 (95% CI, 0.98-1.30; P=0.10). CONCLUSIONS This meta-analysis of randomized controlled trials suggests that the use of neutropenic diet was not associated with decreased risk of infection in neutropenic cancer patients. The continued use of neutropenic diets should be questioned.
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Affiliation(s)
- Somedeb Ball
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | | | - Avash Das
- Department of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Rohan Khera
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
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Ramamoorthy V, Rubens M, Appunni S, Saxena A, McGranaghan P, Veledar E, Viamonte-Ros A, Shehadeh N, Kaiser A, Kotecha R. Lack of Efficacy of the Neutropenic Diet in Decreasing Infections among Cancer Patients: A Systematic Review. Nutr Cancer 2019; 72:1125-1134. [PMID: 31608705 DOI: 10.1080/01635581.2019.1675723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objective of this systematic review is to evaluate the existing evidence supporting the effectiveness of the neutropenic diet in decreasing infection and mortality among cancer patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus for relevant articles published from database inception until March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for this review. Individual studies were evaluated using the Oxford Center for Evidence-Based Medicine guidelines. A total of 473 articles were identified and 11 articles were selected after assessing eligibility. Our review showed that the neutropenic diet does not decrease infection rates or mortality among cancer patients. Currently, there is no uniform definition for the neutropenic diet across different institutions. For example, some institutions follow general food safety practices while others avoid foods that increase exposure to microbes and bacteria, and some follow both. Given these differences in practice regarding what constitutes a neutropenic diet, it is advisable that safe food handling and preparation practices recommended by the Food and Drug Administration be uniformly followed for neutropenic patients.
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Affiliation(s)
| | - Muni Rubens
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Sandeep Appunni
- Department of Biochemistry, Calicut Medical College, Calicut, India
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Peter McGranaghan
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Ana Viamonte-Ros
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Nancy Shehadeh
- Department of Business, Florida Atlantic University, Boca Raton, Florida, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
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Heng MS, Barbon Gauro J, Yaxley A, Thomas J. Does a neutropenic diet reduce adverse outcomes in patients undergoing chemotherapy? Eur J Cancer Care (Engl) 2019; 29:e13155. [DOI: 10.1111/ecc.13155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/30/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mei Shan Heng
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
| | - Jessica Barbon Gauro
- Department of Nutrition and Dietetics Flinders Medical Centre Bedford Park SA Australia
| | - Alison Yaxley
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
| | - Jolene Thomas
- Nutrition and Dietetics College of Nursing and Health Science, Flinders University Adelaide SA Australia
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16
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Comparing a Neutropenic Diet to a Food Safety-Based Diet in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1382-1386. [DOI: 10.1016/j.bbmt.2019.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/14/2019] [Indexed: 12/20/2022]
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17
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Raynard B, Gyan E, St Guily L, Hébuterne X, Goldwasser F. Croyances et idées reçues sur l’alimentation au cours des traitements des cancers. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Neutropenic Dietary Restrictions for Hematopoietic Stem Cell Patients: Time for a Change. Biol Blood Marrow Transplant 2019; 25:e223-e225. [PMID: 31136798 DOI: 10.1016/j.bbmt.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
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19
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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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20
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Wilson BJ, Zitella LJ, Erb CH, Foster J, Peterson M, Wood SK. Prevention of Infection: A Systematic Review of Evidence-Based Practice Interventions for Management in Patients With Cancer. Clin J Oncol Nurs 2019; 22:157-168. [PMID: 29547616 DOI: 10.1188/18.cjon.157-168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer-related infections lead to increases in mortality, antibiotic use, and hospital stays. Other adverse outcomes include dose delays and reductions, which can result in suboptimal treatment outcomes. OBJECTIVES Effective implementation of risk assessment and evidence-based interventions for the prevention and treatment of infection are essential to improve care and reduce costs related to infections in patients with cancer receiving immunosuppressive therapy. METHODS The Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) prevention of infection resource have been developed and updated to identify and disseminate the best available scientific evidence. FINDINGS Pharmacologic and nonpharmacologic interventions were evaluated, resulting in recommended for practice rating for catheter care bundles, antimicrobial prophylaxis, vaccination for specific populations, and implementation of contact precautions for resistant organisms.
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21
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Applying the 'COST' (Culture, Oversight, Systems Change, and Training) Framework to De-Adopt the Neutropenic Diet. Am J Med 2019; 132:42-47. [PMID: 30145223 DOI: 10.1016/j.amjmed.2018.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/16/2022]
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22
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Jalali, Mostafa S, Abdollahi M, Hosseini A, Bozorg DK, Ajami, Azadeh M, Moiniafshar K. The positive effects of Mediterranean-neutropenic diet on nutritional status of acute myeloid leukemia patients under chemotherapy. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11515-018-1519-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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23
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Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, Langston AA, Nastoupil LJ, Rajotte M, Rolston KV, Strasfeld L, Flowers CR. Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol 2018; 36:3043-3054. [PMID: 30179565 DOI: 10.1200/jco.18.00374] [Citation(s) in RCA: 306] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment. METHODS ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel. RESULTS Six new or updated meta-analyses and six new primary studies were added to the updated systematic review. RECOMMENDATIONS Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus-seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Randy A Taplitz
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Erin B Kennedy
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Eric J Bow
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Jennie Crews
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Charise Gleason
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Douglas K Hawley
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Amelia A Langston
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Loretta J Nastoupil
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Michelle Rajotte
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Kenneth V Rolston
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Lynne Strasfeld
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Christopher R Flowers
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
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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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25
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Chaput C, Beaulieu-Gagnon S, Bélanger V, Drouin S, Bertout L, Lafrance L, Olivier C, Robitaille M, Laverdière C, Sinnett D, Marquis M, Marcil V. Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum. JMIR Res Protoc 2018; 7:e2. [PMID: 29317383 PMCID: PMC5980485 DOI: 10.2196/resprot.8302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/04/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Progresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child's optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children's nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment. OBJECTIVE The objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects. METHODS The workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution's clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants' perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants' anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health. RESULTS The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer.
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Affiliation(s)
- Cynthia Chaput
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada.,Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Sabrina Beaulieu-Gagnon
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada.,Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Véronique Bélanger
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada.,Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Simon Drouin
- Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Laurence Bertout
- Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Lucie Lafrance
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Cinthia Olivier
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Marthe Robitaille
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montreal, QC, Canada
| | - Caroline Laverdière
- Division of Hematology-Oncology, Sainte-Justine University Health Center, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Daniel Sinnett
- Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada.,Division of Hematology-Oncology, Sainte-Justine University Health Center, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie Marquis
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Valérie Marcil
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Center of Sainte-Justine University Health Center, Montreal, QC, Canada.,Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
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Moody KM, Baker RA, Santizo RO, Olmez I, Spies JM, Buthmann A, Granowetter L, Dulman RY, Ayyanar K, Gill JB, Carroll AE. A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients. Pediatr Blood Cancer 2018; 65. [PMID: 28696047 DOI: 10.1002/pbc.26711] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy. PROCEDURE Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t-test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a χ2 test. RESULTS One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%). There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% (P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone. CONCLUSION The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs.
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Affiliation(s)
- Karen M Moody
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rebecca A Baker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ruth O Santizo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Inan Olmez
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeanie M Spies
- Rady Children's Hospital, Peckham Center for Cancer and Blood Disorders, San Diego, California
| | - Amanda Buthmann
- The Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York
| | - Linda Granowetter
- Department of Pediatrics, New York University School of Medicine, New York
| | - Robin Y Dulman
- Pediatric Specialists of Virginia and Inova Fairfax Hospital, Virginia
| | | | - Jonathan B Gill
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron E Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Jeon OK, Lee YH, Kim MH. Knowledge of and Compliance with Neutropenic Diet in Patients with Hematologic Malignancy undergoing Chemotherapy. ASIAN ONCOLOGY NURSING 2018. [DOI: 10.5388/aon.2018.18.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ok Kyung Jeon
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Yeon Hee Lee
- Department of Nursing, Dong-Eui University, Busan, Korea
| | - Myung Hee Kim
- College of Nursing, Pusan National University, Yangsan, Korea
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28
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Healthy cooking classes at a children's cancer hospital and patient/survivor summer camps: initial reactions and feasibility. Public Health Nutr 2017; 20:1650-1656. [PMID: 28463101 DOI: 10.1017/s136898001700060x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Childhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour. DESIGN A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. SETTING One paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes. SUBJECTS One hundred and eighty-nine CCS of varying ages and thirteen parents of CCS. RESULTS Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. CONCLUSIONS Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.
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Revisiting nutritional support for allogeneic hematologic stem cell transplantation-a systematic review. Bone Marrow Transplant 2017; 52:506-513. [PMID: 28067888 DOI: 10.1038/bmt.2016.310] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
Abstract
In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.
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30
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Tramsen L, Salzmann-Manrique E, Bochennek K, Klingebiel T, Reinhardt D, Creutzig U, Sung L, Lehrnbecher T. Lack of Effectiveness of Neutropenic Diet and Social Restrictions as Anti-Infective Measures in Children With Acute Myeloid Leukemia: An Analysis of the AML-BFM 2004 Trial. J Clin Oncol 2016; 34:2776-83. [PMID: 27269945 PMCID: PMC5019758 DOI: 10.1200/jco.2016.66.7881] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although nonpharmacologic anti-infective measures are widely used in children treated for acute myeloid leukemia (AML), there is little evidence of their effectiveness. PATIENTS AND METHODS We analyzed infectious complications in children during intensive treatment of AML according to the AML-BFM 2004 trial and surveyed sites on institutional standards regarding recommended restrictions of social contacts (six items), pets (five items), and food (eight items). A scoring system was developed with a restriction score for each item. Multivariable Poisson regression adjusted for sex, age, weight group, risk stratification, and prophylactic antibiotics was used to estimate the impact of the restrictions on the incidence ratios of fever of unknown origin, bacteremia, pneumonia, and gastroenteritis. RESULTS Data on recommendations of nonpharmacologic anti-infective measures and infectious complications were available in 339 patients treated in 37 institutions. Analyses did not demonstrate a significant benefit of any of the restrictions regarding food, social contacts, and pets on the risk of fever, bacteremia, pneumonia, and gastroenteritis. In contrast, age, weight group, risk stratification, and nonabsorbable antibiotics had some influence on infections complications. CONCLUSION The lack of effectiveness of dietary restrictions and restrictions regarding social contacts and pets should result in reconsideration of anti-infective policies.
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Affiliation(s)
- Lars Tramsen
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Emilia Salzmann-Manrique
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Konrad Bochennek
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Klingebiel
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Dirk Reinhardt
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Ursula Creutzig
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Lillian Sung
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Lehrnbecher
- Lars Tramsen, Emilia Salzmann-Manrique, Konrad Bochennek, Thomas Klingebiel, and Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt; Dirk Reinhardt, Medical Center, University of Essen, Essen; Ursula Creutzig, Children's Hospital, Hannover Medical School, Hannover, Germany; and Lillian Sung, The Hospital for Sick Children, Toronto, Canada.
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