title: Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison.
abstract: OBJECTIVE
  In 2009, international nutritional societies published practice guidelines on screening and nutritional support for patients undergoing stem cell transplantation. Little is known about how these guidelines are implemented in clinical practice. We performed a nationwide survey with the aim of understanding current practice patterns, differences between clinical practice, and international recommendations as well as barriers to the use of nutritional therapy.
  
  
  METHODS
  We performed a qualitative survey including all centers across Switzerland offering allogeneic (n = 3) or autologous (n = 7) stem cell transplantation. We focused on in-house protocols pertaining to malnutrition screening, indications for nutritional support, types of nutritional therapy available and provided, and recommendations regarding neutropenic diets.
  
  
  RESULTS
  All centers offering allogeneic, and most of the centers offering autologous transplantation, had a malnutrition screening tool, mainly the nutritional risk score (NRS 2002) method. Only one center does not provide nutritional support. There is wide variation regarding start and stop of nutritional therapy as well as route of delivery, with five centers recommending parenteral nutrition and five centers recommending enteral nutrition as a first step. Although all centers offering allogeneic transplantation, and approximately every other autologous transplant center, used a neutropenic diet, specific recommendations regarding the type of food and food handling showed significant variation.
  
  
  CONCLUSIONS
  This Swiss survey found wide variation in the use of nutritional therapy in patients undergoing stem cell transplantation, with low adherence overall to current practice guidelines. Understanding and reducing barriers to guideline implementation in clinical practice may improve clinical outcomes. Close collaboration of centers will facilitate future research needed to improve current practice and ensure high quality of treatment.
authors.affiliation: Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Annic
authors.initials: A
authors.lastname: Baumgartner
authors.affiliation: Clinic for Hematology and Oncology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Bargetzi
authors.affiliation: Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Annika
authors.initials: A
authors.lastname: Bargetzi
authors.affiliation: Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Noemi
authors.initials: N
authors.lastname: Zueger
authors.affiliation: Clinic for Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Micheal
authors.initials: M
authors.lastname: Medinger
authors.affiliation: Clinic for Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Clinic for Hematology and Clinic for Oncology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Schanz
authors.affiliation: Clinic for Hematology and Clinic for Oncology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Samaras
authors.affiliation: Clinic for Hematology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Chalandon
authors.affiliation: Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
authors.affiliation: Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Limonta
authors.affiliation: Instituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
authors.forename: Luciano
authors.initials: L
authors.lastname: Wannesson
authors.affiliation: Clinic for Hematology and Oncology, University Hospital Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pabst
authors.affiliation: Service and Central Laboratory of Hematology, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Michel A
authors.initials: MA
authors.lastname: Duchosal
authors.affiliation: Clinic for Hematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Hess
authors.affiliation: Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Stanga
authors.affiliation: Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: Schuetzph@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D004032:Diet; D005069:Evaluation Studies as Topic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis; D015596:Nutrition Assessment; D018673:Nutrition Policy; D018529:Nutritional Support / Q000379:methods* / Q000592:standards*; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D013557:Switzerland; D014182:Transplantation, Autologous
keywords: Guidelines; Hematopoietic stem cell transplantation; Nutrition; Survey