Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Early enteral feeding for patients receiving autologous stem cell transplant: When it’s indicated can it be done? (#407)

Rebecca Fichera 1 2 , Sarah Andersen 1 2 , Claire Blake 1 2 , Elise Treleaven 1 2 , Teresa Brown 1 2 3 , Helen MacLaughlin 1 2 4 , Kylie Matthews 1 2
  1. Department of Dietetics & Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  2. Nutrition Research Collaborative, Brisbane, Queensland, Australia
  3. School of School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
  4. School of Exercise and Nutrition Sciences, Faculty of Health,Queensland University of Technology, Brisbane, Queensland, Australia

Aims: Patients receiving autologous stem cell transplants (ASCT) are at risk of malnutrition due to poor oral intake secondary to gastrointestinal toxicity of the conditioning protocol. Evidence for optimal nutrition interventions to prevent malnutrition in this patient group is limited.  A new nutrition care pathway was trialled to identify patients earlier if they developed an indication to commence enteral nutrition (i.e. consuming <60% estimated requirements orally).  The aim of this study was to investigate clinical and patient-reported outcomes of enteral nutrition following implementation of this nutrition care pathway.

Methods: This was a quantitative observational prospective cohort study of patients admitted for ASCT at RBWH between July 2019 and June 2020 who remained an inpatient following D+1 post-ASCT.  Data collected included demographics, clinical data, nutritional status via Subjective Global Assessment, nutritional intake, functional status and quality of life.

Results: Eighteen (50% M, ~60% myeloma diagnosis) of thirty eligible patients admitted during the study period consented to participate. Forty percent (n=7/18) were recommended to commence enteral nutrition (median 5 (0-7 days) post-ASCT), however six of the seven patients declined nasogastric tube insertion.  These patients consumed <60% of their energy requirements for another 4-11 days post this recommendation. At admission and on discharge all patients were well-nourished.  At 2-weeks post-discharge, one patient was moderately malnourished (missing data n=2). 

Conclusions: An unanticipated finding from this study was that patient-decision was the biggest barrier to enteral tube placement when clinically indicated.  This is dissimilar to other studies in the allograft population whereby patients receive education from members of the multidisciplinary team and patient-acceptance of enteral tube placement is high.  Unfortunately, the cohort was too small resulting in inadequate evidence to draw conclusions on nutrition, clinical or patient-reported outcomes.