Enteral nutrition during bone marrow transplantation in patients with pediatric cancer: a prospective cohort study

Abstract

CONTEXT AND OBJECTIVE: Cancer patients undergoing bone marrow transplantation (BMT) often require nutritional therapy due to treatment toxicities. The aim here was to evaluate the use of tube feeding and its applicability, indications, contraindications and complications in these patients. DESIGN AND SETTING: Prospective observational study conducted at a public university in São Paulo between January 2002 and August 2007. METHODS: The patients were followed up daily in the BMT unit by a research dietitian. Tube feeding was indicated when oral supplementation proved to be insufficient, when the patient had severe malnutrition or there was an impediment to use of oral feeding. It was contraindicated in the presence of gastrointestinal toxicity of grade 3 and 4 or other conditions that implied a risk or hindered its use or placement.Complications of tube feeding were divided into minor and major, according to whether they had lifethreatening implications. RESULTS: Forty-two (47.2%) patients had indications for tube feeding: the main reasons were transplantation inadequate food and supplement intake, insufficient intake with malnutrition or weight loss, severe malnutrition or need for oral fasting. Thirty-one (73.8%) received tube feeding: 11 autologous and 20 allogenic patients (P = 0.04). The main contraindications were severe gastrointestinal toxicities and sinusitis. Minor complications from tube feeding were more prevalent in patients with allogenic BMT, but no major complications were observed. CONCLUSION: Enteral nutrition is a feasible procedure in patients undergoing BMT and should be encouraged. The main difficulty in BMT patients, in relation to tube feeding, is gastrointestinal toxicities.reSUMO CONTEXTO E OBJETIVO: Pacientes com câncer submetidos ao transplante de medula óssea (TMO) frequentemente necessitam de terapia nutricional devido às toxicidades do tratamento. O objetivo foi avaliar uso de sonda enteral, aplicabilidade, indicações, contraindicações e complicações nesses pacientes. TIPO DE ESTUDO E LOCAL: Estudo observacional prospectivo, conduzido de janeiro de 2002 a agosto de 2007 em uma universidade pública em São Paulo. MÉTODOS: Os pacientes foram acompanhados diariamente na unidade de TMO por uma nutricionista da pesquisa. Indicações de sonda: suplementação oral insuficiente, desnutrição grave, ou alguma contraindicação para alimentação via oral. A contraindicação da sonda ocorreu na presença de toxicidades gastrintestinais de grau 3 e 4 ou outras condições que implicassem em risco ou impedissem seu uso ou passagem. As complicações da sonda foram divididas em menores e maiores, de acordo com implicações para o risco de vida. RESULTADOS: Quarenta e dois (47,2%) pacientes tiveram indicações de nutrição por sonda: os principais motivos foram: ingestão alimentar e de suplemento inadequada, ingestão insuficiente com desnutrição ou perda de peso, desnutrição grave ou necessidade de jejum. Trinta e um (73,8%) pacientes usaram sonda: 11 com transplantes autólogos e 20 alogênicos (P = 0,04)....

Rehabilitation treatment of enteral nutrition whey protein in lung cancer patients in southern China

“…The choice of nutritional therapy for chemotherapy patients follows the principle of "use the intestine when it is functional and can be used safely", and enteral nutrition is preferred (Lee et al, 2017;Garofolo, 2012;Nogueira et al, 2020). Enteral nutrition is not only safe and inexpensive, but also meets the body's normal physiological needs and protects the intestinal mucosa.…”

Nutritional status and nutritional therapy in pediatric and adolescent patients submitted to autologous hematopoietic stem cell transplantation

“…In a study conducted by Garófolo (2012), the main indications for ETF in patients who underwent autologous transplantation were: inadequate oral intake of food and supplements; insufficient intake of food and supplements with malnutrition or weight loss; and severe malnutrition 10 . The same study also reported that 36% of patients who underwent autologous HSCT had some degree of malnutrition at admission 10 . In the present study, the percentage of patients who were underweight or at risk for underweight at admission was 16.7%, and increased significantly to 33.3% at discharge.…”

“…In the present study, the percentage of patients who were underweight or at risk for underweight at admission was 16.7%, and increased significantly to 33.3% at discharge. Though there has been an increase in the prevalence of overweight among healthy children in the general population 11 , those who are hospitalized for transplant are usually in the normal weight range 10,12,13 . This was observed in our study, where most patients were of normal weight in the pre-transplant period (59.1%), although this assessment did not consider body composition.…”

Outcomes of an enteral feeding protocol in pediatric cancer patients: a non-randomized clinical trial

“…However, further research is needed for developing treatment guidelines, including establishing a timeline for initiation of feeding, and determining which patients are most likely to benefit from enteral feeding Hence, for a more precise interpretation of the results, a multicenter study is warranted in order to follow up a larger number of patients, with a periodic complete nutritional assessment and with enteral protocols included as part of the anticancer protocols. [56][57][58][59][60][61]…”