Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

Laura J Miller; Vanessa Halliday; John A Snowden; Guruprasad P Aithal; Julia Lee; Diana M Greenfield

doi:10.1111/jhn.13315

Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

J Hum Nutr Diet. 2024 May 2. doi: 10.1111/jhn.13315. Online ahead of print.

Authors

Laura J Miller^{1

2}, Vanessa Halliday³, John A Snowden^{4

5}, Guruprasad P Aithal², Julia Lee⁵, Diana M Greenfield⁴

Affiliations

¹ Department of Dietetics and Nutrition, Nottingham University Hospitals NHS Trust, Nottingham, UK.
² School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
³ NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
⁴ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
⁵ British Society of Blood and Marrow Transplantation & Cellular Therapy (BSBMTCT), London, UK.

PMID: 38696512
DOI: 10.1111/jhn.13315

Abstract

Background: Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre-HCT in UK centres.

Methods: An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time.

Results: Seventy-seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre-HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty-two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non-dietitians most routinely provided dietary advice pre-HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high-energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre-HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre-HCT.

Conclusions: Nutrition and prehabilitation pre-HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.

Keywords: diet; haematopoietic cell transplantation; malnutrition; nutrition; prehabilitation; rehabilitation.

Grants and funding

None