Current Practices Regarding Prophylactic Enteral Nutrition in Hematopoietic Stem Cell Transplantation in Canada: A Quality Assurance Study.

Hematopoietic stem cell transplantation (HSCT) and its conditioning regimens negatively affect the gastrointestinal tract, causing complications that may limit oral intake. As a result, HSCT patients are at risk of malnutrition, with parenteral nutrition (PN) often being the default treatment. The American Society for Parenteral and Enteral Nutrition guidelines prioritize enteral nutrition (EN) over PN in HSCT to maintain gut integrity. However, EN is often deferred due to clinical concerns (e.g., thrombocytopenia and mucositis), patient refusal, staff preference for PN, and lack of protocols. It is unknown whether EN is used prophylactically to circumvent these complications. This quality assurance initiative aimed to benchmark current Canadian EN practice in HSCT centres. A benchmarking questionnaire was administered to dietitians working in centres listed on the Cell Therapy Transplant Canada web site (February-March 2025). Dietitians at 10 of 17 adult centres participated. While all centres used PN, only seven used EN, and just one used it prophylactically. Main barriers to prophylactic EN initiation included patient refusal (71%), clinical concerns (71%), staff preference for PN (71%), and lack of protocols (14%). Prophylactic EN remains underutilized in Canadian HSCT centres. Standardized EN protocols, improved patient education, and enhanced multidisciplinary collaboration may improve nutrition care for HSCT patients.