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Recommendations Summary

ONC: Breast Cancer: Auto-HCT and Use of Parenteral Nutrition (PN) 2007

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  ONC: Breast cancer: Auto-HCT and PN

  Parenteral nutrition (PN) should not be routinely recommended for breast cancer patients undergoing auto-HCT who are well-nourished prior to treatment. While PN may preserve nutritional status and lean body mass in these patients, it does not appear to affect LOS or survival, and may increase risk of infectious complications.

  Rating: Weak
  Imperative

  • Risks/Harms of Implementing This Recommendation

    No potential risks or harms are associated with the application of this recommendation.

  • Conditions of Application

    • Application of this recommendation is limited to breast cancer patients who are well-nourished prior to auto-HCT.
    • Auto-HCT is no longer routinely used for breast cancer treatment in the U.S. (Berry et al, 2002; Farquhar et al, 2005; Schmid et al, 2005; Stadtmauer et al, 2000; Vogl and Stadtmauer,  2006).

  • Potential Costs Associated with Application

    No obvious costs are associated with the application of this recommendation.

  • Recommendation Narrative

    • One neutral quality RCT (Roberts et al, 2003) found that PN preserved nutritional status and lean body mass, but did not decrease LOS or improve survival among breast cancer patients undergoing auto-HCT who were well-nourished prior to treatment. The study group had more infections and more days on antibiotics than the control group. 

  • Recommendation Strength Rationale

    • Based on one neutral quality RCT, conclusion statement is a Grade III.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  Is there a relationship between the use of parenteral nutrition vs. control to reduce symptoms and support recovery and the reduction of symptoms associated with inpatient treatment for hematopoietic cell transplant for breast cancer patients?

  • References

    Roberts S, Miller J, Pineiro L, Jennings L.  Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients.  Bone Marrow Transplantation (2003) 32: 715-721.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Berry DA, Broadwater G, Klein JP, et al. High-dose versus standard chemotherapy in metastatic breast cancer: comparison of Cancer and Leukemia Group B trials with data from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 20 (3): 743-50, 2002.

    Farquhar C, Marjoribanks J, Basser R, et al. High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancer. Cochrane Database Syst Rev (3): CD003142, 2005.

    Schmid P, Schippinger W, Nitsch T, et al. Up-front tandem high-dose chemotherapy compared with standard chemotherapy with doxorubicin and paclitaxel in metastatic breast cancer: results of a randomized trial. J Clin Oncol 23 (3): 432-40, 2005.  

    Skipper A, Millikan KW. Parenteral nutrition implementation and management. In: The ASPEN Nutrition Support Practice Manual. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition; 1998; 9-12.

    Stadtmauer EA, O'Neill A, Goldstein LJ, et al. Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group. N Engl J Med 342 (15): 1069-76, 2000.          

    Vogl DT, Stadtmauer EA. High-dose chemotherapy and autologous hematopoietic stem cell transplantation for metastatic breast cancer: a therapy whose time has passed. Bone Marrow Transplantation 2006;37:985-987.