Bergens Matthew A, Lowder Yen P, Li Yan, Johnson Ernaya J, Winthrop Hilary M, Bush Amy T, Xiong Angela, Hill Lauren, Gorski Isabella, Weaver Bethany, Zafar S Yousuf, Alyea Edwin P, Chao Nelson J, Choi Taewoong, Gasparetto Cristina, Hong Sanghee, Horwitz Mitchel E, Lin Chenyu, Long Gwynn D, Lopez Richard D, Ramalingam Sendhilnathan, Sarantopoulos Stefanie, Sullivan Keith M, Sung Anthony D
Duke University School of Medicine, Durham, NC, USA.
Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA.
Bone Marrow Transplant. 2025 Apr 12. doi: 10.1038/s41409-025-02587-1.
Food insecurity (FI), defined as the lack of continuous access to adequate food, affects 17-55% of cancer patients. Effects may be exacerbated in hematopoietic stem cell transplant (HSCT) patients, who face nutritional challenges due to treatment side effects, leading to weight loss and malnutrition. We hypothesize that pre-HSCT FI increases the risk of malnutrition, requiring nutrition support, and adverse psychosocial outcomes. Between February 2018 and August 2022, 284 patients were screened before HSCT for FI. 71 (25%) were excluded due to missing data. Of the remaining 213, 20 (9.4%) reported pre-HSCT FI. Patients with FI were more likely to develop malnutrition during HSCT (70% vs. 45.1%, p = 0.034) and need total parenteral nutrition compared to those without FI (65% vs. 34.2%, p = 0.013). Patients with FI also were more likely to screen positive for depression (40% vs. 10.4%, p = 0.002) and financial toxicity (75% vs. 25%, p < 0.001). There were no significant differences in survival or other secondary outcomes. Our study demonstrates that pre-HSCT FI significantly increases likelihood of malnutrition, the need for total parenteral nutrition, and adverse psychosocial outcomes in HSCT patients. These findings highlight the critical importance of early identification and interventions to address FI as part of comprehensive cancer care.
粮食不安全（FI）被定义为无法持续获得充足食物，影响着17%至55%的癌症患者。造血干细胞移植（HSCT）患者的情况可能会更糟，他们因治疗副作用面临营养挑战，导致体重减轻和营养不良。我们假设HSCT前的FI会增加营养不良、需要营养支持以及出现不良心理社会后果的风险。在2018年2月至2022年8月期间，对284例HSCT患者进行了FI筛查。71例（25%）因数据缺失被排除。在其余213例中，20例（9.4%）报告有HSCT前的FI。与无FI的患者相比，有FI的患者在HSCT期间更易发生营养不良（70%对45.1%，p = 0.034），且更需要全胃肠外营养（65%对34.2%，p = 0.013）。有FI的患者抑郁筛查呈阳性（40%对10.4%，p = 0.002）和出现经济毒性的可能性也更高（75%对25%，p < 0.001）。在生存率或其他次要结局方面无显著差异。我们的研究表明，HSCT前的FI显著增加了HSCT患者发生营养不良、需要全胃肠外营养以及出现不良心理社会后果的可能性。这些发现凸显了在综合癌症护理中早期识别和干预以解决FI的至关重要性。
