According to Gram Research analysis, only 1 out of 10 Canadian stem cell transplant centers uses preventive feeding tubes, even though medical guidelines recommend them. A 2025 survey of Canadian transplant dietitians found that all 10 centers used IV nutrition, but just one used feeding tubes before patients developed complications. Patient refusal (71%), medical concerns (71%), and staff preference for IV nutrition (71%) were the main barriers preventing preventive feeding tube use.
When cancer patients receive stem cell transplants, their digestive systems get damaged and they struggle to eat normally. Doctors have two main feeding options: tubes that go directly into the stomach (enteral nutrition) or IV nutrition (parenteral nutrition). According to Gram Research analysis, a new Canadian study found that most transplant centers use IV feeding as their default choice, even though medical guidelines recommend trying stomach tubes first to keep the gut healthy. Only one out of ten Canadian centers used preventive stomach feeding, mainly because patients refused it, doctors worried about complications, and there were no clear protocols in place.
Key Statistics
A 2025 cross-sectional survey of 10 Canadian stem cell transplant centers found that only 1 center (10%) used preventive feeding tubes, while all 10 centers (100%) used IV nutrition for transplant patients.
According to a 2025 Canadian quality assurance study of stem cell transplant centers, 71% of centers reported patient refusal as a barrier to preventive feeding tubes, 71% cited clinical concerns, and 71% noted staff preference for IV nutrition.
A 2025 survey of Canadian transplant dietitians found that 7 out of 10 centers (70%) used feeding tubes at all, but only 1 center (10%) used them preventively before complications developed.
Research reviewed by Gram found that 14% of Canadian stem cell transplant centers cited lack of written protocols as a barrier to implementing preventive feeding tube programs.
The Quick Take
- What they studied: Whether Canadian cancer transplant centers use preventive feeding tubes to help patients maintain nutrition during stem cell transplants
- Who participated: Dietitians from 10 out of 17 adult stem cell transplant centers across Canada who answered a survey in early 2025
- Key finding: Only 1 out of 10 centers (10%) used preventive feeding tubes, while all 10 used IV nutrition. The main reasons centers avoided feeding tubes were patient refusal (71%), medical concerns (71%), and staff preference for IV nutrition (71%)
- What it means for you: If you’re getting a stem cell transplant, ask your medical team about feeding tube options early. Current practice may not match what medical guidelines recommend, so being informed helps you get the best nutrition support
The Research Details
Researchers sent a survey to dietitians working at Canadian stem cell transplant centers listed on the Cell Therapy Transplant Canada website. The survey was sent in February and March 2025. Dietitians from 10 of the 17 adult centers responded, giving researchers a snapshot of current feeding practices across Canada.
This type of study is called a ‘quality assurance’ or benchmarking study. Instead of testing a new treatment, researchers looked at what centers are actually doing right now and compared it to what medical guidelines recommend. They asked specific questions about whether centers use feeding tubes before patients develop serious problems, what barriers prevent them from using tubes, and what protocols they have in place.
The researchers focused on two main feeding methods: enteral nutrition (feeding tubes that deliver nutrition directly to the stomach or small intestine) and parenteral nutrition (IV nutrition delivered through the bloodstream). They wanted to understand why centers choose one method over the other.
This research matters because stem cell transplants damage the digestive system, making it hard for patients to eat and putting them at risk of malnutrition. Malnutrition can slow recovery and increase complications. Medical guidelines from the American Society for Parenteral and Enteral Nutrition recommend trying feeding tubes first because they help maintain gut health. However, no one knew whether Canadian centers were actually following this recommendation. This study reveals a gap between what guidelines say and what centers actually do, which could help improve patient care.
This study has some important limitations to understand. First, only 10 out of 17 centers responded, so the results may not represent all Canadian centers. Second, the survey was answered by dietitians, who may have different perspectives than doctors or nurses at their centers. Third, this is a snapshot from early 2025, so practices may change over time. However, the study provides valuable real-world information about current practices and identifies specific barriers that prevent centers from using feeding tubes.
What the Results Show
The survey revealed a striking gap between medical guidelines and actual practice. All 10 participating centers used IV nutrition (parenteral nutrition), but only 7 centers used feeding tubes at all, and just 1 center used feeding tubes preventively before complications developed.
The researchers identified four main barriers preventing centers from using preventive feeding tubes. Patient refusal was the most common barrier, with 71% of centers reporting that patients refused feeding tubes. Clinical concerns were equally common at 71%, including worries about low blood platelet counts and mouth sores that could make feeding tubes risky. Staff preference for IV nutrition was also reported by 71% of centers, suggesting that doctors and nurses felt more comfortable with the familiar IV approach. Finally, 14% of centers cited lack of written protocols as a barrier.
These barriers often worked together. For example, when staff preferred IV nutrition and patients were worried about complications, centers rarely attempted preventive feeding tubes. The study suggests that changing practice would require addressing multiple barriers simultaneously, not just one.
The study found that even among the 7 centers using feeding tubes, most used them only after patients developed problems, not preventively. This reactive approach means patients may already be malnourished before receiving feeding tube support. The researchers also noted that lack of standardized protocols was a significant issue—only a minority of centers had clear written guidelines for when and how to use feeding tubes. This lack of standardization likely contributes to inconsistent patient care across different centers.
Previous research and medical guidelines from the American Society for Parenteral and Enteral Nutrition have consistently recommended prioritizing feeding tubes over IV nutrition in transplant patients because feeding tubes maintain gut integrity and function. This Canadian study shows that practice lags significantly behind these recommendations. The findings align with international research suggesting that feeding tubes are underutilized in transplant settings due to clinical concerns and staff preferences, even when guidelines recommend them.
This study has several important limitations. The sample size is small—only 10 centers responded out of 17, which is about 59% participation. This means the results may not represent all Canadian centers or may overrepresent centers with particular practices. The survey was answered by dietitians only, so the perspectives of physicians, nurses, and patients weren’t directly captured. The study was conducted in early 2025, so practices may have changed since then. Additionally, the study was a one-time snapshot rather than tracking changes over time. Finally, the study didn’t examine patient outcomes, so we don’t know whether the centers using more IV nutrition had better or worse results than those using feeding tubes.
The Bottom Line
If you’re scheduled for a stem cell transplant, discuss feeding options with your medical team before the procedure begins. Ask specifically about preventive feeding tubes and why your center does or doesn’t use them. Request written protocols and clear explanations of the risks and benefits of each feeding method. Work with your dietitian to develop a nutrition plan that matches medical guidelines. These conversations should happen early, before complications develop. Confidence level: High—this recommendation aligns with established medical guidelines, though individual circumstances vary.
Stem cell transplant patients and their families should care about this research. Oncologists and transplant specialists should review whether their centers’ practices match current guidelines. Dietitians and nutrition specialists should advocate for standardized protocols and preventive feeding approaches. Hospital administrators should consider implementing written protocols for feeding tube use. Patients with other serious illnesses requiring nutrition support may also benefit from understanding these issues.
If preventive feeding tubes are used, patients may see benefits within days to weeks as they maintain better nutrition during the transplant recovery period. However, the full benefits—including better recovery outcomes and fewer complications—typically become apparent over weeks to months. Changing institutional practices to implement preventive feeding tubes would take several months to a year, including staff training and protocol development.
Frequently Asked Questions
Why don’t stem cell transplant centers use feeding tubes more often?
A 2025 Canadian survey found three main reasons: patients often refuse feeding tubes due to discomfort concerns, doctors worry about complications like bleeding or infections, and staff feel more comfortable with familiar IV nutrition. Lack of written protocols also plays a role.
Is a feeding tube safer than IV nutrition for transplant patients?
Medical guidelines recommend feeding tubes over IV nutrition because they maintain gut health and function. However, individual safety depends on your specific condition. Discuss risks and benefits with your transplant team, as some patients may have legitimate reasons to use IV nutrition instead.
What should I ask my transplant team about nutrition before my procedure?
Ask whether your center uses preventive feeding tubes, what their written protocol is, why they recommend IV or feeding tube nutrition, and what nutrition support plan they recommend for your specific situation. Request this discussion before your transplant begins.
Can I refuse a feeding tube and use only IV nutrition?
Yes, patients can refuse feeding tubes. However, research shows that feeding tubes help maintain gut health during transplants. If you’re considering refusal, discuss your concerns with your medical team so they can address specific worries and help you make an informed decision.
How long do transplant patients need nutrition support?
Duration varies by individual and transplant type, typically ranging from weeks to several months. Your medical team will monitor your ability to eat normally and adjust nutrition support accordingly. Preventive feeding tubes may be needed only temporarily during the most difficult recovery period.
Want to Apply This Research?
- Track daily oral intake (food and drinks consumed by mouth) in grams or milliliters, and note any feeding tube usage or IV nutrition days. This helps you and your medical team see patterns in your nutrition support and identify when preventive feeding might have helped.
- Before your transplant, schedule a meeting with your transplant team and dietitian specifically to discuss nutrition plans. Ask about feeding tube protocols and request written information about when and why each feeding method would be used. Document their responses so you can reference them during your treatment.
- Throughout your transplant recovery, log your nutrition method daily (oral, feeding tube, IV, or combination), any nutrition-related symptoms (nausea, difficulty swallowing, appetite changes), and your weight weekly. Share this log with your dietitian at each visit to track whether your nutrition support is adequate and adjust as needed.
This article summarizes research about nutrition practices in stem cell transplant centers and is for educational purposes only. It does not constitute medical advice. Nutrition decisions for stem cell transplant patients should be made in consultation with your transplant team, oncologist, and registered dietitian who understand your individual medical situation. The findings represent current practices in Canadian centers and may not apply to all transplant programs. Always discuss feeding options, risks, and benefits with your healthcare providers before making decisions about your nutrition support during transplant treatment.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.
