Healthcare professionals' knowledge and attitudes toward the microbiome and fecal microbiotherapy or microbiota transfer in hematology and oncology: an international survey.

Abstract

The gut microbiome has emerged as a critical factor influencing cancer progression, treatment response, and complications in hematology and oncology. Fecal microbiota transfer (FMT) is being explored as a novel biotherapeutic strategy, yet the knowledge and attitudes of healthcare professionals towards its clinical use remain poorly defined. We conducted an international survey of 152 healthcare professionals, including hematologists, oncologists, transplant specialists, and others. Most respondents were affiliated with academic centers (66.0%) and practiced primarily in hematology (48.0%) or transplantation (34.0%). Awareness of the microbiome's clinical relevance was widespread, but perceptions of microbiome profiling and FMT remained cautious. One-third of participants were in favor of routine microbiome profiling, while half considered it promising but still investigational. Direct clinical experience with FMT was limited: only 20.4% had prescribed it and 14.5% had referred patients. Nonetheless, over half indicated they would consider adopting FMT in the near future. The main reported barriers to broader use included limited regulatory approval (63.8%), logistical or supply challenges (57.9%), and physician skepticism or lack of knowledge (51.3%). Despite these challenges, more than 70% of respondents expressed strong interest in further education, standardized guidelines, and training opportunities to support safe and effective implementation. This survey highlights a strong enthusiasm regarding microbiome-based interventions in cancer and transplantation care. While current clinical use remains limited, healthcare professionals recognize the therapeutic potential of FMT and call for structured education, multidisciplinary collaboration, and clear regulatory frameworks to enable its integration into routine practice.