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Mårtensson U, Jenholt Nolbris M, Mellgren K, Wijk H, Nilsson S. Meals are more than nutrition for children with a malignant or non-malignant disorder with a gastrostomy tube: A qualitative study. Eur J Oncol Nurs 2024; 72:102663. [PMID: 39068866 DOI: 10.1016/j.ejon.2024.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To elucidate mealtime experiences of children hospitalized with a malignant or severe non-malignant disorder -and their parents-after a gastrostomy tube insertion. METHODS A qualitative design involving a child-centred care approach was used. Parents of children aged 1-18 years old who had received a gastrostomy tube during treatment for a malignant or non-malignant disorder were included, as were the children themselves when aged 5-18 years old. Semi-structured interviews with 21 families were carried out and a thematic analysis performed. RESULTS The findings were presented in four themes: changed meal conditions, a troublesome sensory dimension, aggravating obstacles and solving the unmanageable. Hospitalization involves challenges regarding environmental aspects, hospital food and side effects, contributing to impaired nutritional intake and aggravated mealtime situations. CONCLUSIONS Hospital environment and hospital food have a profound impact on children's nutritional intake and mealtime situations. In addition, sensory aspects and side effects aggravate the child's motivation to eat, resulting in demanding meals. The families described a gastrostomy tube as a valuable strategy for improving mealtime situations.
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Affiliation(s)
- Ulrika Mårtensson
- Faculty of Care Science, Work Life and Social Welfare, University of Borås, SE - 501 90, Borås, Sweden.
| | - Margaretha Jenholt Nolbris
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden.
| | - Karin Mellgren
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 416 85 Gothenburg, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden; Chalmers Technology University/Centre for Health Care Architecture, SE- 412 96, Gothenburg, Sweden.
| | - Stefan Nilsson
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, SE- 405 30, Gothenburg, Sweden.
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2
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Budka-Chrzęszczyk A, Szlagatys-Sidorkiewicz A, Bień E, Irga-Jaworska N, Borkowska A, Krawczyk MA, Popińska K, Romanowska H, Toporowska-Kowalska E, Świder M, Styczyński J, Szczepański T, Książyk J. Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. Nutrients 2024; 16:1327. [PMID: 38732574 PMCID: PMC11085082 DOI: 10.3390/nu16091327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
"Managing Undernutrition in Pediatric Oncology" is a collaborative consensus statement of the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. The early identification and accurate management of malnutrition in children receiving anticancer treatment are crucial components to integrate into comprehensive medical care. Given the scarcity of high-quality literature on this topic, a consensus statement process was chosen over other approaches, such as guidelines, to provide comprehensive recommendations. Nevertheless, an extensive literature review using the PubMed database was conducted. The following terms, namely pediatric, childhood, cancer, pediatric oncology, malnutrition, undernutrition, refeeding syndrome, nutritional support, and nutrition, were used. The consensus was reached through the Delphi method. Comprehensive recommendations aim to identify malnutrition early in children with cancer and optimize nutritional interventions in this group. The statement underscores the importance of baseline and ongoing assessments of nutritional status and the identification of the risk factors for malnutrition development, and it presents tools that can be used to achieve these goals. This consensus statement establishes a standardized approach to nutritional support, aiming to optimize outcomes in pediatric cancer patients.
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Affiliation(s)
- Agnieszka Budka-Chrzęszczyk
- Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.S.-S.)
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.S.-S.)
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Anna Borkowska
- Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.S.-S.)
| | - Małgorzata Anna Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Katarzyna Popińska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Ewa Toporowska-Kowalska
- Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, 91-738 Lodz, Poland
| | - Magdalena Świder
- Department of Anesthesiology and Critical Care Medicine, Clinical Provincial Hospital No. 2 in Rzeszow, 35-301 Rzeszow, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, 85-000 Bydgoszcz, Poland
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, 40-752 Katowice, Poland
| | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
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3
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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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4
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Rodriguez M, Fekry B, Murphy B, Figueroa M, Cheng T, Raber M, Wartenberg L, Bell D, Triche L, Crawford K, Ma H, Allton K, Ahmed R, Tran J, Ranieri C, Konopleva M, Barton M, Nunez C, Eckel‐Mahan K, Chandra J. Feasible diet and circadian interventions reduce in vivo progression of FLT3-ITD-positive acute myeloid leukemia. Cancer Med 2024; 13:e6949. [PMID: 38334474 PMCID: PMC10854450 DOI: 10.1002/cam4.6949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) with an internal tandem duplication in the fms-like tyrosine kinase receptor 3 gene (FLT3-ITD) is associated with poor survival, and few studies have examined the impact of modifiable behaviors, such as nutrient quality and timing, in this subset of acute leukemia. METHODS The influence of diet composition (low-sucrose and/or low-fat diets) and timing of diet were tested in tandem with anthracycline treatment in orthotopic xenograft mouse models. A pilot clinical study to test receptivity of pediatric leukemia patients to macronutrient matched foods was conducted. A role for the circadian protein, BMAL1 (brain and muscle ARNT-like 1), in effects of diet timing was studied by overexpression in FLT3-ITD-bearing AML cells. RESULTS Reduced tumor burden in FLT3-ITD AML-bearing mice was observed with interventions utilizing low-sucrose and/or low-fat diets, or time-restricted feeding (TRF) compared to mice fed normal chow ad libitum. In a tasting study, macronutrient matched low-sucrose and low-fat meals were offered to pediatric acute leukemia patients who largely reported liking the meals. Expression of the circadian protein, BMAL1, was heightened with TRF and the low-sucrose diet. BMAL1 overexpression and treatment with a pharmacological inducer of BMAL1 was cytotoxic to FLT3-ITD AML cells. CONCLUSIONS Mouse models for FLT3-ITD AML show that diet composition and timing slows progression of FLT3-ITD AML growth in vivo, potentially mediated by BMAL1. These interventions to enhance therapy efficacy show preliminary feasibility, as pediatric leukemia patients responded favorable to preparation of macronutrient matched meals.
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Affiliation(s)
- Megan Rodriguez
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Baharan Fekry
- Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center (UT Health)HoustonTexasUSA
| | - Brianna Murphy
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mary Figueroa
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- University of Texas MD Anderson Cancer Center UT Health Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Tiewei Cheng
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Margaret Raber
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- School of Public Health, Division of Epidemiology, Human Genetics and Environmental SciencesUniversity of TexasHoustonTexasUSA
| | - Lisa Wartenberg
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Donna Bell
- Department of Pediatrics Patient CareThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lisa Triche
- Department of Pediatrics Patient CareThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Karla Crawford
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Huaxian Ma
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kendra Allton
- Bionutrition Research CoreThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ruwaida Ahmed
- Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center (UT Health)HoustonTexasUSA
| | - Jaime Tran
- Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center (UT Health)HoustonTexasUSA
| | - Christine Ranieri
- Bionutrition Research CoreThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Marina Konopleva
- Section of Molecular Hematology and Therapy, Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Michelle Barton
- Department of Epigenetics and Molecular CarcinogenesisThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Cesar Nunez
- Department of Pediatrics Patient CareThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kristin Eckel‐Mahan
- Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center (UT Health)HoustonTexasUSA
| | - Joya Chandra
- Department of Pediatrics‐ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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5
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Damasco-Avila E, Zelaya Sagastizado S, Carrillo M, Blanco J, Fu L, Espinoza D, Ladas EJ. Improving the Quality of the Delivery of Nutritional Care Among Children Undergoing Treatment for Cancer in a Low- and Middle-Income Country. JCO Glob Oncol 2023; 9:e2300074. [PMID: 37384860 PMCID: PMC10497261 DOI: 10.1200/go.23.00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE International twinning programs have been well-established between institutions in childhood cancer and have led to pediatric cancer units in low- and middle-income countries (LMICs) adopting multidisciplinary forms of care. To advance nutritional care in LMICs, the International Initiative for Pediatrics and Nutrition (IIPAN) provided the structural framework and personnel for the delivery of nutritional care. We describe the impact of a newly established nutrition program on the delivery of nutritional care and nutrition-related clinical outcomes in children and adolescents undergoing treatment for cancer in Nicaragua and Honduras. METHODS A prospective cohort (N = 126) collected clinical data over a 2-year period. Collection of IIPAN's nutritional services received during treatment and clinical data were abstracted from medical charts and registered in Research Electronic Data Capture (REDCap) database. Chi-square, ANOVA, and generalized linear mixed models were used; P < .05 was considered statistically significant. RESULTS Nutritional assessments led to a higher number of patients receiving recommended standard of care. Children classified as underweight during treatment presented higher number of infections and toxicities, length of hospital stay, and days of treatment delays during treatment. Overall, from the start to end of treatment, 32.5% of patients improved nutritional status, 35.7% maintained it, and 17.5% worsened. On the basis of metrics, the cost per consultation was less than 4.80 US dollars (USD; Honduras) and 1.60 USD (Nicaragua). CONCLUSION Integration and equitable access of the nutritional care process for all patients needs to be recognized as a component of the basic management in pediatric oncology care. IIPAN's nutritional program demonstrates that nutritional care is economical and feasible in a limited resource setting.
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Affiliation(s)
- Erika Damasco-Avila
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY
| | | | - María Carrillo
- Department of Hematology/Oncology, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua
| | - Jessica Blanco
- National Unit of Pediatric Oncology, Guatemala City, Guatemala
| | - Ligia Fu
- Pediatric Hematology and Oncology Unit, Hospital Escuela, Tegucigalpa, Honduras
| | - Darrell Espinoza
- Department of Hematology/Oncology, Hospital Infantil Manuel de Jesús Rivera, Managua, Nicaragua
| | - Elena J. Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY
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6
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Muratore E, Leardini D, Baccelli F, Venturelli F, Cerasi S, Zanaroli A, Lanari M, Prete A, Masetti R, Zama D. The emerging role of nutritional support in the supportive care of pediatric patients undergoing hematopoietic stem cell transplantation. Front Nutr 2023; 10:1075778. [PMID: 36875838 PMCID: PMC9975569 DOI: 10.3389/fnut.2023.1075778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) represents a potentially curative strategy for many oncological, hematological, metabolic, and immunological diseases in children. The continuous effort in ameliorating supportive care represents one of the cornerstones in the improvement of outcome in these patients. Nowadays, more than ever nutritional support can be considered a key feature. Oral feeding in the early post-transplant period is severely impaired because of mucositis due to conditioning regimen, characterized by, mainly by vomiting, anorexia, and diarrhea. Gastrointestinal acute graft-versus-host-disease (GvHD), infections and associated treatments, and other medications, such as opioids and calcineurin inhibitors, have also been correlated with decreased oral intake. The consequent reduction in caloric intake combined with the catabolic effect of therapies and transplantation-related complications with consequent extended immobilization, results in a rapid deterioration of nutritional status, which is associated with decreased overall survival and higher complication rates during treatment. Thus, nutritional support during the early post-transplantation period becomes an essential and challenging issue for allo-HSCT recipients. In this context, the role of nutrition in the modulation of the intestinal flora is also emerging as a key player in the pathophysiology of the main complications of HSCT. The pediatric setting is characterized by less evidence, considering the challenge of addressing nutritional needs in this specific population, and many questions are still unanswered. Thus, we perform a narrative review regarding all aspects of nutritional support in pediatric allo-HSCT recipients, addressing the assessment of nutritional status, the relationship between nutritional status and clinical outcomes and the evaluation of the nutritional support, ranging from specific diets to artificial feeding.
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Affiliation(s)
- Edoardo Muratore
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Leardini
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Baccelli
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Venturelli
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Sara Cerasi
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Zanaroli
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Daniele Zama
- Pediatric Emergency Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Tripodi SI, Bergami E, Panigari A, Caissutti V, Brovia C, De Cicco M, Cereda E, Caccialanza R, Zecca M. The role of nutrition in children with cancer. TUMORI JOURNAL 2023; 109:19-27. [PMID: 35722985 PMCID: PMC9896537 DOI: 10.1177/03008916221084740] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, the influence of nutrition on the health and growth of children has become increasingly important. The relevance of nutrition is even greater for children who are facing cancer. Malnutrition, within the context of undernutrition and overnutrition, may impact not only the effectiveness of treatments and outcomes, but also the quality of life for patients and their families. In this article, we review nutritional assessment methods for children with cancer, focusing on the specific characteristics of this population and analyze the efficacy of nutritional interventions, which include enteral, parenteral, and nutritional education. From our analysis, two important conclusions emerged: i) there is a need to focus our attention on the nutritional status and the body composition of oncologic children, since these factors have a relevant impact on clinical outcomes during treatment as well as after their conclusion; ii) the support of skilled clinical nutrition personnel would be extremely helpful for the global management of these patients.
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Affiliation(s)
- Serena Ilaria Tripodi
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Serena Ilaria Tripodi, Paediatric
Haematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi
19, Pavia, 27100, Italy.
| | - Elena Bergami
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Arianna Panigari
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Caissutti
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlotta Brovia
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marica De Cicco
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cell Factory, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Zecca
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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8
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Wu WW, Shiu CS, Tang CC, Jou ST, Chen HL. The Moderated Mediating Effects of Nutrition and Physical Activity Between Fatigue and Quality of Life in Childhood Cancer Survivors. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:23-29. [PMID: 36592888 DOI: 10.1016/j.anr.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the associations between nutrition, physical activity, fatigue, and quality of life (QoL) among childhood cancer survivors. The specific purpose was to examine whether nutrition mediated and physical activity moderated the relationship between fatigue and QoL in this population. METHODS A pooled sample of 120 childhood cancer survivors was recruited at pediatric oncology wards and ambulatory settings between August 2020 and May 2021. We collected data on participants' demographic characteristics, fatigue, nutritional status, physical activity, and QoL. We then adapted Hayes Process Macro to examine the mediating and moderating effects of nutrition and physical activity on the relationship between fatigue and QoL. RESULTS In models adjusted for age and sex, (1) the simple mediation analysis identified the mediating effect of nutrition on the relationship between fatigue and QoL; and (2) the mediation and moderation analysis identified that the direct effect of nutrition between fatigue and QoL was significant when adding (a) physical activity and (b) fatigue × physical activity. There were significantly decreasing trends in physical activity at 1 standard deviation below the mean and at the mean, but not at 1 standard deviation above the mean. CONCLUSIONS Our findings demonstrate that nutrition mediated and physical activity moderated the relationship between fatigue and QoL. This highlights an opportunity to enhance QoL among childhood cancer survivors through healthy lifestyle interventions. To ensure that future interventions address children's needs and promote the greatest impact, such interventions should include nutrition and physical activity components that involve nurses, pediatric oncology physicians, nutritionists, and physical therapists.
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Affiliation(s)
- Wei-Wen Wu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Cheng-Shi Shiu
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Chia-Chun Tang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiann-Tang Jou
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huey-Ling Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan; Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
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9
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Role of Nutrition in Pediatric Patients with Cancer. Nutrients 2023; 15:nu15030710. [PMID: 36771416 PMCID: PMC9920596 DOI: 10.3390/nu15030710] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Children with cancer are at high risk for developing short-term and long-term nutritional problems related to their underlying disease and side effects of multimodal treatments. Nutritional status (NS) can influence several clinical outcomes, such as overall survival (OS) and event-free survival (EFS), treatment tolerance, risk of developing infections and quality of life (QoL). However, the importance of nutrition in children with cancer is still underestimated. This review focuses on alterations of NS that occurs in children during cancer treatment. In particular, we reviewed the pathogenesis of undernutrition in oncological children, as well as how NS affects treatment tolerance and response, the immune system and the risk of infections of children with cancer. Thanks to recent advances in all types of supportive therapy and to the progress of knowledge on this topic, it has been realized that NS is a modifiable prognostic factor that can be intervened upon to improve the outcome of these patients. Currently, there is a lack of a systematic approach and standard recommendations for nutritional care in the pediatric cancer population. Literature analysis showed that it is essential to define the NS and treat any alterations in a timely manner ensuring proper growth and development. Nutritional follow-up should become an integral part of the care pathway. Regular nutritional monitoring should be performed at diagnosis, during treatment and during follow-up. A close collaboration and sharing of expertise between pediatric oncologists and nutrition specialists, combined with careful and participatory sharing of the feeding experience with the family and the child (after age 6 years), is strongly required.
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Karalexi MA, Markozannes G, Tagkas CF, Katsimpris A, Tseretopoulou X, Tsilidis KK, Spector LG, Schüz J, Siahanidou T, Petridou ET, Ntzani EE. Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature. Diagnostics (Basel) 2022; 12:2357. [PMID: 36292046 PMCID: PMC9600212 DOI: 10.3390/diagnostics12102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies so far have examined the impact of nutritional status on the survival of children with cancer, with the majority of them focusing on hematological malignancies. We summarized published evidence reporting the association of nutritional status at diagnosis with overall survival (OS), event-free survival (EFS), relapse, and treatment-related toxicity (TRT) in children with cancer. Published studies on children with leukemia, lymphoma, and other solid tumors have shown that both under-nourished and over-nourished children at cancer diagnosis had worse OS and EFS. Particularly, the risk of death and relapse increased by 30-50% among children with leukemia with increased body mass index at diagnosis. Likewise, the risk of TRT was higher among malnourished children with osteosarcoma and Ewing sarcoma. Nutritional status seems to play a crucial role in clinical outcomes of children with cancer, thus providing a significant modifiable prognostic tool in childhood cancer management. Future studies with adequate power and longitudinal design are needed to further evaluate the association of nutritional status with childhood cancer outcomes using a more standardized definition to measure nutritional status in this population. The use of new technologies is expected to shed further light on this understudied area and give room to person-targeted intervention strategies.
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Affiliation(s)
- Maria A. Karalexi
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Christos F. Tagkas
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Andreas Katsimpris
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Xanthippi Tseretopoulou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Pediatric Endocrinology, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Konstantinos K. Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Logan G. Spector
- Department of Pediatrics, Division of Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Th. Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelia E. Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI 02903, USA
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11
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Fabozzi F, Trovato CM, Diamanti A, Mastronuzzi A, Zecca M, Tripodi SI, Masetti R, Leardini D, Muratore E, Barat V, Lezo A, De Lorenzo F, Caccialanza R, Pedrazzoli P. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers (Basel) 2022; 14:cancers14143378. [PMID: 35884438 PMCID: PMC9319266 DOI: 10.3390/cancers14143378] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nutritional management is an underestimated issue in treating pediatric cancer, since a systematic approach is currently lacking. In this consensus statement, a cohort of 12 experts selected from four different tertiary pediatric oncology centers formulated 21 clinical questions regarding the identification and treatment of nutritional issues in children with cancer. These questions were discussed, and practical recommendations were provided. With this paper, we aimed to give consensus-based guidance for addressing the nutritional needs of children with cancer, filling a gap in the field. Abstract Malnutrition, intended as both overnutrition and undernutrition, is a common problem in children with cancer, impacting quality of life as well as survival. In addition, nutritional imbalances during childhood can significantly affect proper growth. Nevertheless, there is currently a lack of a systematic approach to this issue in the pediatric oncology population. To fill this gap, we aimed to provide practice recommendations for the uniform management of nutritional needs in children with cancer. Twenty-one clinical questions addressing evaluation and treatment of nutritional problems in children with cancer were formulated by selected members from four Italian Association of Pediatric Hematology and Oncology (AIEOP) centers and from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. A literature search in PubMed was performed; during two consensus meetings, all recommendations were discussed and finalized using the nominal group technique. Members representing every institution voted on each recommendation. Finally, recommendations were approved by all authors.
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Affiliation(s)
- Francesco Fabozzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
- Department of Pediatrics, University of Rome Tor Vergata, 00165 Rome, Italy
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
- Correspondence:
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
| | - Marco Zecca
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Serena Ilaria Tripodi
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Riccardo Masetti
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Davide Leardini
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Edoardo Muratore
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Veronica Barat
- SC Onco-Ematologia Pediatrica, AOU Città della Salute e della Scienza, 10126 Torino, Italy;
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Children’s Hospital Regina Margherita, AOU Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy;
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12
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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13
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González HR, Mejía SA, Ortiz JOC, Gutiérrez APO, López JEB, Quintana JEF. Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study. Ecancermedicalscience 2022; 15:1327. [PMID: 35211196 PMCID: PMC8816504 DOI: 10.3332/ecancer.2021.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Paediatric cancer is a potentially curable disease and its prognosis has been linked to several factors, such as nutritional status. The impact of malnutrition on these patients, either by overnutrition or undernutrition, varies and its relationship with outcomes is inconsistent. This study was conducted in order to determine the frequency of malnutrition in children with haematolymphoid malignancies at the time of diagnosis, as well as during treatment and to also investigate its relationship with the development of infections and death. Materials and Methods A retrospective cohort study of 191 children with a recent diagnosis of a haematolymphoid malignancy. The risks and nutritional classification were determined using anthropometry, follow-ups were conducted for up to 24 months and the presentation and frequency of infections and/or death were also recorded. Bivariate and multivariate analyses were conducted using binomial logistic regressions, for death and infection outcomes during follow-up. Survival analysis was conducted for various factors and types of cancer. Results 83.7% of children had a sufficient nutritional classification at diagnosis, 6.8% had malnutrition by undernutrition and 9.4% by overnutrition. 83.8% had at least one infectious complication during follow-up and 47.1% had ≥ 3. This percentage increased to 69.2% when configuring it in the malnutrition by undernutrition group. 18.3% of patients died. When configuring the mortality, the percentage was greater in patients with Acute Myeloid Leukaemia (AML) (57.1%) and malnutrition by undernutrition (30.7%). The multivariate analysis for the outcome of death, only showed a statistically significant variable (AML odds ratio = 26.52; confidence interval = 1.09–643.24; p = 0.04). Conclusion No statistically significant relationship was found between the nutritional status of children with haematolymphoid neoplasms, and outcomes such as infections or death. The differences in the results obtained in these investigations may be related to the varied nutritional status definitions and the ways of measuring them, thus limiting comparisons between them.
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Affiliation(s)
| | - Sergio Andrade Mejía
- University of Antioquia, Carrera 51d #62-29, Medellín 050010, Colombia.,https://orcid.org/0000-0001-5823-6110
| | - Javier Orlando Contreras Ortiz
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0001-8568-5421
| | - Adriana Patricia Osorno Gutiérrez
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0003-3513-7659
| | - Jorge Eliécer Botero López
- An tioquia School of Engineering, Universidad EIA, Vda. El Penasco, Envigado, Antioquia 055428, Colombia.,https://orcid.org/0000-0003-2907-5500
| | - Javier Enrique Fox Quintana
- San Vicente Children's Hospital Foundation, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0002-1014-9402
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14
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Zhu S, Cheng Z, Hu Y, Chen Z, Zhang J, Ke C, Yang Q, Lin F, Chen Y, Wang J. Prognostic Value of the Systemic Immune-Inflammation Index and Prognostic Nutritional Index in Patients With Medulloblastoma Undergoing Surgical Resection. Front Nutr 2022; 8:754958. [PMID: 34977115 PMCID: PMC8718683 DOI: 10.3389/fnut.2021.754958] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/18/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The progression and metastasis of cancers are associated with systematic immune inflammation and nutritional dysfunction. The systemic immune-inflammation index and prognostic nutritional index (PNI) have shown a prognostic impact in several malignancies. Therefore, our study aimed to evaluate immune inflammation and nutritional index prognostic significance in patients with medulloblastoma (MB). Methods: We retrospectively analyzed 111 patients with MB between 2001 and 2021 at our institution. The optimal cutoff values for systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte counts ration (MLR), and PNI were evaluated with receiver operating characteristic (ROC) curve analysis. Clinical characteristics and SII, NLR, MLR, and PNI were tested with the Pearson's chi-squared test. The Kaplan–Meier survival curves and the Cox proportional hazards model were used to evaluate the effects of immune inflammation and nutritional index on overall survival (OS). Results: Receiver operating characteristic curve analysis determined the optimal SII, NLR, MLR, and PNI cutoff values of 2,278, 14.83, 0.219, and 56.5 that significantly interacts with OS and divided the patients into two groups. Comparative survival analysis exhibited that the high-SII cohort had significantly shorter OS (p = 0.0048) than the low-SII cohort. For the univariate analysis, the results revealed that preoperative hydrocephalus (p = 0.01), SII (p = 0.006), albumin–bilirubin score (ALBI) (p = 0.04), and coSII–PNI were predictors of OS. In the multivariate analysis, preoperative hydrocephalus (p < 0.001), ALBI (p = 0.010), SII (p < 0.001), and coSII–PNI as independent prognostic factors were significantly correlated with OS. Conclusion: The preoperative SII, ALBI, and coSII–PNI serve as robust prognostic biomarkers for patients with MB undergoing surgical resection.
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Affiliation(s)
- Sihan Zhu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhuqing Cheng
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanjun Hu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhenghe Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ji Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chao Ke
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qunying Yang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fuhua Lin
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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