1
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Colunga-Pedraza PR, Colunga-Pedraza JE, Peña-Lozano SP, Gómez-De León A, Ruiz-Delgado GJ, Ribeiro RC. Diagnosis and treatment of acute lymphoblastic leukemia in Latin America. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:971-976. [PMID: 36040187 DOI: 10.1080/16078454.2022.2117119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE to discuss the status and challenges associated with the management of acute lymphoblastic leukemia (ALL) in Latin America. METHODS This review summarizes various insights gained from information regarding diagnostic approaches and treatment strategies in adult patients with ALL in Latin American Countries. RESULTS Information regarding ALL in Latin America is scarce; however, many efforts have been made to overcomes these barriers. Nevertheless, major obstacles to successful treatment in Latin America and LMIC remain poor adherence, abandonment of treatment, and lack of supportive therapy and new therapeutic agents. CONCLUSION Further improvements in survival should be pursued by developing more Latin American registries, forming cooperative groups, developing educational models to facilitate earlier diagnosis and prevention of complications, better support therapy and management of infections, and adapting treatment strategies.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Julia E Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Samantha P Peña-Lozano
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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2
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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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3
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Jaime-Pérez JC, Turrubiates-Hernández GA, García-Salas G, de la Torre-Salinas AM, Áncer-Rodríguez P, Villarreal-Martínez L, Gómez-Almaguer D. The Influence of Nutritional Status at Diagnosis of Childhood B-Cell Acute Lymphoblastic Leukemia on Survival Rates: Data from a Hispanic Cohort. Nutr Cancer 2021; 74:889-895. [PMID: 34180310 DOI: 10.1080/01635581.2021.1934042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The impact of nutritional status at diagnosis of childhood acute lymphoblastic leukemia (ALL) on survival rates was assessed in a Hispanic cohort. Children <16 years with newly diagnosed ALL-B from 2011 to 2019 were studied. Overweight and obesity were classified by body mass index (BMI) and Z-score according to WHO and CDC criteria. BMI, weight percentiles for age and Z-Score were assessed using the WHO Anthro (0-5 years) and AnthroPlus (5-19 years) programs. Cox model was used to estimate risk factors for relapse and death; differences between groups were assessed with Student's T test for parametric and Mann-Whitney U test for non-parametric variables. Disease-free survival (DFS) and overall survival (OS) were determined by the Kaplan-Meier method, calculating time, status, cumulative survival and standard error with a 95% confidence interval. Equal data distribution was estimated with the log-rank test. One-hundred and seventy-two B-ALL children were studied. The overweight-obese group had a non-significant lower DFS (CDC: 54% vs. 60%, p = 0.80; WHO: 57% vs. 64%, p = 0.89) and OS rate (CDC:76% vs. 82%, p = 0.38; WHO:65% vs. 81%, p = 0.13). An association between nutritional status determined by CDC and WHO criteria at diagnosis of B-cell ALL and survival rates was not documented.
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Affiliation(s)
- José C Jaime-Pérez
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Grecia A Turrubiates-Hernández
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Gerardo García-Salas
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Anel M de la Torre-Salinas
- Clinical Nutrition, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Patricia Áncer-Rodríguez
- Clinical Nutrition, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Laura Villarreal-Martínez
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
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4
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Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. CHILDREN-BASEL 2020; 7:children7110218. [PMID: 33171756 PMCID: PMC7694979 DOI: 10.3390/children7110218] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Malnutrition is caused either by cancer itself or by its treatment, and affects the clinical outcome, the quality of life (QOL), and the overall survival (OS) of the patient. However, malnutrition in children with cancer should not be accepted or tolerated as an inevitable procedure at any stage of the disease. A review of the international literature from 2014 to 2019 was performed. Despite the difficulty of accurately assessing the prevalence of malnutrition, poor nutritional status has adverse effects from diagnosis to subsequent survival. Nutritional status (NS) at diagnosis relates to undernutrition, while correlations with clinical outcome are still unclear. Malnutrition adversely affects health-related quality of life (HRQOL) in children with cancer and collective evidence constantly shows poor nutritional quality in childhood cancer survivors (CCSs). Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on QOL, in view of the potentially manageable nature of this risk factor.
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Affiliation(s)
- Vassiliki Diakatou
- Children’s & Adolescents’ Oncology Radiotherapy Department, Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, GR-11527 Athens, Greece;
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-213-2010-283
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5
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Varghese B, Joobomary AA, Savida P. Five-Year Survival Rate and the Factors for Risk-Directed Therapy in Acute Lymphoblastic Leukemia. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_9_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Acute lymphoblastic leukemia (ALL) has 5-year survival of more than 90% in many advanced cancer research institutes. However, advanced cancer care is not available to majority of poor in developing countries. The experience of treating such patients in a resource-scarce setting is described herewith. Of the 75 individuals studied, 11% of the children were stunted, >21% were underweight, and 16% of the under-five children had acute malnutrition. Massive hepatosplenomegaly and lymphadenopathy were present in 75% and 77% children, respectively. About 71% patients achieved complete remission (CR). A total of 30 (40%) children lived for >5 years after diagnosis and 21 (28%) of them had event-free 5 years. Weight for height for under-five children (P = 0.029) and total count (P = 0.019) were found to be significantly associated with deaths during induction. Weight for age (P = 0.024), weight for height of under-five children (P = 0.009), and lymphadenopathy (P = 0.049) had a strong association with 5-year event-free survival. Using multivariate model, only weight for height among under five remained significantly associated with induction deaths (P = 0.021) and absence of lymphadenopathy with event-free 5-year survival (P = 0.042). Context: ALL has 5-year survival of >90% in many advanced cancer research institutes. However, advanced care is not available to majority of poor in the periphery of developing countries. Data available on the survival and the factors affecting the outcome among patients treated in poor resource settings are limited. Aims: This study aims to find the 5-year survival rate and the factors for risk-directed therapy in the region. Settings and Design: Cross-sectional analytical study at a tertiary center of public health in central Kerala. Subjects and Methods: Retrospective analysis of case sheets of 75 children who were treated at the institute from March 2006 to March 2011. Statistical Analysis Used: Univariate and Multivariate analysis using IBM SPSS Statistics for Windows, Version 20.0. Results:: Of the 75 individuals studied, 11% of the children were stunted, >21% were underweight, and 16% of the under-five children had acute malnutrition. Massive hepatosplenomegaly and lymphadenopathy were present in 75% and 77% children, respectively. About 71% patients achieved CR. A total of 30 (40%) children lived for >5 years after diagnosis and 21 (28%) of them had event-free 5 years. Weight for height for under-five children (P = 0.029) and total count (P = 0.019) were found to be significantly associated with deaths during induction. Weight for age (P = 0.024), weight for height of under-five children (P = 0.009), and lymphadenopathy (P = 0.049) had a strong association with 5-year event-free survival. Using multivariate model, only weight for height among under five remained significantly associated with induction deaths (P = 0.021) and absence of lymphadenopathy with event-free 5-year survival (P = 0.042). Conclusions: Overall survival was 40% and event-free survival was 28%. Children with acute malnutrition and a higher white blood cell count were more likely to die during induction. Underweight children, malnourished children, and children with lymphadenopathy had significantly poor chances of surviving 5 years' event free.
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Affiliation(s)
- Bibin Varghese
- Department of Paediatrics, Institute of Child Health, Kottayam, Kerala, India
| | | | - P Savida
- Department of Paediatrics, Institute of Child Health, Kottayam, Kerala, India
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6
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Ren G, Cai W, Wang L, Huang J, Yi S, Lu L, Wang J. Impact of body mass index at different transplantation stages on postoperative outcomes in patients with hematological malignancies: a meta-analysis. Bone Marrow Transplant 2018; 53:708-721. [DOI: 10.1038/s41409-018-0234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
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7
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Ringwald-Smith K, Hobar A, Flowers C, Badgett K, Williams-Hooker R, Roach RR, Sykes A, Lu Z, Mackert P, Mandrell BN. Comparison of Resting Energy Expenditure Assessment in Pediatric Oncology Patients. Nutr Clin Pract 2018; 33:224-231. [PMID: 29393551 DOI: 10.1002/ncp.10002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/14/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evaluation of energy requirements is an important part of the nutrition assessment of pediatric oncology patients. Adequate provision of energy in this population is of extreme importance because of the prevalence of malnutrition and its effect on growth, development, quality of life, morbidity, and mortality. Numerous methods are used in clinical practice for estimating the resting energy expenditures (REE), specifically indirect calorimetry and predictive equations. A relatively new instrument used to assess REE is the hand-held indirect calorimeter. The purpose of this quality improvement project was to compare the accuracy of REE measurements taken by a hand-held indirect calorimeter and predictive equations to that of a standard indirect calorimeter metabolic cart. METHODS Patients receiving therapy for pediatric cancer, aged 7-18 years, and having a weight ≥15 kg and scheduled for a REE nutrition assessment were eligible. Sequentially, the patient's REE was assessed with the cart and the hand-held indirect calorimeter along with the predictive equation calculation. RESULTS Post hoc pairwise comparisons revealed that all 3 methods were significantly different from one another (P < .0001). When compared with the cart, the portable hand-held calorimeter was found to underestimate REE by 11.9%, whereas predictive equations overestimated REE by 12.4%. CONCLUSION Our quality improvement project suggests that the hand-held indirect calorimeter underestimated REE, and predictive equations overestimated REE in pediatric oncology nutrition assessment. Therefore, we recommend that these limitations in assessment be considered when assessing REE using a hand-held indirect calorimeter or predictive equations.
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Affiliation(s)
- Karen Ringwald-Smith
- Clinical Nutrition Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ashley Hobar
- LeBonheur Children's Hospital, Nutrition Services, Memphis, Tennessee, USA
| | - Casey Flowers
- Tennova Hospital, Clinical Nutrition, Clarksville, Tennessee, USA
| | - Katie Badgett
- Clinical Nutrition Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Robin R Roach
- School of Health Studies, University of Memphis, Memphis, Tennessee, USA
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Paul Mackert
- Cardiopulmonary Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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8
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Mantzorou M, Koutelidakis A, Theocharis S, Giaginis C. Clinical Value of Nutritional Status in Cancer: What is its Impact and how it Affects Disease Progression and Prognosis? Nutr Cancer 2017; 69:1151-1176. [PMID: 29083236 DOI: 10.1080/01635581.2017.1367947] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Malnutrition is a common finding in cancer patients, which can affect disease progression and survival. This review aims to critically summarize the prognostic role of nutritional status, from Body Mass Index (BMI) and weight loss to nutrition screening tools and biochemical indices, in cancer patients. According to the currently available data, Prognostic Nutritional Index (PNI) was a significant prognostic factor of patients' survival, both in univariate and multivariate analyses. Pre-operative albumin was also correlated with worse outcomes, being an independent prognostic factor of survival in several studies. BMI was also well-studied, with contradictory results. Although, lower BMI was found to be an independent prognostic factor of shorter survival in some studies, in others it did not have an impact on survival. In this aspect, this review highlights the significant prognostic role of nutritional status in the disease progression and survival of cancer patients. Further, good-quality prospective studies are needed in order to draw precise conclusions on the prognostic role of specific nutritional assessment tools, and biochemical indices associated with the nutritional status in more cancer types, such as liver, breast and prostate cancer, and hematological malignancies.
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Affiliation(s)
- Maria Mantzorou
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Antonios Koutelidakis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Stamatios Theocharis
- b First Department of Pathology , Medical School, University of Athens , Athens , Greece
| | - Constantinos Giaginis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
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9
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Protein blend ingestion before allogeneic stem cell transplantation improves protein-energy malnutrition in patients with leukemia. Nutr Res 2017; 46:68-77. [DOI: 10.1016/j.nutres.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/04/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022]
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10
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Pérez-Pitarch A, Guglieri-López B, Nacher A, Merino V, Merino-Sanjuán M. Impact of Undernutrition on the Pharmacokinetics and Pharmacodynamics of Anticancer Drugs: A Literature Review. Nutr Cancer 2017; 69:555-563. [DOI: 10.1080/01635581.2017.1299878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Henry C, Dumoucel S, Taque S, Esvan M, Pellier I, Minckes O, Blouin P, Carausu L, Gandemer V. Évaluation de la gastrostomie précoce dans la prise en charge des tumeurs osseuses primitives malignes de l’enfant. Expérience du groupe Grand Ouest Cancer de l’Enfant (GOCE) sur 10 ans. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.oncohp.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Ladas EJ, Sacks N, Meacham L, Henry D, Enriquez L, Lowry G, Hawkes R, Dadd G, Rogers P. A Multidisciplinary Review of Nutrition Considerations in the Pediatric Oncology Population: A Perspective From Children's Oncology Group. Nutr Clin Pract 2017; 20:377-93. [PMID: 16207678 DOI: 10.1177/0115426505020004377] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the past few decades, great progress has been made in the survival rates of childhood cancer. As survival rates have improved, there has been an increased focus on supportive care. Nutrition is a supportive-care modality that has been associated with improved tolerance to chemotherapy, improved survival, increased quality of life, and decreased risk of infection in children undergoing anticancer therapy. Guidelines and assessment criteria have been proposed for the nutrition management of a child with cancer; however, there is no consistent use of criteria among institutions treating children with cancer. This review will present the current evidence and standards of practice incorporating aspects of nutrition, nursing, pharmacology, and psychosocial challenges to consider in the nutrition management of a child with cancer. Recommendations for clinical practice are presented.
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Affiliation(s)
- Elena J Ladas
- Division of Pediatric Oncology, Columbia University, Children's Hospital of New York, 161 Ft. Washington, Room 728, New York, New York 10032, USA.
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Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents. Arch Med Res 2016; 47:585-592. [DOI: 10.1016/j.arcmed.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022]
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14
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Martín-Trejo JA, Núñez-Enríquez JC, Fajardo-Gutiérrez A, Medina-Sansón A, Flores-Lujano J, Jiménez-Hernández E, Amador-Sanchez R, Peñaloza-Gonzalez JG, Alvarez-Rodriguez FJ, Bolea-Murga V, Espinosa-Elizondo RM, de Diego Flores-Chapa J, Pérez-Saldivar ML, Rodriguez-Zepeda MDC, Dorantes-Acosta EM, Núñez-Villegas NN, Velazquez-Aviña MM, Torres-Nava JR, Reyes-Zepeda NC, González-Bonilla CR, Flores-Villegas LV, Rangel-López A, Rivera-Luna R, Paredes-Aguilera R, Cárdenas-Cardós R, Martínez-Avalos A, Gil-Hernández AE, Duarte-Rodríguez DA, Mejía-Aranguré JM. Early mortality in children with acute lymphoblastic leukemia in a developing country: the role of malnutrition at diagnosis. A multicenter cohort MIGICCL study. Leuk Lymphoma 2016; 58:898-908. [DOI: 10.1080/10428194.2016.1219904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Chaudhuri J, Biswas T, Datta J, Sabui TK, Chatterjee S, Ray S, Raychaudhuri D, Mandal K, Chatterjee K, Chakraborty S. Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies. J Paediatr Child Health 2016; 52:704-9. [PMID: 27439631 DOI: 10.1111/jpc.13233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 01/02/2023]
Abstract
AIM Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. METHODS A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. RESULTS Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2) = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not. CONCLUSION Malnutrition may be a potential predictor of mortality in febrile neutropenia.
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Affiliation(s)
| | - Tamoghna Biswas
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Jyotishka Datta
- Department of Pediatric Medicine, KPC Medical College and Hospital, Kolkata, India
| | - Tapas Kumar Sabui
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Sukanta Chatterjee
- Department of Pediatric Medicine, Tripura Medical College and Dr BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India
| | - Somosri Ray
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Kalyanbrata Mandal
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Swapna Chakraborty
- Department of Statistical Science, Duke University and Statistical and Applied Mathematical Sciences Institute, Durham, North Carolina, United States
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Conner JM, Aviles-Robles MJ, Asdahl PH, Zhang FF, Ojha RP. Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective. BMJ Support Palliat Care 2016; 6:338-43. [PMID: 27267224 DOI: 10.1136/bmjspcare-2015-001020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/10/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence of malnourishment among paediatric cancer patients in Mexico City, and assess the association between malnourishment and length of hospital stay. METHODS Individuals eligible for this study were paediatric cancer patients (aged <18 years) admitted to Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-score<-2 (ie, 2 SDs below the expected mean of the WHO reference population). We estimated time ratios (TRs) and 95% confidence limits (CLs) for the association between malnourishment and length of hospital stay. RESULTS Our study population comprised 111 paediatric cancer patients with febrile neutropaenia, of whom 71% were aged <10 years and 52% were males. The prevalence of malnourishment was 14%, equal to a 530% (standardised morbidity ratio=6.3; 95% CL 3.7, 10) excess of malnourishment compared with the world reference population. The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had the shortest length of stay. CONCLUSIONS Future studies should explore potential interventions for malnourishment to reduce the length of hospital stay or other established adverse consequences of malnourishment.
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Affiliation(s)
- J Michael Conner
- Department of Public Health, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Martha J Aviles-Robles
- Department of Infectious Diseases, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Peter H Asdahl
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition and Policy, Tufts University, Boston, Massachusetts, USA Jean Mayer United States Department of Agriculture Human Nutrition Research on Aging, Tufts University, Boston, Massachusetts, USA
| | - Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Barr RD, Mosby TT. Nutritional status in children and adolescents with leukemia: An emphasis on clinical outcomes in low and middle income countries. Hematology 2016; 21:199-205. [DOI: 10.1080/10245332.2015.1101968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ronald D. Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terezie T. Mosby
- College of Agriculture and Human Ecology, Tennessee Technological University, Cookeville, USA
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Iniesta RR, Paciarotti I, Brougham MFH, McKenzie JM, Wilson DC. Effects of pediatric cancer and its treatment on nutritional status: a systematic review. Nutr Rev 2015; 73:276-95. [PMID: 26011902 DOI: 10.1093/nutrit/nuu062] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. OBJECTIVE The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. DATA SOURCES Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). STUDY SELECTION Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported and included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. DATA EXTRACTION Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. DATA SYNTHESIS A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. CONCLUSION The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, population-based, longitudinal studies using standard criteria to identify malnutrition.
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Affiliation(s)
- Raquel Revuelta Iniesta
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
| | - Ilenia Paciarotti
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Mark F H Brougham
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Jane M McKenzie
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - David C Wilson
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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19
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Why the oncologist should consider the nutritional status of the elderly cancer patient. Nutrition 2015; 31:590-3. [DOI: 10.1016/j.nut.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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20
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Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol 2013; 87:172-200. [DOI: 10.1016/j.critrevonc.2013.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/28/2013] [Accepted: 03/06/2013] [Indexed: 01/06/2023] Open
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Burke ME, Lyden ER, Meza JL, Ladas EJ, Dasgupta R, Wiegner EA, Arndt CA. Does body mass index at diagnosis or weight change during therapy predict toxicity or survival in intermediate risk rhabdomyosarcoma? A report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2013; 60:748-53. [PMID: 23335502 PMCID: PMC5152587 DOI: 10.1002/pbc.24322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Weight loss prevalence and its impact on toxicities and survival in intermediate risk rhabdomyosarcoma (IRMS) patients are unknown. We evaluated the association between weight change during therapy and number of toxicities, hospital days, infections, and overall survival and between baseline body mass index (BMI) and survival in patients treated on Children's Oncology Group trial D9803. PROCEDURE Four hundred sixty-eight IRMS patients age ≥2 and <21 years treated on D9803 had required data. Regression models evaluated association between weight loss from baseline and toxicities, hospital days, infections, and survival. Kaplan-Meier curves and regression models evaluated baseline BMI percentile's association with survival. RESULTS Thirty-five percent and 37% of patients had >5% weight loss at 12 and 24 weeks, respectively, with 16% and 19% losing >10% weight respectively. Greater than 10% weight loss at 24 weeks was associated with more toxicities and hospital days during subsequent therapy but not infection rate or survival. Baseline underweight patients (<5th percentile BMI) had borderline inferior survival compared with baseline average weight patients while there was no difference in survival seen between average weight and overweight or obese patients. CONCLUSIONS Nearly one in five IRMS patients experienced >10% weight loss on therapy. This was associated with increased toxicity but not decreased survival compared with patients who had less weight loss. Baseline BMI percentile trended toward a significant association with survival. Future studies might investigate nutritional impact on quality of life and if weight loss is preventable by early nutritional intervention.
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Affiliation(s)
- Megan E. Burke
- Division of Hematology/Oncology, Children’s Hospital of The King’s Daughters, Norfolk, Virginia,Correspondence to: Megan E. Burke, MD, 601 Children’s Lane, Norfolk, VA 23507.
| | - Elizabeth R. Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jane L. Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elena J. Ladas
- Division of Pediatric Oncology, Columbia University, New York, New York
| | - Roshni Dasgupta
- Division of Pediatric and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ellen A. Wiegner
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Carola A.S. Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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22
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NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation. Chin J Cancer Res 2013. [DOI: 10.1007/s11670-012-0267-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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Liu P, Zhang ZF, Cai JJ, Wang BS, Yan X. NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation. Chin J Cancer Res 2013; 24:299-303. [PMID: 23359777 DOI: 10.3978/j.issn.1000-9604.2012.09.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/07/2012] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To discuss whether nutritional risk screening 2002 (NRS2002) is appropriate for nutritional risk screening for leukemia patients before and after hematopoietic stem cell transplantation (HSCT), and whether there are risk differences in other conditions, such as age, gender and matching degree; to find the methods and indicators of nutritional risk screening for these patients before and after HSCT, in order to give timely intervention to guarantee the successful completion of the entire transplantation process. METHODS Nutritional risk of 99 leukemia patients was screened with NRS2002 before and after HSCT. The (χ) (2) test was applied to compare the risk differences between groups such as age, gender and matching degree, while the differences of other enumeration data, such as recent (1-3 months) weight loss, reduced food intake within one week and BMI, were compared by continuity correction. RESULTS Of the 99 leukemia patients, 22 cases (22.2%) had nutritional risk before HSCT, while all patients had nutritional risk after HSCT; there is no significant difference in nutritional risk between male and female, and patients of less than 30 years old, not-full matched, recent (1-3 months) weight loss, reduced food intake within a week or BMI <18.5 were more likely to have nutritional risk; and 77 cases (77.8%) had weight loss, among which 49 patients (63.6%) had more than 5% weight loss within one month. CONCLUSIONS This study showed that leukemia patients should receive the nutritional risk screening conventionally before and after HSCT, and NRS2002 was only appropriate for nutritional risk screening before HSCT. More attention should be paid to the patients less than 30 years old or not-full matched. Weight change was one of the important nutritional indicators for patients after HSCT.
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Affiliation(s)
- Peng Liu
- Department of Clinical Nutrition, Peking University People's Hospital, Beijing 100044, China
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Co-Reyes E, Li R, Huh W, Chandra J. Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatr Blood Cancer 2012; 59:1160-7. [PMID: 22948929 PMCID: PMC3468697 DOI: 10.1002/pbc.24272] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/05/2012] [Indexed: 01/06/2023]
Abstract
In children with cancer, suboptimal nutrition states are common consequences of the disease and its treatment. These nutrition states have been attributed to a number of etiologies dependent on the patient's tumor type and treatment, and are associated with increased morbidity and mortality. Interventions vary from psychosocial to pharmacological and surgical management. Further research is necessary to understand the epidemiology and etiology of these nutrition states. Of great importance is the development and implementation of effective interventions to optimize nutritional status among children with cancer during and after therapy.
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Affiliation(s)
| | - Rhea Li
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Winston Huh
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joya Chandra
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
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Schmitt F, Caldari D, Corradini N, Gicquel P, Lutz P, Leclair MD, Podevin G. Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology. Pediatr Blood Cancer 2012; 59:874-80. [PMID: 22492612 DOI: 10.1002/pbc.24161] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/12/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malnutrition in pediatric oncology remains underestimated, although having a negative impact on outcome. Enteral nutrition (EN) using percutaneous endoscopic gastrostomy (PEG) may prevent or reverse malnutrition consequences. We aimed to evaluate both efficacy and safety of early EN during tumors treatment in children. PROCEDURES Medical records of pediatric patients having a PEG tube inserted between 1995 and 2009 were retrospectively reviewed. We compared type and incidence of complications in Group 1, including 74 patients suffering from cancer, and control Group 2, including 57 patients with neurological impairment. Efficacy of EN was evaluated through nutritional parameters [Z-scores weight for height (W/H) and height for age (H/A)], post-operative complications and relapse rates. Statistical significance was set for P < 0.05. RESULTS PEG tolerance was similar in both groups, as shown by comparable complication rates (62% vs. 76%, NS). EN allowed improvement or stabilization of Z-score W/H in 76% of oncologic patients. The final height loss was lower (-0.5 vs. -1.2 SD of Z-scores H/A) when EN was started at the beginning of the oncologic treatment. In bone tumors, EN prevented weight loss during chemotherapy, and tended to lessen surgical complications, relapses and deaths. CONCLUSIONS Early gastrostomy feeding represents a relatively safe way to prevent malnutrition in children with cancer, and might play a role in bone tumors oncological outcome. Further prospective studies are needed to confirm these results and assess the impact of EN and PEG on quality of life.
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Affiliation(s)
- Françoise Schmitt
- Department of Pediatric Surgery, Mother and Child Hospital, Nantes University Hospital, Nantes, France.
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26
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Tenardi RD, Frühwald MC, Jürgens H, Hertroijs D, Bauer J. Nutritional status of children and young adults with Ewing sarcoma or osteosarcoma at diagnosis and during multimodality therapy. Pediatr Blood Cancer 2012; 59:621-6. [PMID: 22147309 DOI: 10.1002/pbc.24001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/17/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Objective of our study was to evaluate the nutritional status and growth of children and adolescents with common malignancies of the musculoskeletal system at diagnosis, and undergoing multimodality therapy. METHODS A retrospective analysis of data from 2001 to 2009 was conducted. Hospital charts were used as a source of clinical data. Primary endpoint of the analyses was to identify variations in anthropometric parameters at diagnosis and during the first 2 years of follow-up in children and adolescents with osteosarcoma or Ewing sarcoma. Factors contributing to disorders of growth in this population were sought. RESULTS A total of 139 children were registered, 62 with Ewing sarcoma and 77 with osteosarcoma. At diagnosis 72.7% of all patients were classified as adequately nourished (BMI 5th to <85th percentiles). During treatment all anthropometric parameters were markedly reduced (P < 0.001) in both groups with extreme changes in body weight from -30% to +44%. This was pronounced in children affected by osteosarcoma (P < 0.05). During follow-up, recovery of body weight was noted in both groups. Height Z-scores remained low (P < 0.001) in comparison to the general population. After the observation period 43.4% of the children with osteosarcoma and 25.5% of the patients with Ewing sarcoma demonstrated an altered body mass. CONCLUSIONS Pediatric patients with Ewing sarcoma or osteosarcoma are at an increased risk for developing malnutrition, in the form of either over- or underweight during multimodality therapy. Early recognition of abnormal body mass is required to prevent and to treat long-term comorbidities caused by malnutrition.
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Affiliation(s)
- Retno D Tenardi
- Department of Pediatrics, University Children's Hospital Münster, Münster, Germany
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Cakir FB, Aydogan G, Timur C, Canpolat C, Tulunay A, Eksioglu Demiralp E, Berrak SG. Effects of malnutrition on oxidative burst functions and infection episodes in children with acute lymphoblastic leukemia. Int J Lab Hematol 2012; 34:648-54. [PMID: 22830439 DOI: 10.1111/j.1751-553x.2012.01451.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to determine the effect of malnutrition on oxidative burst functions (OBF) of neutrophils in children with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS Twenty-eight patients with ALL and thirty healthy controls were enrolled to the study. Thirteen patients with ALL were found to have malnutrition. While neutrophil OBF of ALL patients without malnutrition were studied both before induction chemotherapy and 3 months after, the same functions in ALL patients with malnutrition were studied both before induction chemotherapy and when the nutritional status improved. Control group were studied at admission and 3 months later. RESULTS The OBF of ALL patients with and without malnutrition before induction chemotherapy were found to be significantly lower than the control group (P = 0.009), whereas the OBF were found to be similar in both patient groups with ALL (P = 0.27). The median infection episode rate and the duration of antibiotics therapy during the study period were similar in both patient groups with ALL. The repeated OBF of both patient groups with ALL were shown to increase to similar values with the control group in the third month of chemotherapy (P = 0.002). The median infection episode rate during the first month of chemotherapy was shown to decrease significantly during the third month of chemotherapy in both patient with ALL groups (P < 0.001). CONCLUSIONS We have not been able to demonstrate an overt effect of malnutrition on OBF. However, our results still need to be verified via further larger scaled studies of OBF in leukemic children with and without malnutrition.
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Affiliation(s)
- F B Cakir
- Pediatric Hematology-Oncology Department, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - G Aydogan
- Pediatric Hematology-Oncology Clinics, Bakirkoy Government Maternity and Children Education and Research Hospital, Istanbul, Turkey
| | - C Timur
- Pediatric Hematology-Oncology Clinics, Goztepe Government Education and Research Hospital, Istanbul, Turkey
| | - C Canpolat
- Pediatric Hematology-Oncology Department, Acibadem University Hospital, Istanbul, Turkey
| | - A Tulunay
- Internal Medicine Hematology-Immunology Department, Marmara University Medical Center, Istanbul, Turkey
| | - E Eksioglu Demiralp
- Internal Medicine Hematology-Immunology Department, Marmara University Medical Center, Istanbul, Turkey
| | - S G Berrak
- Department of Pediatrics, The Children's Hospital at Monmouth Medical Center, Long Branch, NJ, USA
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Rogers PC, Ladas EJ. The impact of nutritional status on outcomes: a neglected area of research. Pediatr Blood Cancer 2011; 57:902-3. [PMID: 21594981 DOI: 10.1002/pbc.23165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Paul C Rogers
- Division of Haematology/Oncology/BMT, BC Children's Hospital & University of BC, Vancouver, British Columbia, Canada.
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Abstract
BACKGROUND Nutritional status, as represented by body composition, is an important consideration in the treatment of pediatric cancer patients because it is linked to poor outcomes. Little is known about how a child's body composition responds to cancer and treatment. OBJECTIVES We aimed to compare the body composition of children undergoing treatment of cancer with that of healthy controls and to compare body composition between children with hematologic malignancies and children with solid tumors. DESIGN This cross-sectional study measured height, weight, body cell mass, fat-free mass, and fat mass in 48 children undergoing treatment of cancer and blood-related disorders and in age-matched healthy controls. RESULTS Patients with cancer had a significantly lower body cell mass index z score (body cell mass/height raised to the power of 2.5 for females and 3 for males) than did controls (P = 0.0001), and 45% of the patients with cancer were considered malnourished according to body cell mass. Subjects with cancer had a significantly higher percentage of body fat (P = 0.0001) and fat mass (P = 0.0001) than did controls; however, there was no significant difference in fat-free mass (P = 0.09). On the basis of percentage fat, 77% of subjects with cancer were considered obese. No difference in body composition was observed between cancer types. CONCLUSIONS This study showed that children undergoing treatment of all types of cancer have a significantly lower body cell mass and a significantly higher fat mass than do healthy controls. Nutritional support is suggested for all children undergoing treatment of cancer.
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Affiliation(s)
- Alexia J Murphy
- Discipline of Paediatrics, The University of Queensland Royal Children's Hospital, Queensland, Australia.
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Arends J, Zuercher G, Dossett A, Fietkau R, Hug M, Schmid I, Shang E, Zander A. Non-surgical oncology - Guidelines on Parenteral Nutrition, Chapter 19. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc09. [PMID: 20049066 PMCID: PMC2795366 DOI: 10.3205/000068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 11/30/2022]
Abstract
Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.
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Affiliation(s)
- J Arends
- Dept. of Medical Oncology, Tumour Biology Center, University of Freiburg, Germany
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The validity of simple methods to detect poor nutritional status in paediatric oncology patients. Br J Nutr 2008; 101:1388-92. [DOI: 10.1017/s0007114508076241] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Undernutrition in elderly patients with cancer: Target for diagnosis and intervention. Crit Rev Oncol Hematol 2008; 67:243-54. [DOI: 10.1016/j.critrevonc.2008.04.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 04/18/2008] [Accepted: 04/24/2008] [Indexed: 12/22/2022] Open
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Jaime-Pérez JC, González-Llano O, Herrera-Garza JL, Gutiérrez-Aguirre H, Vázquez-Garza E, Gómez-Almaguer D. Assessment of nutritional status in children with acute lymphoblastic leukemia in Northern México: A 5-year experience. Pediatr Blood Cancer 2008; 50:506-8; discussion 517. [PMID: 18064642 DOI: 10.1002/pbc.21397] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nutritional status is an important variable when planning the treatment of children with acute lymphoblastic leukemia (ALL). We determined the nutritional status of children from Northern Mexico diagnosed with ALL during a 5-year period at a public university hospital. One hundred and two children were included. Evaluation by a clinical nutritionist through a food frequency questionnaire and anthropometrical measurements was carried out. Dual energy X-ray absorptiometry (DEXA) for body composition analysis was performed. Based on their body mass index (BMI) percentile, children were classified in four groups as underweight, normal weight, at-risk for overweight and overweight. Fifty-four patients were boys (53%) and 48 (47%) girls. Median values were: age, 6.0 years; weight, 23 kg, height, 118 cm. BMI median value was 16.7. In 78 patients studied by DEXA, median body mass was 24,335 g, with 66.4% from lean tissue, 23.5% from fat. Bone mineral content was 10.6%. Bone density was 0.754 g/cm(2). The majority of children with ALL in Northern Mexico are well nourished at diagnosis and have a normal body composition. Early nutritional intervention is important to maintain this status and correct specific abnormalities.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autónoma de Nuevo Leon, Monterrey, Mexico.
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Rivera-Luna R, Olaya-Vargas A, Velásquez-Aviña M, Frenk S, Cárdenas-Cardós R, Leal-Leal C, Pérez-González O, Martínez-Avalos A. Early death in children with acute lymphoblastic leukemia: does malnutrition play a role? Pediatr Hematol Oncol 2008; 25:17-26. [PMID: 18231951 DOI: 10.1080/08880010701774132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study aim was to correlate malnutrition and early death in children with acute lymphoblastic leukemia (ALL). A study was conducted in 100 consecutive children with ALL. An analysis included clinical and laboratory parameters as well as co-morbidity factors. Forty patients were standard risk and 60 high risk. Multivariate analysis showed variables of statistical importance, including female gender (p 010), ALL high-risk (p 04), and infection (p 036). Malnutrition (p 1.0) and poverty (p 0.5) did not influence. Early mortality was documented in 15/100 (15%) patients. The study shows that high-risk ALL and infection represent the leading causes of early mortality.
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Affiliation(s)
- Roberto Rivera-Luna
- Division of Hem-Oncology, National Institute of Pediatrics (Instituto Nacional de Pediatría), Mexico City, Mexico.
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Hijiya N, Panetta JC, Zhou Y, Kyzer EP, Howard SC, Jeha S, Razzouk BI, Ribeiro RC, Rubnitz JE, Hudson MM, Sandlund JT, Pui CH, Relling MV. Body mass index does not influence pharmacokinetics or outcome of treatment in children with acute lymphoblastic leukemia. Blood 2006; 108:3997-4002. [PMID: 16917005 PMCID: PMC1895448 DOI: 10.1182/blood-2006-05-024414] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 08/08/2006] [Indexed: 12/21/2022] Open
Abstract
There is conflicting information about the influence of body mass index (BMI) on the pharmacokinetics, toxicity, and outcome of chemotherapy. We compared pharmacokinetics, outcome, and toxicity data across 4 BMI groups (underweight, BMI < or = 10th percentile; normal; at risk of overweight, BMI > or = 85th and < 95th percentile; overweight, BMI > or = 95th percentile) in 621 children with acute lymphoblastic leukemia (ALL) treated on 4 consecutive St Jude Total Therapy studies. Chemotherapy doses were not adjusted to ideal BMI. Estimates of overall survival (86.1% +/- 3.4%, 86.0% +/- 1.7%, 85.9% +/- 4.3%, and 78.2% +/- 5.5%, respectively; P = .533), event-free survival (76.2% +/- 4.2%, 78.7% +/- 2.1%, 73.4% +/- 5.5%, and 72.7% +/- 5.9%, respectively; P = .722), and cumulative incidence of relapse (16.0% +/- 3.7%, 14.4% +/- 1.8%, 20.6% +/- 5.1%, and 16.7% +/- 5.1%, respectively; P = .862) did not differ across the 4 groups. In addition, the intracellular levels of thioguanine nucleotides and methotrexate polyglutamates did not differ between the 4 BMI groups (P = .73 and P = .74, respectively). The 4 groups also did not differ in the overall incidence of grade 3 or 4 toxicity during the induction or postinduction periods. Further, the systemic clearance of methotrexate, teniposide, etoposide, and cytarabine did not differ with BMI (P > .3). We conclude that BMI does not affect the outcome or toxicity of chemotherapy in this patient population with ALL.
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Affiliation(s)
- Nobuko Hijiya
- Department of Oncology, St Jude Children's Research Hospital, 332 North Lauderdale St, Memphis, TN 38105-2794, USA.
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Charalampopoulou A, Petridou E, Spyridopoulos T, Dessypris N, Oikonomou A, Athanasiadou-Piperopoulou F, Baka M, Kalmanti M, Polychronopoulou S, Trichopoulos D. An integrated evaluation of socioeconomic and clinical factors in the survival from childhood acute lymphoblastic leukaemia: a study in Greece. Eur J Cancer Prev 2004; 13:397-401. [PMID: 15452452 DOI: 10.1097/00008469-200410000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An evaluation of the role of socioeconomic factors in the survival of children with leukaemia, controlling for major clinical prognostic indicators, has been attempted in very few studies and the role of these factors may be different in various cultural settings. Our investigation aims to study the independent role of socioeconomic factors on the prognosis of childhood acute lymphoblastic leukaemia (ALL) in Greece. During a 7-year period (1996-2002) 293 cases of incident ALL were diagnosed and followed up in four Childhood Haematology-Oncology Units, which covered over half of all childhood ALL cases nationwide. At the time of diagnosis, information concerning age, gender, maternal schooling, maternal marital status, sibship size, distance of residence from the treating centre, attendance of day care centre and clinical information was recorded. The influence of these factors on survival was studied by modelling the data through Cox's proportional-hazards regression. After adjustment for clinical prognostic factors, children of mothers who were not currently married, were of low educational level or were living far from the treating centre tended to have lower survival (P-values 0.02, 0.14 and 0.08, respectively). There was also evidence that two factors that are predictive of disease occurrence, that is sibship size and attendance of day care centre, may also predict survival (P-values 0.04 and 0.26, respectively). In conclusion, socioeconomic factors are likely to influence survival from ALL at least in some sociocultural contexts. Moreover, there is evidence that factors that could affect incidence of ALL through modulation of herd immunity may also have prognostic implications for this disease.
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Affiliation(s)
- A Charalampopoulou
- Department of Hygiene and Epidemiology, Athens University Medical School, Greece
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Kennedy DD, Tucker KL, Ladas ED, Rheingold SR, Blumberg J, Kelly KM. Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia. Am J Clin Nutr 2004; 79:1029-36. [PMID: 15159233 DOI: 10.1093/ajcn/79.6.1029] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chemotherapy leads to an increase in reactive oxygen species, which stresses the antioxidant defense system. Children with acute lymphoblastic leukemia rarely are overtly malnourished, which makes this population ideal for an investigation of the relations between dietary antioxidant consumption, plasma antioxidant concentrations, and chemotherapy-induced toxicity. OBJECTIVE This study was conducted to investigate the effect of therapy on antioxidant intakes in children with acute lymphoblastic leukemia, the relation between dietary antioxidant intakes and plasma antioxidant concentrations, and the relation between the incidence of side effects due to treatment and antioxidant intake. DESIGN We conducted a 6-mo observational study of 103 children with acute lymphoblastic leukemia. Plasma micronutrient concentrations, dietary intakes, and incidence of side effects of chemotherapy were ascertained at diagnosis and after 3 and 6 mo of therapy. RESULTS Throughout the 6-mo study period, subjects ingested vitamin E, total carotenoid, beta-carotene, and vitamin A in amounts that were 66%, 30%, 59%, and 29%, respectively, of the US recommended dietary allowance or of the amounts specified in the third National Health and Nutrition Examination Survey. Greater vitamin C intakes at 6 mo were associated with fewer therapy delays, less toxicity, and fewer days spent in the hospital. Greater vitamin E intakes at 3 mo were associated with a lower incidence of infection. Greater beta-carotene intakes at 6 mo were associated with a decreased risk of toxicity. CONCLUSION A large percentage of children undergoing treatment for acute lymphoblastic leukemia have inadequate intakes of antioxidants and vitamin A. Lower intakes of antioxidants are associated with increases in the adverse side effects of chemotherapy.
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Affiliation(s)
- Deborah D Kennedy
- Division of Pediatric Oncology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
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González A, Cortina L, González P, González C, García T, de Svarch EG. Longitudinal assessment of nutritional status in children treated for acute lymphoblastic leukaemia in Cuba. Eur J Cancer 2004; 40:1031-4. [PMID: 15093578 DOI: 10.1016/j.ejca.2003.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Revised: 12/03/2003] [Accepted: 12/05/2003] [Indexed: 11/23/2022]
Abstract
Malnutrition has a deleterious effect on the results of therapy for malignant diseases in childhood. The impact of radiotherapy on growth is well known but the impact of cytotoxic drugs on nutritional status is more controversial. The purpose of this study was to determine the nutritional status of a cohort of children treated for acute lymphoblastic leukaemia (ALL) in Cuba. The study involved 49 children admitted to a single center and treated with a Berlin-Frankfurt-Munster-based protocol. Nutritional assessment included measurements of height, weight, body mass index and skin-fold thickness, made at diagnosis, after the intensive phase of treatment and at the end of therapy. Z-scores were used for height and comparison of percentiles for the rest of the variables. All the patients were above the third percentile in all the measurements. There were no statistically significant differences between the results at diagnosis, after intensive therapy and at the end of treatment. Although the sample was small, there was no demonstrable effect of chemotherapy on nutritional status in this Cuban paediatric population, in contrast to that reported in children with ALL in other developing countries.
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Affiliation(s)
- A González
- Instituto de Hematología e Inmunología, Apartado 8070, Ciudad de La Habana, Cuba CP 10800, Havana, Cuba.
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Abstract
The overall cure rate for cancer in childhood now exceeds 70% and is projected to reach 85% by the year 2010 in industrialized countries. Therefore, major attention is being placed on reducing the side effects of therapy. However, 85% of the world's children live in developing countries, where access to adequate care often is limited and health status frequently is influenced adversely by prevalent infectious diseases and malnutrition. Despite several confounding factors (different definitions of nutritional status, the wide variety of measures used for its assessment, the selection biases by disease and stage, treatment protocols of variable dose intensity and efficacy, small sample sizes of the studies conducted in the last 20 years), it is accepted that the prevalence of malnutrition at diagnosis averages 50% in children with cancer in developing countries; whereas, in industrialized countries, it is related to the type of tumor and the extent of the disease, ranging from < 10% in patients with standard-risk acute lymphoblastic leukemia to 50% in patients with advanced neuroblastoma. The importance of nutritional status in children with cancer is related to its possible influence on the course of the disease and survival. Some authors have described decreased tolerance of chemotherapy associated with altered metabolism of antineoplastic drugs, increased infection rates, and poor clinical outcome in malnourished children. In this article, the authors review methods of nutritional assessment and the pathogenesis of nutritional morbidity in children with cancer as well as correlations of nutritional status with diagnosis, treatment, and outcome.
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Affiliation(s)
- Alessandra Sala
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
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Gridelli C, De Vivo R, Monfardini S. Management of small-cell lung cancer in the elderly. Crit Rev Oncol Hematol 2002; 41:79-88. [PMID: 11796233 DOI: 10.1016/s1040-8428(01)00163-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
More than 50% of lung cancer patients are diagnosed over the age of 65 and about 30% over 70. Small-cell lung cancer (SCLC) accounts for 20-25% of lung carcinomas. Chemotherapy is the cornerstone of treatment for SCLC. Usually in the elderly it is difficult to administer the same chemotherapy administered to younger patients because elderly patients tolerate chemotherapy poorly. The empirical reduction of drug doses may be criticized. The best approach is to design specific trials in order to develop active and well-tolerated chemotherapy regimens for SCLC elderly patients. The standard therapy in limited disease is combined chemo-radiotherapy followed by prophylactic brain irradiation for patients achieving a complete response. In the elderly, the addition of radiotherapy to chemotherapy must be accurately evaluated, considering the slight survival improvement and the potential relevant toxicity.
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Affiliation(s)
- C Gridelli
- Unità Operativa di Oncologia Medica B, Istituto Nazionale Tumori, Via M. Semmola 3, 80131 Naples, Italy.
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Affiliation(s)
- R D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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43
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Pedrosa F, Bonilla M, Liu A, Smith K, Davis D, Ribeiro RC, Wilimas JA. Effect of malnutrition at the time of diagnosis on the survival of children treated for cancer in El Salvador and Northern Brazil. J Pediatr Hematol Oncol 2000; 22:502-5. [PMID: 11132216 DOI: 10.1097/00043426-200011000-00005] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the relationship between survival and malnutrition at the time of diagnosis among children treated for cancer in two developing countries. PATIENTS AND METHODS We studied 443 children treated for cancer between 1995 and 1998 at two centers in San Salvador, El Salvador, and Recife, Brazil. Median age at diagnosis was 4.9 years; 283 children had leukemia and 160 had solid tumors. Z-scores were calculated for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) at diagnosis. Z scores <-2 indicated malnutrition. Patients were also stratified by low-risk disease (solid tumors: stage I, stage II, or localized; acute lymphocytic leukemia: white blood cell count <25,000/microL, no central nervous system involvement, no mediastinal mass and age >1 and <10 yrs) and high-risk disease (all other patients, including those with acute or chronic myelocytic leukemia). RESULTS Z-scores indicated malnutrition in 23.5% (WAZ), 22.8% (HAZ), and 15.7% (WHZ) of patients. Z-score was not significantly related to overall survival rates, to survival rates analyzed by type of malignancy or risk status, or to survival rates at the end of the first month of treatment. CONCLUSIONS We found no relationship between nutritional status and survival in these patients. This implies that future protocols for use in developing countries can be designed to provide optimal treatment intensity despite the high incidence of malnutrition.
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Affiliation(s)
- F Pedrosa
- Department of Hematology-Oncology, Instituto Materno-Infantil de Pernambuco, Recife, Brazil
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Abstract
The correct assessment of a cancer patient is a key step in the treatment process. In older people, this assessment entails not only the patient's basic medical history and the standard cancer staging, but also much more comprehensive evaluation of the various facets of the patient's health and environment that may interfere with his or her therapy. Patient fitness for elective surgery, radiation therapy, and chemotherapy must be considered. Geriatricians have defined the relevant aspects of the general evaluation of the older person, and now this work is being adapted to cancer patients. This article reviews the various aspects of a comprehensive assessment applicable to the cancer patient in settings such as academic oncology programs, cooperative group studies, and private oncology practice.
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Affiliation(s)
- M Extermann
- Department of Internal Medicine, University of South Florida College of Medicine, USA.
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Reilly JJ, Weir J, McColl JH, Gibson BE. Prevalence of protein-energy malnutrition at diagnosis in children with acute lymphoblastic leukemia. J Pediatr Gastroenterol Nutr 1999; 29:194-7. [PMID: 10435658 DOI: 10.1097/00005176-199908000-00017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The purpose of the present study was to test the hypothesis that protein-energy undernutrition is common in patients with acute lymphoblastic leukemia at diagnosis. Previous studies have failed to establish whether undernutrition is a common feature at diagnosis. METHODS Body mass index (BMI, weight/height2), expressed as a standard deviation score (SDS) relative to contemporary United Kingdom reference data, was used as the index of nutritional status. The index was calculated in a national cohort of standard-risk patients (n = 1019) treated in the same protocol in the United Kingdom. RESULTS Prevalence of undernutrition (defined as BMI SDS <-2.0) exceeded expected frequencies in boys (7.6%) and girls (6.7%). These differences were statistically significant (p < 0.001), with a 95% confidence interval for the prevalence of undernutrition of 5.8% to 9.0%. CONCLUSIONS Undernutrition is relatively common in patients with newly diagnosed acute lymphoblastic leukemia, with a threefold excess of patients below the cutoff used to define undernutrition. Screening for undernutrition at diagnosis of acute lymphoblastic leukemia is indicated, and the BMI SDS is a simple index of nutritional status that could be readily calculated using measurements routinely made at diagnosis. The same simple screening technique could also be used clinically to detect and manage or prevent overnutrition (obesity), which is common in these patients after diagnosis.
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Affiliation(s)
- J J Reilly
- Department of Human Nutrition, University of Glasgow, Yorkhill Hospitals, Scotland, United Kingdom
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Ringwald-Smith K, Williams R, Mackert P, Stricklin L, Sargent T, Bowman L. Comparison of energy estimation equations with measured energy expenditure in obese adolescent patients with cancer. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:844-8. [PMID: 10405683 DOI: 10.1016/s0002-8223(99)00199-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obesity is increasing in the US adolescent population. As the number of obese adolescents increases, obesity is becoming a more frequent problem in the hospital setting, sometimes causing patients to have complicated and prolonged hospital stays. Calculation of the energy requirements of obese adolescent patients with chronic diseases such as cancer is complicated by increased energy requirements as a result of disease state and growth. This study examined the accuracy of the commonly used equations for calculating energy requirements. Estimated energy expenditure was compared with measured energy expenditure determined by indirect calorimetry. All energy estimation equations were inaccurate, which indicates the need for a specific equation for determination of energy needs in this special patient population. Until further research is done, indirect calorimetry is recommended for all obese adolescent patients with cancer who require nutrition support.
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Affiliation(s)
- K Ringwald-Smith
- Department of Clinical Nutrition Services, St Jude's Children's Research Hospital, Memphis, TN 38105, USA
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Mejía-Aranguré JM, Fajardo-Gutiérrez A, Reyes-Ruíz NI, Bernáldez-Ríos R, Mejía-Domínguez AM, Navarrete-Navarro S, Martínez-García MC. Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment. Arch Med Res 1999; 30:150-3. [PMID: 10372451 DOI: 10.1016/s0188-0128(98)00026-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Previous reports have shown that undernourished children with acute lymphoblastic leukemia (ALL) have a poorer long-term survival as compared with children with normal nourishment status. It has been shown that both the relapse and mortality rates of undernourished children with ALL are higher during the continuation phase of the chemotherapy and are apparently related to a poor tolerance of ablative chemotherapy. No previous articles have analyzed the early mortality rate of these patients. METHODS We carried out a case-control study, and have studied the effect of severe malnutrition on the mortality of 17 children with ALL during the initial induction-to-remission phase of the treatment. These 17 cases were compared with 76 controls who had survived at least the phases of induction and consolidation. RESULTS It was found that the chance of dying during the initial phase of the treatment was 2.6 times higher (confidence interval 95%: 0.55-11.89) in undernourished children with ALL than in those children with normal nourishment status. The risk of death increased with the severity of undernourishment (p = 0.04). CONCLUSIONS These data confirm the prognostic value of malnutrition in children with ALL and suggest that undernourishment may also influence early mortality during the induction-to-remission phase of the treatment.
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Affiliation(s)
- J M Mejía-Aranguré
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, D.F., México
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Advani S, Pai S, Venzon D, Adde M, Kurkure PK, Nair CN, Sirohi B, Banavali SD, Hawaldar R, Kolhatkar BB, Vats T, Magrath I. Acute lymphoblastic leukemia in India: an analysis of prognostic factors using a single treatment regimen. Ann Oncol 1999; 10:167-76. [PMID: 10093685 DOI: 10.1023/a:1008366814109] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the past, treatment results in Indian children with ALL have been poor, primarily due to inadequate chemotherapy and supportive care, but perhaps reflecting differences from Western countries in the pattern of subtypes. In an attempt to improve survival, we have used a more intensive treatment protocol, MCP841, and examined prognostic factors. PATIENTS AND METHODS Five hundred thirty previously untreated patients < 25 years of age with ALL were entered on study at the Tata Memorial Hospital, Mumbai. Treatment consisted of three successive induction cycles, consolidation and six maintenance cycles. CNS prophylactic therapy consisted of cranial irradiation (2000 cGy) for patients above two years and high-dose cytarabine for patients less than two years. The total treatment duration was two years. RESULTS Most patients had hepatosplenomegaly (80%) and or lymphadenopathy (79%) and 21% were of T-cell immunophenotype, but very few (1.3%) had CNS disease. CR was achieved in 484 (91.3%) patients and 145 (29.9%) patients relapsed. There were 36 induction deaths and 49 remission deaths, but the toxic death rate was significantly lower after 1990. In patients treated since 1990, three risk groups could be discerned: 1) WBC < 60,000 per mm3 and no lymphadenopathy (77% event-free survival (EFS) at five years): 2) WBC < 60,000 per mm3 with lymphadenopathy (53% EFS) or, WBC > 60,000 per mm3 and Hb 6 gm/dl or above (48% EFS): and 3) WBC > 60,000 per mm3 and Hb below 6 gm dl (16% EFS). In a multivariate model, only WBC, Hb and lymphadenopathy were significantly associated with EFS (P < 0.01). CONCLUSIONS The CR and EFS rates achieved represent a significant improvement over previous results at this institution. Bulky extramedullary disease was an important risk factor in this series, but age and WBC alone inadequately defined risk groups, suggesting that prognostic factors may vary in different world regions.
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Affiliation(s)
- S Advani
- Tata Memorial Hospital, Mumbai, India
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49
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Gómez-Almaguer D, Ruiz-Argüelles GJ, Ponce-de-León S. Nutritional status and socio-economic conditions as prognostic factors in the outcome of therapy in childhood acute lymphoblastic leukemia. INTERNATIONAL JOURNAL OF CANCER. SUPPLEMENT = JOURNAL INTERNATIONAL DU CANCER. SUPPLEMENT 1999; 11:52-5. [PMID: 9876479 DOI: 10.1002/(sici)1097-0215(1998)78:11+<52::aid-ijc15>3.0.co;2-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The majority of children on earth are to be found in the developing world, many of them malnourished members of impoverished families. Thus, the effects of socio-economic status (SES) on the therapeutic response of children with cancer are obviously relevant. The outcome of treatment in patients with the commonest form of cancer in childhood (acute lymphoblastic leukemia, ALL) is clearly related to their SES. Studies conducted mainly in developing countries have shown malnutrition to be an important prognostic factor in such children. However, other socio-economic conditions could affect the outcome of therapy in patients with ALL: access to communications, transportation, laboratory studies and therapy. Even in children with an "adequate" SES, malnutrition is still an adverse prognostic factor. Nutritional supplementation appears to be a valuable addition to chemotherapy in undernourished children with ALL. The choice of treatment for these children should accommodate the cultural, economic and nutritional status of the patients and their families. Protocols must be created for testing methods of nutritional intervention and their influence on pharmacology, drug tolerance and survival in ALL. The influences of poverty and illiteracy on compliance with treatment, especially oral medication, need to be evaluated. Such investigations are essential to improve results of treatment of socio-economically disadvantaged children suffering from ALL and other forms of cancer.
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Affiliation(s)
- D Gómez-Almaguer
- Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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50
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Murry DJ, Riva L, Poplack DG. Impact of nutrition on pharmacokinetics of anti-neoplastic agents. INTERNATIONAL JOURNAL OF CANCER. SUPPLEMENT = JOURNAL INTERNATIONAL DU CANCER. SUPPLEMENT 1999; 11:48-51. [PMID: 9876478 DOI: 10.1002/(sici)1097-0215(1998)78:11+<48::aid-ijc14>3.0.co;2-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been estimated that approximately 80% of the world's pediatric population lives in countries with limited resources, and that 43% of these children are malnourished. In children with cancer, malnutrition may antedate the diagnosis or be a result of aggressive chemotherapeutic regimens. Studies have shown that children with cancer and malnutrition have a less favorable prognosis, a higher risk of early relapse, and tolerate chemotherapy poorly when compared with children with normal nutritional status. Improvements in nutritional status may improve tolerance to chemotherapy. An understanding of the mechanisms responsible for the effects of malnutrition on drug disposition and pharmacodynamic response is important, especially for anti-neoplastic agents, which have a narrow therapeutic index and may be associated with potentially severe or life-threatening side-effects. Several factors related to malnutrition have been suggested to alter drug disposition. Diminished protein "status" in malnourished children results in lower amounts of plasma proteins, increasing the concentration of free drug available to exert its cytotoxic effect. Severely malnourished individuals also exhibit decreased oxidative metabolism and reduced glomerular filtration rate (GFR), potentially increasing concentrations of parent drug or active metabolites. Malnourished children receiving chemotherapy for the treatment of an underlying malignancy may need specifically "tailored" protocols to achieve therapeutic response while minimizing adverse acute and long-term side effects. The role of specific interventions, such as correction of nutritional status or pharmacokinetic drug monitoring, should be evaluated in this context.
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Affiliation(s)
- D J Murry
- Baylor College of Medicine, Houston, TX, USA.
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