Causes of inadequate intake of nutrients during the treatment of children with chemotherapy

Clinician perspectives on nutritional impairment in children undergoing cancer chemotherapy in Thailand: A qualitative descriptive study

Objective

This study aimed to explore the perspectives of pediatric oncology clinicians in Thailand on children's gastrointestinal ​symptoms, eating habits, and nutrition during cancer chemotherapy. Additionally, it sought to identify factors influencing children's nutritional status, including the characteristics of the children, clinician-related factors, and hospital-level factors.

Methods

The study involved pediatric oncology clinicians working at a tertiary hospital in Bangkok. Data were collected through interviews, focusing on three key areas: (1) children's gastrointestinal symptoms, eating behaviors, and nutrition, (2) clinicians' cognitions and behaviors that impact children's nutrition, and (3) environmental factors. Each participating clinician also identified a colleague who could offer additional perspectives. Interviews were conducted in the Thai language and analyzed using directed content analysis.

Results

A total of 22 participants were enrolled in the study, comprising sixteen nurses, four physicians, one child life specialist, and one Hospital Nutrition Service staff member. The majority of participants were female (95.4%), with an average age of 37.77 years and an average of 15.55 years of experience in caring for children with cancer. Factors influencing children's nutritional status included the children's cancer diagnosis, treatment exposures, and symptoms. Clinicians attributed changes in children's weight and eating patterns to these symptoms. Influential clinician-related factors included current practices that impacted children's symptoms and food intake. Hospital-level factors included both direct influences on children and those arising from clinical practices.

Conclusions

To optimize the nutritional status of Thai children undergoing chemotherapy, multi-level interventions are needed. These interventions should target children's symptoms, clinician knowledge, role norms, and address issues related to the hospital environment, specifically those elements that contribute to unpleasant experiences.

Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective

Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders’ expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents’ limited attention span and avoiding the use of long-term health benefits as a motivator.

Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children

There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.

The five aspect meal model as a conceptual framework for children with a gastrostomy tube in paediatric care

BACKGROUND

Cancer treatments may induce side effects and cause eating problems. A gastrostomy tube may be required in order to maintain and optimise the child's nutritional needs. Despite the use of a gastrostomy tube, it is important to maintain a natural and attractive mealtime for the child. The Five Aspect Meal Model is age neutral and originally designed to improve restaurant visits. Its five aspects conceptualise what is necessary to ensure a complete meal experience. To date, there is lack of knowledge to guided model development about mealtimes adapted to children and limited knowledge regarding mealtime experiences for children with a gastrostomy tube.

AIM

The aim was to investigate whether the Five Aspect Meal Model could be appropriate to be used for children with a gastrostomy tube in caring science and paediatric care.

METHODS

The design followed steps retrieved from Renjith and colleagues. Seven interviews were performed with the Five Aspect Meal Model as a base in the interview guide. The transcripts were analysed by using a qualitative directed content analysis with a deductive approach, which finally passed into a more inductive one.

FINDINGS

All aspects of the Five Aspect Meal Model were represented in the interviews. There were also experiences related to the gastrostomy tube and the mealtimes that did not fit into any of the five predetermined categories. As a result, the modified version was developed, an adapted prescribing practice model that includes seven aspects, whereof bodily discomfort and time for change and acceptance are specific to children with a gastrostomy tube.

CONCLUSION

Based on children and their parent's experiences, the Five Aspect Meal Model has been developed and adapted into a modified version, which includes seven aspects. The modified version seems to be appropriate to use within caring science and paediatric care.

Nutritional Deficits In Children With Cancer: A Situation-Specific Theory

PURPOSE

To construct a situation-specific theory (SST) to represent nutritional deficits for assessing children with cancer.

DATA SOURCES

Literature review.

DATA SYNTHESIS

The SST included the definition of key concepts, a pictorial scheme, propositions, causal relationships, and evidence for nursing practice.

CONCLUSIONS

It was possible to characterize the elements as antecedent and consequent clinical factors to allow for an understanding of the existing relationships between them and their temporality. These elements differed considerably from those included in NANDA International.

IMPLICATIONS FOR NURSING PRACTICE

This study provides additional information so that nurses in clinical practice can infer the presence of nutritional deficits in children with cancer early, given the risk already inherent in the diagnosis of cancer and treatment.

Nutrition education and cooking workshops for families of children with cancer: a feasibility study

Background

Changes in food intake are common in children with cancer and are often caused by nausea and perturbations in sense of taste. The VIE (Valorization, Implication, Education) study proposes family-based nutrition and cooking education workshops during childhood cancer treatments. Process evaluation during implementation allows to assess if the intervention was delivered as planned and to determine its barriers and facilitators. The study objective was to describe the implementation process of a nutrition education and cooking workshop program for families of children actively treated for cancer in a non-randomized non-controlled feasibility study.

Methods

Six open-to-all in-hospital workshops were offered on a weekly basis during a one-year implementation phase. We collected qualitative and quantitative data using field notes and activity reports completed by the registered dietician facilitator; surveys and questionnaires fulfilled by the workshop participants and by the families enrolled in the VIE study. Field notes were used to collect only qualitative data. Survey respondents (n = 26) were mostly mothers (n = 19, 73%). Children’s mean age was 7.80 (± 4.99) years and the mean time since diagnosis was 7.98 (± 0.81) months. Qualitative data were codified using hybrid content analysis. The first deductive analysis was based on the Steckler & Linnan concepts. Subthemes were then identified inductively. Quantitative data were presented with descriptive statistics.

Results

Workshop attendance was low (17 participants over 1 year) and 71% of the planned workshops were cancelled due to lack of participants. The principal barriers to participation referred the child’s medical condition, parental presence required at the child’s bedside and challenges related to logistics and time management. The level of interest in the topics addressed was found high or very high for 92% of the participants. The themes that were perceived as the most useful by parents were related to the child’s specific medical condition.

Conclusions

Despite high interest, workshops delivered in a face-to-face format were poorly feasible in our sample population. This supports the need to develop educational programs in pediatric oncology using strategies and delivery formats that address the major barriers for participation encountered by families.

Food habits during treatment of childhood cancer: a critical review

Several factors can affect the nutritional status of children undergoing cancer therapy. The present review aims to describe children’s food intake during cancer treatments and to explore the contributing determinants. It also assesses the nutritional educational interventions developed for this clientele. Scientific literature from January 1995 to January 2018 was searched through PubMed and MEDLINE using keywords related to childhood cancer and nutritional intake. Quantitative and qualitative studies were reviewed: forty-seven articles were selected: thirty-eight related to food intake and parental practices and nine related to nutritional interventions. Patients’ intakes in energy, macronutrients and micronutrients were compared with those of healthy controls or with requirement standards. Generally, patients ate less energy and proteins than healthy children, but adhered similarly to national guidelines. There is a lack of consensus for standard nutrient requirement in this population and a need for more prospective evaluations. Qualitative studies provide an insight into the perceptions of children, parents and nurses on several determinants influencing eating behaviours, including the type of treatment and their side effects. Parental practices were found to be diverse. In general, savoury and salty foods were preferred to sweet foods. Finally, most interventional studies in childhood cancer have presented their protocol or assessed the feasibility of an intervention. Therefore, because of the variability of study designs and since only a few studies have presented results, their impact on the development of healthful eating habits remains unclear. A better understanding of children’s nutritional intakes and eating behaviours during cancer treatment could guide future nutritional interventions.

Short-term follow-up of the nutritional status of children with Fanconi anemia undergoing hematopoietic stem cell transplant

OBJECTIVE

The objective of this study was to evaluate the nutritional status of children diagnosed with Fanconi anemia (FA) during hematopoietic stem cell transplant (HSCT), comparing it with healthy children and children with other hematologic diseases.

METHODS

Observational retrospective study was conducted with patients submitted to HSCT in a period of 5 years. We assessed anthropometric and biochemical data, food intake, and gastrointestinal complications in 49 FA patients. We compared the anthropometric information with those of transplanted patients with other diagnoses (n = 54) in three periods (pre-transplant, 15 and 30 days after the HSCT), and with a group of healthy children (n = 24).

RESULTS

Throughout the post-HSCT period, there was a significant decline in the nutritional status of FA patients: 83.3% presented weight loss equal to or greater than 5%. A progressive decrease in food intake after the transplantation was observed, with weekly deficits reaching 7841.3 kcal and 347.6 g of protein (both p < 0.05). When comparing FA with other diagnoses patients, the former displayed a poorer nutritional status prior to HSCT (p < 0.01 for BMI/age z-score), and that difference was maintained during the transplant (p < 0.01 for the same parameter), with similar weight loss values for both groups (8.99 vs 7.91%, respectively; p > 0.05). When compared to the control group of healthy children, FA patients prior HSCT showed substantially lower z-scores for Ht./age (p < 0.01) and BMI/age (p < 0.05).

CONCLUSION

Although FA patients demonstrated poorer nutritional status as compared to other diagnosis and healthy children, the decline of anthropometric measures along the treatment is similar to other transplanted patients, imposing a greater risk to FA patients.

Cellular mechanisms of cyclophosphamide-induced taste loss in mice

Many commonly prescribed chemotherapy drugs such as cyclophosphamide (CYP) have adverse side effects including disruptions in taste which can result in loss of appetite, malnutrition, poorer recovery and reduced quality of life. Previous studies in mice found evidence that CYP has a two-phase disturbance in taste behavior: a disturbance immediately following drug administration and a second which emerges several days later. In this study, we examined the processes by which CYP disturbs the taste system by examining the effects of the drug on taste buds and cells responsible for taste cell renewal using immunohistochemical assays. Data reported here suggest CYP has direct cytotoxic effects on lingual epithelium immediately following administration, causing an early loss of taste sensory cells. Types II and III cells in fungiform taste buds appear to be more susceptible to this effect than circumvallate cells. In addition, CYP disrupts the population of rapidly dividing cells in the basal layer of taste epithelium responsible for taste cell renewal, manifesting a disturbance days later. The loss of these cells temporarily retards the system’s capacity to replace Type II and Type III taste sensory cells that survived the cytotoxic effects of CYP and died at the end of their natural lifespan. The timing of an immediate, direct loss of taste cells and a delayed, indirect loss without replacement of taste sensory cells are broadly congruent with previously published behavioral data reporting two periods of elevated detection thresholds for umami and sucrose stimuli. These findings suggest that chemotherapeutic disturbances in the peripheral mechanisms of the taste system may cause dietary challenges at a time when the cancer patient has significant need for well balanced, high energy nutritional intake.