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van der Haak N, Edwards S, Perem M, Landorf E, Osborn M. Nutritional Status at Diagnosis, During, and After Treatment in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:668-674. [PMID: 33844931 DOI: 10.1089/jayao.2020.0197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Malnutrition is commonly observed during cancer treatment, while some cancer survivors are at risk of overweight and obesity. This study investigated nutritional status during and after treatment in adolescents and young adults (AYA) with cancer. Methods: A retrospective chart review of AYA diagnosed with cancer was conducted. Data were collected monthly during treatment, then annually for 3 years of follow-up. Results: Of 93 AYA, 8% were underweight at diagnosis versus 20% during treatment (p = 0.012). Forty-four percent experienced ≥5% loss of weight (LOW) during treatment, and 23% of those were not referred to a dietitian. While 47% were referred to a dietitian at some point during treatment, 77% did not have dietetic involvement in the month after reaching greatest percentage LOW. Different tumor types were associated with different risks of LOW. Eighty-six percent with acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LL) and 86% with acute myeloid leukemia had ≥5% LOW during treatment, compared with 17% with Hodgkin lymphoma (p < 0.0001). In year 3 of follow-up, 36% of all AYA were overweight or obese versus 25% at diagnosis (p = 0.2). Overweight/obesity was more common in ALL/LL survivors than other tumor types (67% vs. 14%, p = 0.037). No patients had dietitian involvement in year 3 of follow-up. Conclusions: AYA, particularly those with ALL/LL, are at risk of significant weight loss during treatment and overweight and obesity during survivorship. Dietetic involvement was inconsistent in this cohort. These data may guide which diagnoses warrant preemptive dietetic input during treatment and highlight the importance of dietetic involvement in survivorship.
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Affiliation(s)
- Natalie van der Haak
- Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, Data, Design and Statistics Service, School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Merike Perem
- Youth Cancer Service, Royal Adelaide Hospital, Adelaide, South Australia
| | - Emma Landorf
- Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia
| | - Michael Osborn
- Youth Cancer Service, Royal Adelaide Hospital, Adelaide, South Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia
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McGrath KH, Hardikar W. Gastrostomy tube use in children with cancer. Pediatr Blood Cancer 2019; 66:e27702. [PMID: 30854790 DOI: 10.1002/pbc.27702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/14/2023]
Abstract
Children with cancer are at risk of malnutrition, which can impair critical childhood processes of growth and development and contribute to poor health outcomes. Enteral nutrition can effectively ameliorate malnutrition or weight loss in children with cancer; however, published nutrition support algorithms contain minimal specific information on gastrostomy tube use, and current literature is limited. Decisions about gastrostomy tube insertion in children with cancer can be challenging. Consideration of gastrostomy tube insertion is only appropriate in children with long-term dependence on enteral nutrition, particularly when nasogastric tube insertion is predicted or proven to be problematic. Specific indications for patient selection are unclear, and referring clinicians may be unaware of important absolute and relative contraindications. Complications are predominantly minor in nature; however, reported rates are high. Morbidity must be weighed carefully against the need and anticipated duration of enteral nutrition support, and further research in this area is needed.
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Affiliation(s)
- Kathleen H McGrath
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.,Intestinal Failure and Clinical Nutrition Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Winita Hardikar
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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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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4
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Ceppi F, Antillon F, Pacheco C, Sullivan CE, Lam CG, Howard SC, Conter V. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries. Expert Rev Hematol 2015; 8:613-26. [DOI: 10.1586/17474086.2015.1049594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr 2010; 29:106-11. [DOI: 10.1016/j.clnu.2009.07.006] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/09/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW Hospital protein-energy malnutrition and its adverse consequences were already described back in 1980. The purpose of this review is to describe the current prevalence of malnutrition in hospitalized children and to describe current risk groups. RECENT FINDINGS Different definitions have been used to describe malnutrition. According to WHO criteria, the SD score with a cutoff of less than -2 should be used to define malnutrition and to compare prevalence data. Using the SD score for weight for height or equivalent criteria, the prevalence of acute malnutrition over the last 10 years in hospitalized children in Germany, France, the UK and the USA varied between 6.1 and 14%, whereas in Turkey up to 32% of patients with malnutrition were reported. Acute malnutrition is still highly prevalent in children with an underlying disease; however, the prevalence rate seems lower in children with cystic fibrosis and malignancies. SUMMARY The prevalence of acute malnutrition of children admitted to hospital is still considerably high, but there is a scarcity of data concerning the nutritional status during hospital admission. Screening tools to identify children at risk of developing malnutrition might be helpful.
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Ernährungsproblematik krebskranker Kinder und Jugendlicher. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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de Koning BA, van der Schoor SR, Wattimena DL, de Laat PC, Pieters R, van Goudoever JB. Chemotherapy does not influence intestinal amino acid uptake in children. Pediatr Res 2007; 62:195-9. [PMID: 17597661 DOI: 10.1203/pdr.0b013e3180986d19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chemotherapy will frequently induce intestinal damage (mucositis). Enteral nutrition is then often withheld for fear of impaired intestinal absorption as shown in animal models. There is no clinical evidence, however, that absorption is indeed compromised during chemotherapy-induced mucositis. The aim of this study was to evaluate systemic availability of dietary amino acids (leucine) during chemotherapy-induced mucositis. We studied eight childhood cancer patients (age 1.5-16 y) on 2 d, i.e. the day before chemotherapy and 3-5 d after. Chemotherapy-induced oral mucositis and diarrhea were scored on a World Health Organization toxicity scale. Stable isotope tracers were used to measure first-pass splanchnic leucine uptake and whole-body leucine kinetics. Patients showed increased mucositis and/or diarrhea toxicity scores (p < 0.0001) after chemotherapy. Systemic availability of enterally administered leucine was not significantly affected by chemotherapy (before 60%, after 90%, p = 0.46). Interestingly, five patients already showed a negative leucine balance before chemotherapy. In conclusion, most children receiving chemotherapy are already catabolic before start of a new cycle of chemotherapy. Amino acid transport as measured by leucine uptake in the intestine is not affected by chemotherapy-induced mucositis.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Breath Tests
- Carbon Dioxide/metabolism
- Carbon Isotopes
- Child
- Child, Preschool
- Diarrhea/chemically induced
- Diarrhea/metabolism
- Enteral Nutrition
- Humans
- Infant
- Intestinal Absorption
- Leucine/administration & dosage
- Leucine/pharmacokinetics
- Leukemia, Lymphoid/drug therapy
- Leukemia, Lymphoid/metabolism
- Leukemia, Lymphoid/therapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/therapy
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/therapy
- Severity of Illness Index
- Splanchnic Circulation
- Stomatitis/chemically induced
- Stomatitis/metabolism
- Treatment Outcome
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Affiliation(s)
- Barbara A de Koning
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, 3015GJ Rotterdam, the Netherlands
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Martin E, Belleton F, Lallemand Y, Goy F, Pérol D, Bachmann P, Marec-Bérard P. Dénutrition en cancérologie pédiatrique : prévalence et dépistage. Arch Pediatr 2006; 13:352-7. [PMID: 16488583 DOI: 10.1016/j.arcped.2005.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 12/17/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Algorithms for nutritional pediatric support have been proposed in a French national nutritional framework program. However, they are not specific for oncology. With the pediatric nutritional risk score (PNRS) all children with cancer have a high risk of malnutrition, but a systematic nutritional support is not possible for all of them. AIM Estimation of malnutrition prevalence and identification of predictive factors of major weight loss during treatment defined by a weight loss more than 5% within 1 month, 7.5% within 3 months, 10% within 6 months. POPULATION AND METHODS This historical study included children registered with a solid tumor in 2002 in an oncology pediatric unit. Data collected at diagnosis were weight, height, PNRS, the Lansky functional score, tumor type. Furthermore weight, height, and major weight loss were collected at each cure of chemotherapy and during evolution. Malnutrition at diagnosis was defined using the weight for height ratio. Relations between major weight loss and risks factors were estimated using logistic regression. RESULTS Seventy children were included, 16 (22.9%) were malnourished at admission. During chemotherapy, 29 (41.4%) children experienced a major weight loss. Odds ratio of those who were malnourished at diagnosis was not significantly higher in comparison to well-nourished children. Children with a high risk of malnutrition are those affected by Ewing tumor, B lymphom, head and neck localisations, osteosarcomas, metastatic cancers, or cancers treated by high dose chemotherapy with stem cell rescue. For these 29 (41.4%) children the major weight loss odds ratio was 5.9 [IC95% 2.0-16.7]. CONCLUSION Taking into account others factors with items of PNRS allows to screen children with an higher risk of a major weight loss during treatment and to enhance nutritional care plan for them.
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Affiliation(s)
- E Martin
- Unité de biostatistiques, CRLCC Léon-Bérard, 28, rue Laennec, 69000 Lyon, France.
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Verger JT, Bradshaw DJ, Henry E, Roberts KE. The pragmatics of feeding the pediatric patient with acute respiratory distress syndrome. Crit Care Nurs Clin North Am 2004; 16:431-43, x. [PMID: 15358390 DOI: 10.1016/j.ccell.2004.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute respiratory distress syndrome (ARDS) represents the ultimate pulmonary response to a wide range of injuries, from septicemia to trauma. Optimal nutrition is vital to enhancing oxygen delivery, supporting adequate cardiac contractility and respiratory musculature, eliminating fluid and electrolyte imbalances, and supporting the proinflammatory response. Research is providing a better understanding of nutrients that specifically address the complex physiologic changes in ARDS. This article highlights the pathophysiology of ARDS as it relates to nutrition, relevant nutritional assessment, and important enteral and parenteral considerations for the pediatric patient who has ARDS.
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Affiliation(s)
- Judy T Verger
- School of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Traunecker HC, Morland BJ. Indwelling lines and nutrition. Eur J Cancer 2001; 37:1649-58. [PMID: 11527691 DOI: 10.1016/s0959-8049(01)00208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H C Traunecker
- Department of Paediatric Oncology, Birmingham Children's Hospital NHS Trust, B4 6NH, Birmingham, UK
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den Broeder E, Lippens RJ, van 't Hof MA, Tolboom JJ, Sengers RC, van den Berg AM, van Houdt NB, Hofman Z, van Staveren WA. Nasogastric tube feeding in children with cancer: the effect of two different formulas on weight, body composition, and serum protein concentrations. JPEN J Parenter Enteral Nutr 2000; 24:351-60. [PMID: 11071595 DOI: 10.1177/0148607100024006351] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment of cancer cachexia partly involves the administration of adequate amounts of energy. The aim of this study was to assess the tolerance and efficacy of two equal volumes of tube feeding, one with a standard (1 kcal/mL) and one with a high energy density (1.5 kcal/mL), during the intensive phase of treatment. METHODS Nutritional status was assessed weekly, in 27 children with a solid tumor, by measuring weight, height, midupper arm circumference, biceps and triceps skinfold, and serum proteins. Tolerance was assessed by recording the occurrence of vomiting and by expressing the administered volume as a percentage of the required volume. RESULTS Both formulas were equally well tolerated, leading to a significantly higher energy intake in the energy-enriched formula group. In both formula groups, all anthropometric variables increased significantly (range of mean increase, 5.2% to 25.5%; p < .05) during the first 4 weeks of intervention. Between 4 and 10 weeks, variables continued to increase significantly in the energy-enriched group, resulting in adequate repletion, in contrast to the standard formula group. The concentration of serum proteins, low at initiation of tube feeding, returned to the normal range within 2 to 4 weeks with no significant differences between the two groups. CONCLUSIONS The energy-enriched formula was more effective in improving the nutritional status of children with cancer during the intensive phase of treatment than the standard formula. Intensive, protocolized administration of an energy-enriched formula should therefore be initiated as soon as one of the criteria for initiation of tube feeding is met.
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Affiliation(s)
- E den Broeder
- Department of Pediatrics, University Hospital Nijmegen, The Netherlands.
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