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Tokala M, Weber J, Gilbert R, Dreyer Gillette ML, August KJ, Befort CA, Bates CR. Caregiver perceptions of child heath behaviors and weight during treatment for acute lymphoblastic leukemia. Pediatr Blood Cancer 2024; 71:e30984. [PMID: 38584336 DOI: 10.1002/pbc.30984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Changes in health behaviors and weight are common during the early phases of pediatric acute lymphoblastic leukemia treatment, and may negatively impact treatment tolerability. Given that ALL is most prevalent in children, caregivers play an essential role in shaping health behaviors during treatment. This study presents a qualitative analysis of semi-structured interviews with caregivers of youth in the early phases of ALL treatment. PROCEDURE Caregivers (N = 17, 95% female) of a child (M age = 6.76 years) diagnosed with ALL and on treatment for less than 1 year (M = 8.7 months since diagnosis) completed a semi-structured interview about perceptions of their child's nutrition, physical activity, sedentary time, and weight during ALL treatment. Thematic analysis followed Braun and Clark's six-step framework (2006). Two coders established reliability (alpha = .88) and used a multi-pass coding system to extract themes. RESULTS Caregivers' concerns around their child's weight during ALL treatment primarily centered around avoiding malnutrition. Weight gain during treatment was less of a concern and often viewed as protective. Caregivers reported encouraging their child to eat palatable, calorie-dense foods to mitigate risk for weight loss. Caregivers also expressed concern that children were less active and more sedentary due to treatment-related pain. Caregivers discussed health behaviors during treatment as being child-directed, rather than parent- or provider-directed. CONCLUSION Future interventions may consider strategies to engage in joint parent-child decisions and caregiver education around risks of excessive weight gain during treatment. Interventions should include anticipatory guidance and aim to support parents in developing skills to support their child's health behaviors during treatment.
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Affiliation(s)
- Meghan Tokala
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jacee Weber
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA
| | - Renee Gilbert
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Meredith L Dreyer Gillette
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Keith J August
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Christie A Befort
- University of Kansas Medical Center, Kansas City, Kansas, USA
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
- University of Kansas Cancer Center, Westwood, Kansas, USA
| | - Carolyn R Bates
- University of Kansas Medical Center, Kansas City, Kansas, USA
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
- University of Kansas Cancer Center, Westwood, Kansas, USA
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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Fistikçi Y, Bilsin Kocamaz E. Eating Behavior, Nutritional Status, and Taste Perception Alteration in Children with Cancer. J Pediatr Hematol Oncol 2024; 46:88-95. [PMID: 38237000 DOI: 10.1097/mph.0000000000002814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/27/2023] [Indexed: 02/28/2024]
Abstract
The aim of this study was to investigate eating behavior, nutritional status, and taste alterations in children with cancer. The population of the study consisted of children 8 to 18 years of age and their parents who were followed up and received chemotherapy in the pediatric hematology and oncology clinic and outpatient clinic of a University Faculty of Medicine Oncology Hospital. Data were collected using the Child Identification Form, the Children's Eating Behavior Questionnaire (CEBQ), the Taste Alteration Scale for Children Receiving Chemotherapy (TAC-TAS), and the Subjective Total Taste Acuity Scale (STTA). Body Mass Index (BMI) Z score was between -2 and +2 (normal) in 92.5% of the children and below ≤-2 (malnutrition) in 7.5%. The mean CEBQ subdimensions scores were food craving 12.48±5.36, emotional overeating 5.28±1.45, enjoyment of food 16.83±5.41, passion for drinking 9.72±5.13, satiety enthusiasm 22.93±6.65, slow eating 9.81±4.95, emotional undereating 16.38±4.41, and food selectivity 10.72±2.86, and the mean total TAC-TAS score was 8.66±10.22. A negative, moderate correlation was determined between food craving and enjoyment of food and taste alteration, with food craving and enjoyment decreasing as food alteration increased. A positive moderate correlation was observed between slow eating and taste alteration, with eating slowing down as taste alteration increased.
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Affiliation(s)
- Yasemin Fistikçi
- Blood Collection Department, Nizip Public Hospital, Gaziantep, Turkey
| | - Elif Bilsin Kocamaz
- Department of Child Health and Diseases Nursing, Dicle University Atatürk Health Science Faculty, Sur, Diyarbakir, Turkey
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Lovell AL, Gardiner B, Henry L, Bate JM, Brougham MFH, Iniesta RR. The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review. J Hum Nutr Diet 2024. [PMID: 38185902 DOI: 10.1111/jhn.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment. METHODS This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. RESULTS The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. CONCLUSIONS With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.
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Affiliation(s)
- Amy L Lovell
- Department of Nutrition and Dietetics, The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
| | - Breeana Gardiner
- Department of Nutrition and Dietetics, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Louise Henry
- Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jessica M Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Mark F H Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Raquel Revuelta Iniesta
- Children's Health and Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, Public Health and Sport Sciences, Medical School, St Luke's Campus, University of Exeter, Exeter, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
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Lazar DE, Postolica R, Hanganu B, Mocanu V, Ioan BG. Web-based nutrition: a useful resource for cancer patients? Front Nutr 2023; 10:1134793. [PMID: 37457987 PMCID: PMC10348813 DOI: 10.3389/fnut.2023.1134793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction An accessible and affordable way to deliver behavior change programs to a large proportion of the growing community of cancer patients and survivors is through web-based methods of nutritional counselling. Objective The aim of this systematic review was to evaluate the effectiveness of web-based nutritional therapies targeting physical activity, diet, and/or weight control for cancer patients or survivors, primarily disseminated via modern technologies (mobile phone applications) or online. Materials and methods The authors conducted a structured search of the PubMed database. Studies that have focused on physical activity (PA) and dietary change and/or weight control in adolescent and adult cancer patients and survivors have reported outcomes conducted via a broad modality. Results Nine articles focused on web-based nutrition for patients with cancer and cancer survivors. They were conducted in the United States, Australia, Korea, China, and in the United Kingdom, and were published between 2018 and 2022 in a variety of scientific journals. The number of participants ranged from 20 to 159. Conclusion Web-based nutrition counselling helps cancer patients and survivors improve their dietary intake, impacts their weight and quality of life, and promotes a healthy lifestyle. Future research should evaluate (1) the differences in cost and coverage between face-to-face and web-based nutrition, (2) long-term outcomes, (3) cost-effectiveness, and last but not least, (4) the effectiveness of web-based nutrition in adolescents and children who suffer from cancer or who survived cancer, as nutritional status and body composition have a marked impact on clinical outcomes during and after treatment. The strength of this review lies in the large number of randomized controlled trials, which offer a guarantee of effectiveness and objectivity compared to cross-sectional studies.
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Affiliation(s)
- Diana Elena Lazar
- Doctoral School, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
- Municipal Hospital “St. Hierarch Dr. Luca”, Onesti, Romania
| | - Roxana Postolica
- Department of Psychology, Regional Institute of Oncology, Iași, Romania
| | - Bianca Hanganu
- IIIrd Medical Department, Legal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Veronica Mocanu
- Department of Morpho-Functional Sciences (Pathophysiology), Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Beatrice Gabriela Ioan
- IIIrd Medical Department, Legal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
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Clarke E, Pugh G, van den Heuvel E, Winstanley M, Wood AC, Laughton SJ, Lovell AL. Understanding the patient and family experience of nutrition and dietetic support during childhood cancer treatment. Support Care Cancer 2023; 31:326. [PMID: 37154869 PMCID: PMC10167176 DOI: 10.1007/s00520-023-07787-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE This study aimed to understand the experience of families caring for a child with cancer in New Zealand (NZ) who received nutrition and dietetic support during cancer treatment and their preferences for the delivery, format, and timing of nutrition information. METHODS Childhood cancer patients and their families (N = 21) participated in a mixed-methods study at a specialist paediatric oncology centre in Auckland, NZ. Before the semi-structured interview, participants completed a questionnaire capturing demographic, disease, and treatment characteristics of their child, their nutrition concerns, and their information needs. Quantitative data were described, and qualitative thematic analysis of the semi-structured interviews was performed using NVivo data analysis software. RESULTS Eighty-six percent of participants indicated they had concerns about their child's nutrition during treatment. The most common concerns were anorexia, vomiting, and weight loss. While many were happy with the quality of the nutrition support received, one-third of the patients wanted more support. Four key themes emerged from the interviews: (1) patients experience significant and distressing nutrition challenges; (2) patients and families have mixed perceptions of EN; (3) there are gaps in the current nutrition support system for inpatients; and (4) a desire for more accessible nutrition support. CONCLUSION Childhood cancer patients and families experience significant and distressing nutrition challenges during treatment. Standardising information given to patients and their families may optimise nutrition support for paediatric oncology patients and reduce the discordance between families and health professionals. Future implementation of a nutrition decision aid in this population is warranted.
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Affiliation(s)
- Emma Clarke
- The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Gemma Pugh
- National Child Cancer Network, Te Aho O Te Kahu Cancer Control Agency, Wellington, New Zealand
| | | | - Mark Winstanley
- Starship Blood and Cancer Centre, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Andrew C Wood
- Starship Blood and Cancer Centre, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Stephen J Laughton
- Starship Blood and Cancer Centre, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Amy L Lovell
- The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
- Starship Blood and Cancer Centre, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand.
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Napartuk M, Bélanger V, Bouchard I, Meloche C, Curnier D, Sultan S, Laverdière C, Sinnett D, Marcil V. Improvement of Diet after an Early Nutritional Intervention in Pediatric Oncology. CHILDREN 2023; 10:children10040667. [PMID: 37189915 DOI: 10.3390/children10040667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
Pediatric cancer survivors may experience cardiometabolic sequelae over the course of their lives as a result of the treatments they have received. While nutrition consists of an actionable target for cardiometabolic health, few nutritional interventions have been documented in this population. This study assessed the changes in diet during a one-year nutritional intervention for children and adolescents undergoing cancer treatments and the participants’ anthropometric and cardiometabolic profiles. A total of 36 children and adolescents (mean age: 7.9 years, 52.8% male) newly diagnosed with cancer (50% leukemia) and their parents underwent a one-year individualized nutrition intervention. The mean number of follow-up visits with the dietitian during the intervention was 4.72 ± 1.06. Between the initial and one-year assessments, there was an improvement in diet quality reflected by the Diet Quality Index (5.22 ± 9.95, p = 0.003). Similarly, the proportion of participants with moderate and good adherence (vs. low adherence) to the Healthy Diet Index score almost tripled after one year of intervention (14% vs. 39%, p = 0.012). In parallel, there was an increase in the mean z-scores for weight (0.29 ± 0.70, p = 0.019) and BMI (0.50 ± 0.88, p = 0.002), and in the mean levels of HDL-C (0.27 ± 0.37 mmol/L, p = 0.002) and 25-hydroxy vitamin D (14.5 ± 28.1 mmol/L, p = 0.03). Overall, this study supports that a one-year nutritional intervention deployed early after a pediatric cancer diagnosis is associated with an improvement in the diets of children and adolescents.
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Affiliation(s)
- Mélanie Napartuk
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1A8, Canada
| | - Véronique Bélanger
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1A8, Canada
| | - Isabelle Bouchard
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Caroline Meloche
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Daniel Curnier
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC H3G 1Y5, Canada
| | - Serge Sultan
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Caroline Laverdière
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Daniel Sinnett
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Valérie Marcil
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1A8, Canada
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Ermamilia A, Aulia B, Mulatsih S. A cross-sectional study of nutritional status and dietary intake of paediatric oncology patients in Indonesia: Comparison between cancer aetiologies. Nutr Health 2023:2601060231166163. [PMID: 36972507 DOI: 10.1177/02601060231166163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background: Adequate energy and protein intakes are required to maintain nutritional status and prevent clinical deterioration in paediatric oncology patients. There are limited investigations of malnutrition and dietary intake adequacy during treatment in developing countries. Aim: This study aimed to assess the nutritional status and macro- and micronutrient intake adequacy in paediatric oncology patients undergoing therapy. Methods: This cross-sectional study was conducted at Dr Sardjito Hospital, Indonesia. Sociodemographic, anthropometry, dietary intake, and anxiety status were collected. Patients were grouped based on cancer aetiology (haematological malignancy (HM) or solid tumour (ST). Variables between groups were compared. P-values of <0.05 were considered statistically significant. Results: 82 patients aged 5-17 years (65.9% HM) were analysed. The prevalence of underweight was 24.4% (ST vs HM: 26.9% vs 23.2%), overweight 9.8% (ST vs HM: 11.5% vs 8.5%), and obesity 6.1% (ST vs HM: 0.0% vs 8.5%) according to BMI-for-age z-score. Mid-upper-arm circumference identified undernutrition in 55.7% and overnutrition in 3.7% of the patients. Stunted growth was found in 20.8% of the patients. Percentages of children with inadequate energy and protein intake were 43.9% and 26.8%, respectively. The percentages of participants meeting the national micronutrient requirements were low, ranging from 3.8% to 56.1%, with the highest adherence rate observed for vitamin A and the lowest for vitamin E. Appetite loss was associated with lower overall intake. Conclusion: This study confirmed that malnutrition is prevalent in paediatric patients treated for cancer. Inadequate intakes of macro- and micro-nutrients were also common, highlighting the need for early nutritional assessment and intervention.
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Affiliation(s)
- Aviria Ermamilia
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, 59166Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bianda Aulia
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, 59166Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Pediatrics, Faculty of Medicine, Public Health & Nursing, 59166Universitas Gadjah Mada - Dr Sardjito Hospital, Yogyakarta, Indonesia
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