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Damasco-Avila E, Ubico P, Blanco J, Perez M, Farncombe T, Morales G, Antillon-Klussmann F, Ladas E, Barr R. The Nutritional Burden of Cancer: Nutritional Status and Body Composition Differences Between Children with Acute Lymphoblastic Leukemia and their Siblings in Guatemala. Nutr Cancer 2024:1-7. [PMID: 39033402 DOI: 10.1080/01635581.2024.2382391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
During treatment, children with acute lymphoblastic leukemia (ALL) gain fat mass and lose skeletal muscle mass. The great majority live in low- and middle-income countries with few studies of their body composition and none addressing the hypothesis that the disease itself contributes to nutritional morbidity. At diagnosis, children with ALL were compared to their siblings on socioeconomic status (SES). Nutritional status was assessed by mid-upper arm circumference (MUAC)-for-age Z scores and body composition by dual energy x-ray absorptiometry (DXA). Median SES scores for the patients (47.5) and their siblings (47.0) were very similar (P = 0.5). MUAC Z scores for patients aged >5 years were lower than for siblings (P < 0.001). On DXA siblings had a higher mean appendicular lean mass index Z score, a surrogate of skeletal muscle mass, than patients (P = 0.019). A logistic model to estimate the odds ratio (OR) of being severely/moderately under-nourished (classified by MUAC Z score) by SES revealed that, compared with siblings (n = 49), children with ALL (n = 60) had a higher probability of being under-nourished (OR 5.25, 95% CI 1.44-25.95, P = 0.02). The results support the hypothesis that children at diagnosis of ALL in Guatemala are more nutritionally depleted than their apparently healthy siblings.
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Affiliation(s)
- Erika Damasco-Avila
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Paulina Ubico
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Jessica Blanco
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Troy Farncombe
- Department of Nuclear Medicine, McMaster University and Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Gerson Morales
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- School of Medicine, Francisco Marroquín University, Guatemala
| | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Murphy JD, Symons HJ, Cooke KR. Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:637. [PMID: 38929217 PMCID: PMC11202119 DOI: 10.3390/children11060637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.
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Affiliation(s)
- Jessica D. Murphy
- School of Nursing, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Heather J. Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Kenneth R. Cooke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
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Muratore E, Leardini D, Baccelli F, Fabozzi F. Editorial: Nutritional support in pediatric cancer: novel insights and future perspectives. Front Nutr 2024; 11:1397439. [PMID: 38765821 PMCID: PMC11100350 DOI: 10.3389/fnut.2024.1397439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Edoardo Muratore
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Leardini
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Baccelli
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Fabozzi
- Department of Hematology/Oncology, Cell and Gene Therapy – IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
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Venturelli F, Leardini D, Baccelli F, Gottardi F, Barat V, Vendemini F, Folsi VM, Meazza C, Marinoni M, Bernardo ME, Tumino M, Brugiolo A, Pizzato C, Battisti L, Bertolini P, Pancaldi A, Rinieri S, Pericoli R, Coccia P, Onofrillo D, Fabozzi F, Bianchi S, Rizzo D, Daniele RM, Stellato P, Prete A, Masetti R, Muratore E. Current practices for nutritional evaluation and care during the treatment of pediatric oncology patients: a survey among AIEOP centers. Eur J Pediatr 2024; 183:1137-1144. [PMID: 38095717 DOI: 10.1007/s00431-023-05368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 03/20/2024]
Abstract
Nutritional status plays a crucial role in the mortality rates of the pediatric oncology patients. However, there is a lack of systematic approaches for nutritional assessment in this population. This study aims to assess the current practice for nutritional assessment and care of pediatric cancer patients in Italy. A 25-items web-based, nation-wide questionnaire was circulated as of January 9, 2023 among physicians within the AIEOP network, composed of 49 national centers, out of which 21 routinely perform HCT. This survey examined the practices of 21 Italian pediatric oncology centers, revealing significant heterogeneity in nutritional practices. Only half of the centers routinely assessed all patients, utilizing different clinical and biochemical parameters. The use of neutropenic diets remained prevalent after chemotherapy or stem cell transplantation. CONCLUSION This study underscores the pressing need for unified recommendations to improve nutritional care and potentially enhance outcomes for pediatric cancer patients. WHAT IS KNOWN • The assessment and support of nutrition are gaining interest in the overall care of children with cancer. • The assessment and management of nutritional needs in pediatric cancer patients, including those undergoing hematopoietic cell transplantation, currently lack a systematic approach. WHAT IS NEW • There is considerable variability in the nutritional assessment and support among Italian centers treating pediatric patients with cancer. • To enhance nutritional assessment and support for pediatric cancer patients, it is essential to establish shared national and international guidelines.
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Affiliation(s)
- Francesco Venturelli
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Davide Leardini
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Francesco Baccelli
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Gottardi
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Veronica Barat
- A.O.U. Città della Salute e della Scienza di Torino Presidio Infantile Regina Margherita S.C. Oncoematologia Pediatrica e Centro Trapianti, Torino, Italy
| | | | - Veronica Maria Folsi
- U.C. Oncoematologia e TMO Pediatrico, Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Meazza
- Fondazione IRCCS Istituto Nazionale dei Tumori S.C. Pediatrica Oncologica, Milano, Italy
| | - Maddalena Marinoni
- SSD oncoematologia pediatrica, Ospedale "Filippo Del Ponte" Pediatria, Varese, Italy
| | - Maria Ester Bernardo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute" San Raffaele University, Milan, Italy
| | - Manuela Tumino
- Oncoematologia Pediatrica, Azienda Ospedale Università Padova, Padova, Italy
| | | | - Cristina Pizzato
- UOS Emato-oncologia Pediatrica, UOC di Pediatria, Ospedale Ca' Foncello di Treviso, Treviso, Italy
| | - Laura Battisti
- Oncoematologia Pediatrica, Ospedale Provinciale di Bolzano, Bolzano, Italy
| | - Patrizia Bertolini
- U.O.C di Pediatria e Oncoematologia, Azienda Ospedaliero universitaria Parma, Parma, Italy
| | - Alessia Pancaldi
- UOC Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Simona Rinieri
- DH Oncoematologia Pediatrica, AOU S.Anna, Ferrara, Italy
| | | | - Paola Coccia
- SOSD Oncoematologia Pediatrica, Ospedale Pediatrico G. Salesi AOU delle Marche, Ancona, Italy
| | - Daniela Onofrillo
- UOSD di Onco-ematologia Pediatrica, Ospedale Spirito Santo, Pescara, Italy
| | - Francesco Fabozzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Childrens Hospital, IRCCS, Rome, Italy
| | - Simona Bianchi
- Sezione ematologia, dipartimento di medicina traslazionale e di precisione, Università Sapienza di Roma, Roma, Italy
| | - Daniela Rizzo
- U.O.C. Oncoematologia Pediatrica, P.O. "Vito Fazzi, Lecce, Italy
| | - Rosa Maria Daniele
- UOC di Pediatria ad indirizzo Oncoematologico, AOU Policlinico di Bari, Bari, Italy
| | - Pio Stellato
- Oncohematology Unit, Department of Oncology, Hematology and Cellular Therapies, AORN Santobono-Pausilipon, Napoli, Italy
| | - Arcangelo Prete
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Edoardo Muratore
- Pediatric Hematology and Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
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Muñoz-Serrano AJ, Estefanía-Fernández K, Oterino C, Ramírez-Amoros C, Navarro G, Sastre A, Pérez-Martínez A, Barrena S, Oliveros FH, Martínez L. Sarcopenia as a Prognostic Factor in Patients with Hepatoblastoma: Does It Influence Surgical Outcomes and Survival? Preliminary Retrospective Study. J Pediatr Surg 2023; 58:2149-2155. [PMID: 37286413 DOI: 10.1016/j.jpedsurg.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Abstract
AIM Sarcopenia is associated with poor prognosis in adult oncologic patients, with little evidence of this association in pediatric population, including hepatoblastoma. METHODS Retrospective study in patients with hepatoblastoma, divided into those with or without sarcopenia. Sarcopenia was assessed by measuring psoas muscle area (PMA) at L4-L5 level on the CT/MR and defined as z-score values ≤ 2. Relapse and mortality were analyzed. RESULTS Twenty-one patients (57.1% male) were included, with median age 35.7 months (IQR: 23.5-58.5). Seven (33.3%) had sarcopenia on initial studies compared to 14 (66.7%) who did not. No differences were found between groups in age, weight, PRETEXT, surgical treatment or. α-fetoprotein levels. Sarcopenia was associated with a higher rate of metastases at diagnosis (49.2% vs 0.0%; p = 0.026) and surgical complications (57.1% vs 21.4%, p = 0.047). After a median follow-up of 65.1 months (1.7-144.8), 2 patients (28.6%) had tumor relapse in sarcopenic group compared to 1 (7.1%) in non-sarcopenic group. Two patients died in sarcopenic group and 1 in non-sarcopenic group. Median event-free survival (EFS) was lower in sarcopenic group (100.38 ± 25.63 vs 118.91 ± 11.52 months) as well as overall survival (OS) (101.72 ± 24.86 vs 121.78 ± 8.75 months) with no statistical significance. Five-year EFS was also lower in sarcopenic group (71% vs 93%) as well as 5-year OS (71% vs 87%). CONCLUSIONS Sarcopenia at diagnosis was associated with a higher rate of metastases and surgical complications in hepatoblastoma. Our data shows the first evidence of its role as a possible poor prognostic factor, influencing survival and risk of relapse. LEVEL OF EVIDENCE II. TYPE OF STUDY Original article. Retrospective study.
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Affiliation(s)
| | | | - César Oterino
- Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Gema Navarro
- School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Ana Sastre
- Department of Pediatric Hematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Pérez-Martínez
- Department of Pediatric Hematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Sátur Barrena
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Leopoldo Martínez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
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6
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Pedro J, Martucci R, Monteiro G, Saraiva D. Mid-upper arm circumference in hospitalized pediatric patients with cancer: Is there an association with malnutrition? Nutr Clin Pract 2023; 38:1133-1141. [PMID: 37461825 DOI: 10.1002/ncp.11039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/13/2023] [Accepted: 06/11/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Malnutrition is common in children/adolescents with cancer. Mid-upper arm circumference (MUAC) is recommended by the International Society of Pediatric Oncology for measuring nutrition status. The aim was to evaluate the nutrition status of pediatric patients with cancer and verify whether MUAC is associated with malnutrition and length of stay (LOS). METHODS This was an observational study of patients aged 0-19 years with solid and hematological neoplasms. Data included anthropometric measurements of nutrition status by body mass index/age (BMI/A), weight/age, weight/height, height/age, MUAC, mid-arm muscle circumference, triceps skinfold thickness (TSF), and biochemical measurements of characterizing inflammation (serum prealbumin level, serum albumin level, and C-reactive protein [CRP]). Statistical tests such as the Student t test, Mann-Whitney test, and Spearman correlation were employed to analyze the data. Logistic regression was used for multivariate analysis. RESULTS Of 111 patients, 51.7% (n = 57) were male, and solid tumors were prevalent (76.6%, n = 85). The median age was 8.5 years. The anthropometric measurements of the arm revealed a higher prevalence of malnutrition when compared with anthropometric indices. According to the Spearman correlation, a high and positive correlation was observed between MUAC and BMI/A (ρ = 0.800 and P < 0.001). There was an association between MUAC, TSF, and high CRP with LOS (P = 0.025, P = 0.003, and P < 0.001, respectively). Patients with a MUAC (less than the fifth percentile) had almost 2.73 times the chance of having a prolonged LOS. CONCLUSION MUAC was a good parameter for the classification of nutrition status and the assessment of LOS in pediatric patients with cancer.
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Affiliation(s)
- Jéssica Pedro
- Multiprofessional Residency Program in Oncology of the National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Renata Martucci
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
- Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gina Monteiro
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danúbia Saraiva
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
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Barr RD, Antillon-Klussmann F. Cancer and nutrition among children and adolescents in low- and middle-income countries. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:987-993. [PMID: 36094475 DOI: 10.1080/16078454.2022.2115437] [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 : The primary purpose of this review is to investigate the relationships between cancer and nutrition in children and adolescents living in resource-poor, low- and middle-income countries (LMICs) in order to explore potential opportunities for interventions which could improve clinical outcomes in this population. METHOD : The implications of overlapping age groups of children and adolescents with cancer are examined, as are the adverse influences of under-nutrition and socio-economic deprivation on the efficacy of treatment and cancer survival. Evidence suggestive of novel avenues to enhance prospects for cure, based on increased understanding of the dynamic of nutrition and cancer, is evaluated. RESULT : Cancer adds to the burden of under-nutrition in disadvantaged populations which is reflective, in large measure, on inadequate governmental expenditure on health which demands public-private partnerships and the use of hospital-based foundations. Structured approaches to the measurement of nutritional status and the design of effective programmes of nutritional supplementation are of proven benefit. Initial results from studies of the perturbed gut microbiome hold considerable promise for further gains. CONCLUSION A large minority of children with cancer in LMICs are never diagnosed and the same may be true of adolescents. Investing in the training of nutritionists will have substantial returns as will increasing access to essential medicines. Recognition of these challenges has stimulated WHO and other entities to devise major strategies for comprehensive changes in the care of children and adolescents with cancer in LMICs, offering realistic prospects for improved clinical outcomes.
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Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics and Medicine, McMaster University, Hamilton, Canada
| | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, and School of Medicine, Francisco Marroquín University, Guatemala, Guatemala
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Prasad M, Ladas EJ, Barr R. Addition of arm anthropometry to body mass index for age, but not serum albumin, improves the accuracy of the nutritional assessment in severely and moderately malnourished children with cancer. Pediatr Blood Cancer 2022; 69:e29718. [PMID: 35441783 DOI: 10.1002/pbc.29718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 11/11/2022]
Abstract
Arm anthropometry is a more sensitive measure of nutritional status than body mass index for age (BMI) in children with cancer, but the added utility of serum albumin remains uncertain. Concordance was determined among four forms of classifying nutritional status in a cohort of undernourished children with cancer: method 1: BMI-for-age Z score; method 2: method 1 + mid-upper arm circumference (MUAC) percentile; method 3: method 2 + triceps skinfold thickness (TSFT) percentile; and method 4: method 3 + serum albumin. Concordance was highest between methods 2 and 3, followed closely by 3 and 4, indicating that addition of arm anthropometry, but not serum albumin, to BMI increased the sensitivity of baseline nutritional assessment.
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Affiliation(s)
- Maya Prasad
- Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Elena J Ladas
- Global Integrative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ronald Barr
- Paediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
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Fabozzi F, Trovato CM, Diamanti A, Mastronuzzi A, Zecca M, Tripodi SI, Masetti R, Leardini D, Muratore E, Barat V, Lezo A, De Lorenzo F, Caccialanza R, Pedrazzoli P. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers (Basel) 2022; 14:cancers14143378. [PMID: 35884438 PMCID: PMC9319266 DOI: 10.3390/cancers14143378] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nutritional management is an underestimated issue in treating pediatric cancer, since a systematic approach is currently lacking. In this consensus statement, a cohort of 12 experts selected from four different tertiary pediatric oncology centers formulated 21 clinical questions regarding the identification and treatment of nutritional issues in children with cancer. These questions were discussed, and practical recommendations were provided. With this paper, we aimed to give consensus-based guidance for addressing the nutritional needs of children with cancer, filling a gap in the field. Abstract Malnutrition, intended as both overnutrition and undernutrition, is a common problem in children with cancer, impacting quality of life as well as survival. In addition, nutritional imbalances during childhood can significantly affect proper growth. Nevertheless, there is currently a lack of a systematic approach to this issue in the pediatric oncology population. To fill this gap, we aimed to provide practice recommendations for the uniform management of nutritional needs in children with cancer. Twenty-one clinical questions addressing evaluation and treatment of nutritional problems in children with cancer were formulated by selected members from four Italian Association of Pediatric Hematology and Oncology (AIEOP) centers and from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. A literature search in PubMed was performed; during two consensus meetings, all recommendations were discussed and finalized using the nominal group technique. Members representing every institution voted on each recommendation. Finally, recommendations were approved by all authors.
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Affiliation(s)
- Francesco Fabozzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
- Department of Pediatrics, University of Rome Tor Vergata, 00165 Rome, Italy
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
- Correspondence:
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.F.); (A.M.)
| | - Marco Zecca
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Serena Ilaria Tripodi
- Pediatric Hematology-Oncology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (M.Z.); (S.I.T.)
| | - Riccardo Masetti
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Davide Leardini
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Edoardo Muratore
- Pediatric Oncology and Hematology “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.M.); (D.L.); (E.M.)
| | - Veronica Barat
- SC Onco-Ematologia Pediatrica, AOU Città della Salute e della Scienza, 10126 Torino, Italy;
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Children’s Hospital Regina Margherita, AOU Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy;
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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11
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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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12
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Sasse P, Bergmann A, Afonso W, Ladas EJ, Ferman S. Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single-institution study in a developing country. Pediatr Blood Cancer 2021; 68:e29317. [PMID: 34490992 DOI: 10.1002/pbc.29317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changesin nutritional status can constitute a risk factor for reduced tolerance and effectiveness of antineoplastic treatment. Knowledge of the nutritional status of pediatric patients is important for implementing interventions to improve outcomes. We aimed to evaluate nutritional status at diagnosis and throughout therapy in pediatric patients with solid tumors. OBJECTIVES To study the prevalence of malnutrition at diagnosis, compare different assessment tools, and examine longitudinal changes in nutritional status during the treatment of pediatric patients with solid tumors in a Brazilian institution. METHODS This prospective single-center study enrolled patients with solid tumors (age <19 years) from June 2017 to May 2018. Nutritional evaluations were performed at diagnosis and after 3 and 6 months of treatment. z-Scores for height for age (H/A) and body mass index for age (BMI/A) were calculated using the Anthro/AnthroPlus software and mid-upper arm circumference (MUAC) percentile was used for nutritional classification. RESULTS The prevalence of nutritional status at diagnosis was 29.3% malnourished, 49.5% adequate, and 21.2% overweight/obese. Nutritional status improved during the first 3 months of treatment, with a reduction in the proportion of malnourished patients and an increased number of patients with adequate nutritional status. CONCLUSIONS The two combined indices, BMI/A and MUAC, facilitated the diagnosis of a greater number of patients with solid tumors who had nutritional alterations. A high prevalence of malnutrition was present at diagnosis. Nutritional status improved in the first 3 months of treatment and could be related to the multidisciplinary institutional approach following the diagnosis.
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Affiliation(s)
- Patricia Sasse
- Department of Pediatric Oncology, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Anke Bergmann
- Clinical Research Division, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Wanelia Afonso
- Department of Nutrition, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
| | - Sima Ferman
- Department of Pediatric Oncology, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
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13
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Wartenberg L, Raber M, Chandra J. Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study. J Med Internet Res 2021; 23:e24515. [PMID: 34515643 PMCID: PMC8477295 DOI: 10.2196/24515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Accepted: 03/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience.
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Affiliation(s)
- Lisa Wartenberg
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Margaret Raber
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joya Chandra
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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14
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Prasad M, Tandon S, Gala R, Kannan S, Chinnaswamy G, Narula G, Vora T, Banavali S, Mehta S, Paradkar A, Goswami S, Ghadge M, Jagiasi D, Sharma S, Fernandes L, Manglani M, Jadhav A, Barr R, Ladas E. Efficacy of ready-to-use therapeutic food in malnourished children with cancer: Results of a randomized, open-label phase 3 trial. Pediatr Blood Cancer 2021; 68:e29197. [PMID: 34212474 DOI: 10.1002/pbc.29197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The adverse influence of undernutrition in children with cancer may be remediated by early nutritional intervention. This study assessed the efficacy of ready-to-use therapeutic food (RUTF) in improving nutritional status and reducing treatment-related toxicities (TRTs) in such children. METHODS In a randomized controlled phase-3 open-label trial, severely and moderately undernourished children with cancer were randomized 1:1 to receive standard nutritional therapy (SNT) or SNT+RUTF for 6 weeks. The primary outcome (weight gain >10%) and secondary outcomes (improved/maintained nutritional status, improved body composition) were assessed after 6 weeks. TRTs were assessed over 6 months. RESULTS Between July 2015 and March 2018, 260 subjects were enrolled, 126 were analyzable in both arms at 6 weeks. More children on RUTF had weight gain (98 [77.8%] vs. 81 [64.2%], p = .025) with a greater increase in fat mass as a percentage of body mass (median 2% [IQR -0.12 to 4.9] vs. 0.5% [IQR -1.45 to 2.27, p = .005]) but a greater loss of lean mass (median -1.86% [IQR -4.4 to 0.50] vs. -0.4% [IQR -2.4 to 1.4, p = .007]) compared to the SNT arm. Fewer subjects on the RUTF arm had episodes of severe infection (10.6% vs. 31%, p < .0001), treatment delays (17.7% vs. 39%, p < .0001), and severe mucositis (11% vs. 23.8%, p = .006) compared to the SNT arm. The odds of developing TRTs on the RUTF arm were lower even after adjusting for improvement in nutritional status. CONCLUSIONS RUTF is efficacious in improving weight gain and nutritional status in undernourished children with cancer and decreases TRTs. Incorporating RUTF into a healthy, balanced diet should be considered in undernourished children with cancer.
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Affiliation(s)
- Maya Prasad
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sneha Tandon
- Division of Paediatric Oncology, Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rajul Gala
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biostatistics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gaurav Narula
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tushar Vora
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shripad Banavali
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Medical Oncology, Tata Memorial Centre Parel, Mumbai, Maharashtra, India
| | - Shaesta Mehta
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Digestive Disease and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amey Paradkar
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Savita Goswami
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Psycho-Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meera Ghadge
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biochemistry, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Sujata Sharma
- Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Lavina Fernandes
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Mamta Manglani
- Paediatric Haematoology Oncology, Comprehensive Thalassemia Care and Bone Marrow Transplant Centre, Mumbai, Maharashtra, India
| | - Alka Jadhav
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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15
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Yaprak DS, Yalçın B, Pınar AA, Büyükpamukçu M. Assessment of nutritional status in children with cancer: Significance of arm anthropometry and serum visceral proteins. Pediatr Blood Cancer 2021; 68:e28752. [PMID: 33034161 DOI: 10.1002/pbc.28752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arm anthropometry is a better indicator of nutritional status in children with cancer. The value of serum albumin and prealbumin in nutritional assesment is debatable. We investigated the nutritional status of children with cancer and their serum albumin and prealbumin levels. PATIENTS AND METHODS At diagnosis and following induction therapies, weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), and triceps skin-fold thickness (TSFT) were measured; serum albumin and prealbumin levels were determined. Prevalences of malnutrition defined by anthropometric indices were calculated. Correlations of anthropometric indices with each other, with serum albumin/prealbumin levels, and clinicopathological parameters were analyzed. RESULTS In 81 patients, median age was 7.5 years (males/females = 50/31), tumors were located mostly in the abdomen, and abdominal tumors were more common under 5 years. Prevalence of malnutrition according to weight for age, BMI, MUAC, TSFT z scores were 14.8%, 23.5%, 27.2%, 21%, respectively. Defined by combined BMI/MUAC/TSFT measurements, 33/81 cases (40.7%) had malnutrition (z scores < -1, 23 mild; z scores < -2, 10 moderate). Malnutrition was more prevalent under 5 years (P = .03), also in abdominal tumors (P = .03) and advanced disease (P < .001). Younger age and advanced disease were risk factors for malnutrition. At diagnosis, prevalences of low serum albumin and prealbumin levels were 7.4% and 54%, respectively. Cases with malnutrition had significantly lower survival rates. CONCLUSIONS Nutritional status is assessed best by MUAC and TSFT measurements. Serum prealbumin levels can be used to identify patients at risk of undernutrition. Presence of malnutrition is a significant poor prognostic factor. All children with cancer should undergo nutritional evaluation and active nutritional support.
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Affiliation(s)
- Deniz Sül Yaprak
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalçın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aslı Akhun Pınar
- Department of Medical Biochemistry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Münevver Büyükpamukçu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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16
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Chheda E, Prasad M. Focused nutrition clinic for severely malnourished children with cancer is feasible and effective in high-volume, resource-constrained settings. Expert Rev Anticancer Ther 2020; 20:919-920. [PMID: 32924649 DOI: 10.1080/14737140.2020.1823225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ekta Chheda
- Division of Pediatric Oncology, Tata Memorial Hospital , Mumbai, India
| | - Maya Prasad
- Division of Pediatric Oncology, Tata Memorial Hospital , Mumbai, India
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17
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Swartz MC, Teague AK, Wells SJ, Honey T, Fu M, Mahadeo KM, Kabiri LS, Chandra J, Moody K, Schadler K. Feasibility and Acceptability Findings of an Energy Balance Data Repository of Children, Adolescents, and Young Adults with Cancer. J Clin Med 2020; 9:E2879. [PMID: 32899945 PMCID: PMC7564246 DOI: 10.3390/jcm9092879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Cancer patients suffer changes in energy balance (EB), the combination of energy intake (nutrition) and energy expenditure (physical activity (PA)), which may influence cancer-related morbidity, mortality, and quality of life. Significant gaps remain in our understanding of the frequency and magnitude of these EB changes. Herein, we report on the feasibility and acceptability of a longitudinal repository of EB outcomes in children, adolescents and young adults (AYA) with cancer along the cancer continuum to fill these gaps. This EB repository includes PA, nutrition, and physical function (PF) parameters. PA data were gathered through activity trackers. Nutritional data were gathered through food diaries and micronutrient labs. PF was assessed with validated objective and patient-reported measures. Feasibility was achieved with >50% enrollment of eligible patients (n = 80, Mage = 18.1 ± 7.5); 26 were children with cancer and 54 were AYAs with cancer. An 88.75% retention rate indicated acceptability. Despite COVID-19 disruptions, >50% of participants provided completed data for PA and micronutrient labs as of April 2020. Food diaries and PF data collection experienced disruptions. Methodological adaptations are in progress to minimize future disruptions. Overall, our findings demonstrate that prospective EB assessments are feasible and acceptable among children and AYAs with cancer.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
| | - Alaina K. Teague
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA
| | - Stephanie J. Wells
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
| | - Theresa Honey
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
| | - Min Fu
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.F.); (K.M.M.); (K.M.)
| | - Kris M. Mahadeo
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.F.); (K.M.M.); (K.M.)
| | - Laura S. Kabiri
- Department of Kinesiology, Rice University, 6100 Main St. MS-545, Houston, TX 77005, USA;
| | - Joya Chandra
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
| | - Karen Moody
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.F.); (K.M.M.); (K.M.)
| | - Keri Schadler
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA; (M.C.S.); (A.K.T.); (S.J.W.); (T.H.); (J.C.)
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