A Framework for Adapted Nutritional Therapy for Children With Cancer in Low- and Middle-Income Countries: A Report From the SIOP PODC Nutrition Working Group

Abstract

The utilization of adapted regimens for the treatment of pediatric malignancies has greatly improved clinical outcomes for children receiving treatment in low‐ and middle‐income countries (LMIC). Nutritional depletion has been associated with poorer outcomes, increased abandonment of therapy, and treatment‐related toxicities. Surveys have found that nutritional intervention is not incorporated routinely into supportive care regimens. Establishing nutritional programs based upon institutional resources may facilitate the incorporation of nutritional therapy into clinical care in a way that is feasible in all settings. We present a framework for establishing and monitoring of nutritional care based on the infrastructure of institutions in LMIC.

Effects of malnutrition on treatment‐related morbidity and survival of children with cancer in Nicaragua

“…In our study only 63% of eligible patients had a complete nutritional assessment completed within 48 hr of diagnosis largely because of inadequate staffing and insufficient allocation of resources to nutrition as a key area of supportive care. Recently, a framework for establishing and monitoring nutritional care based on the infrastructure of institutions in LMIC was developed by the Nutrition Working Group of the Society of Pediatric Oncology Committee on Pediatric Oncology in Developing Countries . Levels of care are defined for nutritional services highlighting the need for complete anthropometric assessment (including MUAC and TSFT) for even limited (level 2) care, and setting a standard for optimal care .…”

“…Recently, a framework for establishing and monitoring nutritional care based on the infrastructure of institutions in LMIC was developed by the Nutrition Working Group of the Society of Pediatric Oncology Committee on Pediatric Oncology in Developing Countries . Levels of care are defined for nutritional services highlighting the need for complete anthropometric assessment (including MUAC and TSFT) for even limited (level 2) care, and setting a standard for optimal care . The report provides a blueprint for the assessment of existing resources and a graded progression for development of a comprehensive program to provide relatively inexpensive supportive care that can significantly impact outcomes of pediatric oncology patients treated in LIMCs.…”

Validation of an algorithmic nutritional approach in children undergoing chemotherapy for cancer

“…Thirty‐eight percent and 21% of Indian children under the age of 5 years are stunted and wasted, respectively . Optimizing nutritional therapy is a vital step towards closing the survival gap that exists between children with cancer in high‐income countries and those in LMICs . The Nutrition Working Group of the International Society of Pediatric Oncology (SIOP), committee on Pediatric Oncology in Developing Countries (PODC), described a resource‐adapted framework for assessment of nutritional status and delivery of nutritional care .…”

Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes

“…In contrast, weight loss occurred in 37% of 468 patients with intermediate rhabdomyosarcoma, and low baseline BMI correlated with borderline inferior survival (22). Collectively, these data indicate that weight management early during cancer treatment is an opportunity for interventions, and to be successful, a nutritional program needs to be integrated into the clinical care model and must be sustained throughout treatment (23). However, research remains to be done to define precisely what “obesity management” or “good nutrition” means for these patients.…”