Effects of pediatric cancer and its treatment on nutritional status: a systematic review

Iniesta, Raquel; Paciarotti, Ilenia; Brougham, Mark; McKenzie, Jane; Wilson, David C.

doi:10.1093/nutrit/nuu062

Cited by 75 publications

(124 citation statements)

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“…The evidence for overweight and obese children indicates that where pharmacological treatment is not demonstrated as effective, surgical intervention may require consideration, 13,14,21,25,27,28,31 although the long-term outcomes are yet to be determined. Studies need to identify the causes of weight change in children following ABI 7 and the potential prophylactic effects of medication. Children with ABI need regular review of body composition.…”

Section: Resultsmentioning

confidence: 99%

“…Weight gain resulting from paediatric ABI is often associated with hypothalamic dysfunction, while weight loss is often attributed to the effects of treatment(s). 7 Further research is required to explore these mechanisms, with an aim to develop effective interventions. The health economics of weight change in this population need to be determined with intervention costs and benefits associated with intervention and the long-term outcomes established.…”

Section: Recommendationsmentioning

confidence: 99%

“…There is a paucity of research concerning weight change in relation to paediatric brain tumours. 7 This is of particular concern, because the presence of 'undernutrition' in paediatric patients with brain tumours has been associated with poorer outcomes, with underweight and undernourished children being more likely to abandon therapy and experience lower rates of event-free survival than adequately nourished children. 8 While there are National Institute for Health and Care Excellence (NICE) guidelines for lifestyle weight management and services for young people who are overweight or obese, 9 no specific guidance exists for the management of weight change following paediatric ABI.…”

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confidence: 99%

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Interventions for managing weight change following paediatric acquired brain injury: a systematic review

Shah

Lodh

Siddell

et al. 2016

Develop Med Child Neuro

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ABI Acquired brain injury BMIBody mass index TBI Traumatic brain injury OBJECTIVE To systematically review literature reporting interventions for weight change following paediatric acquired brain injury (ABI).METHOD A systematic search of the literature was conducted using advanced search techniques. The retrieval identified 1562 papers, of which 30 were relevant. The total number of paediatric participants was 759. RESULTSThere is a paucity of higher quality evidence to support the use of weight change interventions following paediatric ABI. Substantial variation in screening, outcome measures, intervention, and reporting were demonstrated. Some support was found for the use of hypothalamic-sparing surgery as a method to prevent obesity following craniopharyngioma resection.INTERPRETATION There is a need for further study in this area to inform clinical and research practice; recommendations are given.Paediatric acquired brain injury (ABI) consists predominantly of traumatic brain injury (TBI) and brain tumours. In 2013 to 2014, there were 13 266 admissions for TBI and 5595 admissions for malignant neoplasms of the brain for patients under 18 years of age in UK hospitals. 1 There are a range of physical and neuropsychological sequelae following ABI associated with lasting impact on quality of life and survival.2 One such consequence is on appetite and weight, with the latter being frequently gained or lost significantly as a result of ABI and/or interventions.2 In addition to correlation with mortality, obesity and low body weight are associated with type 2 diabetes mellitus, cardiovascular disease, hypertension, and an increased risk of chronic respiratory diseases.3 Impaired stamina is a wellrecognized feature post-ABI, with disordered appetite and inadequate nutrition compounding this effect. 4 Children with ABI face greater risk of developing obesity than the general population.2 In one study investigating adverse effects in survivors following childhood low grade glioma, cumulative incidence of being overweight (body mass index [BMI] <30 but ≥25) or obese (BMI ≥30) at 5, 10, and 15 years was 18%, 35%, and 53% respectively. 5 Similarly, weight gain in children during the first year following TBI was demonstrated to be 'rapid and excessive', with males being at a higher risk of excessive weight gain than females. 6 The majority of studies investigating the impact of childhood cancer on weight focus on advanced lymphoma and leukaemia. There is a paucity of research concerning weight change in relation to paediatric brain tumours. 7This is of particular concern, because the presence of 'undernutrition' in paediatric patients with brain tumours has been associated with poorer outcomes, with underweight and undernourished children being more likely to abandon therapy and experience lower rates of event-free survival than adequately nourished children. 8While there are National Institute for Health and Care Excellence (NICE) guidelines for lifestyle weight management and services for young people who are overwei...

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Section: Resultsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Interventions for managing weight change following paediatric acquired brain injury: a systematic review

Shah

Lodh

Siddell

et al. 2016

Develop Med Child Neuro

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confidence: 99%

“…Currently, no clinical nutritional guidelines specific to paediatric cancer are available and best practice is relied upon (1,2) ; often theoretical nutritional practice is not executed in the clinical setting as per research recommendations (3) . The Department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh is involved in a quality improvement project aiming to improve clinical nutritional practice.…”

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confidence: 99%

A quality improvement project: nutritional management of paediatric cancer patients

et al. 2018

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Paediatric cancer patients are at high risk of malnutrition, which is associated with adverse outcomes during treatment and survivorship (1,2) . Currently, no clinical nutritional guidelines specific to paediatric cancer are available and best practice is relied upon (1,2) ; often theoretical nutritional practice is not executed in the clinical setting as per research recommendations (3) . The Department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh is involved in a quality improvement project aiming to improve clinical nutritional practice. The objective of this project is to conduct the first clinical audit series; to assess and document the current nutritional practice for paediatric cancer patients at RHSC and establish baseline data, and compare the observed practice to RHSC nutritional standards; thereby identifying areas for nutritional-practice improvement.The audit was conducted by two researchers over four weeks using one of three different audit tools (depending on data collection location; inpatient (IP), day-care (DC), or outpatient (OP)), by analysing documentation and observing clinical practice, and comparing the collected nutritional practice to recently developed RHSC nutritional standards. The RHSC nutritional standards encompass anthropometry, malnutrition assessment, ward nutritional practices, dietetic review (including dietary advice for neutropenic patients and assessment of refeeding syndrome risk), nutritional bloods, vitamin and mineral supplementation and physical activity. Inclusion criteria: patients aged 0-18 years and undergoing treatment for childhood cancer (ICCC-3 or Langerhans Cell Histiocytosis). Data is purely descriptive and presented as percentages; no statistical analysis was performed.78 patient records (10 IP, 17 DC and 51 OP) were analysed; 49 % of the 187 audit criteria met the 100 % RHSC Standard, 11 % were between 99-70 % and 40 % were 69 % and below. The areas which were ≤69 % of the standard were: height and weight assessment and documentation in day-care; head-circumference, mid-upper arm circumference and tricep skinfold thickness assessment in all locations; assessment of daily weights and select biochemistry for in-patients receiving parenteral nutritional support; dietetic documentation of refeeding-syndrome risk, dietary advice for neutropenia, and estimation of intake, deficit and total energy requirements; monitoring of select nutritional bloods (Vitamins D, A, E, and B 12 ) and vitamin supplementation in patients ≤5years old (only 23 % (n = 5) of ≤5year-old patient records were documented as receiving supplements). Recommendations to improve nutritional practice include staff training, clear delegation of nutritional care, and more user-friendly documentation and completion thereof; if improvements to clinical nutritional practice at the RHSC are not made, current and future patient nutritional care may jeopardise nutritional and clinical patient outcomes.In conclusion, the RHSC Oncology and Haematology nutritiona...

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Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China

Li,

Lu,

et al. 2023

Cancer Medicine

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ObjectiveTo investigate the long‐term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes.MethodsThis study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes.ResultsAmong the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow‐up duration was 6 months (range: 3–40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (−0.56 (−1.47, 0.23) vs. −0.44 (−1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571–14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010–2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed.ConclusionThere is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.

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Effects of pediatric cancer and its treatment on nutritional status: a systematic review

Abstract: The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, population-based, longitudinal studies using standard criteria to identify malnutrition.

Cited by 75 publications

References 74 publications

Interventions for managing weight change following paediatric acquired brain injury: a systematic review

Interventions for managing weight change following paediatric acquired brain injury: a systematic review

A quality improvement project: nutritional management of paediatric cancer patients

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China

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