Integrative Nutrition and Nutrition/Herbal Supplements

Abstract

Nutrition is a component of supportive care that expands throughout the spectrum of cancer care. Practitioners must balance the delivery of the necessary medications for cancer treatment while maintaining growth and development. This can be challenging especially during times of malnutrition. The prevalence of malnutrition is common among children with cancer with previous surveys reporting that nearly 25 % of patients present with malnutrition in developed countries. This figure increases to over 50 % when developing countries are considered. Malnutrition often develops over the course of therapy and is related to the intensity of therapy and diagnosis. It was not until the late 1970s that the role of nutrition status began to be described among children with cancer. Initial studies reported increased toxicity and adverse outcomes in children who were malnourished compared to nourished children. Recent studies have confirmed some of these initial findings and have reported that poor nutrition status, either over- or undernutrition, was associated with increased therapy-related side effects and poor survival (Brinksma et al. 2012). Patients with acute myeloid leukemia who presented with either over- or undernutrition had poorer survival when compared to well-nourished patients (Lange et al. 2005. In children with osteosarcoma, malnutrition was associated with a trend toward increased slough and wound infections and arterial thrombosis (Hingorani et al. 2011; Hingorani et al. 2011). Most recently, a retrospective study exploring the effect of nutrition status at diagnosis and throughout therapy in children with high-risk ALL reported that patients who were malnourished experienced increased toxicity and reduced survival (Etan). When evaluated as a whole, these studies underscore the importance of timely and effective nutrition interventions.