Skip to main content
SpringerLink
Log in

Nutrition

  • Chapter
  • First Online:
Supportive Care in Pediatric Oncology

Part of the book series: Pediatric Oncology ((PEDIATRICO))

  • 1434 Accesses

Abstract

Nutrition assessment and intervention is an important component of supportive care that is often overlooked as a part of the standards of care. The prevalence of malnutrition (i.e., undernutrition and overnutrition) has been the subject of many published papers which have found that up to 50 % of children and adolescents with cancer present with malnutrition, a prevalence that is affected by diagnosis, stage, socioeconomic status and nutritional index. Poor nutrition status has been associated with reduced survival and increased therapy-related side effects in patients with acute lymphoblastic leukemia, acute myelogenous leukemia, rhabdomyosarcoma and osteosarcoma. Current guidelines emphasize the practice of proactive nutrition therapy so as to avert the development of malnutrition, which may include the administration of enteral tube feeding. Nutrition assessment and intervention is a component of supportive care that should be offered throughout the spectrum of cancer care to optimize treatment delivery and outcomes and improve the quality of life of our patients. Here we review the evidence basis, consensus guidelines and expert opinion for the management of malnutrition in pediatric oncology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Antillon F, Rossi E, Molina AL et al (2013) Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr Blood Cancer 60:911–915

    Article  PubMed  Google Scholar 

  • Aquino VM, Smyrl CB, Hagg R et al (1995) Enteral nutritional support by gastrostomy tube in children with cancer. J Pediatr 127:58–62

    Article  CAS  PubMed  Google Scholar 

  • Arroyave WD, Clipp EC, Miller PE et al (2008) Childhood cancer survivors’ perceived barriers to improving exercise and dietary behaviors. Oncol Nurs Forum 35:121–130

    Article  PubMed  Google Scholar 

  • ASPEN Board of Directors and the Clinical Guidelines Task Force (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 26:1SA–138SA

    Article  Google Scholar 

  • Bakish J, Hargrave D, Tariq N et al (2003) Evaluation of dietetic intervention in children with medulloblastoma or supratentorial primitive neuroectodermal tumors. Cancer 98:1014–1020

    Article  PubMed  Google Scholar 

  • Barr R, Collins L, Nayiager T et al (2011) Nutritional status at diagnosis in children with cancer. 2. An assessment by arm anthropometry. J Pediatr Hematol Oncol 33:e101–e104

    Article  PubMed  Google Scholar 

  • Bolze MS, Fosmire GJ, Stryker JA et al (1982) Taste acuity, plasma zinc levels, and weight loss during radiotherapy: a study of relationships. Radiology 144:163–169

    Article  CAS  PubMed  Google Scholar 

  • Brinksma A, Huizinga G, Sulkers E et al (2012) Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol Hematol 83:249–275

    Article  PubMed  Google Scholar 

  • Burke M, Lyden ER, Meza JL et al (2013) Does body mass index at diagnosis or weight change during therapy predict toxicity or survival in intermediate risk rhabdomyosarcoma? A report from Children’s Oncology Group Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 60:748–753

    Article  PubMed  Google Scholar 

  • Butturini AM, Dorey FJ, Lange BJ et al (2007) Obesity and outcome in pediatric acute lymphoblastic leukemia. J Clin Oncol 25:2063–2069

    Article  PubMed  Google Scholar 

  • Charuhas PM, Fosberg KL, Bruemmer B et al (1997) A double-blind randomized trial comparing outpatient parenteral nutrition with intravenous hydration: effect on resumption of oral intake after marrow transplantation. JPEN J Parenter Enteral Nutr 21:157–161

    Article  CAS  PubMed  Google Scholar 

  • Christensen ML, Hancock ML, Gattuso J et al (1993) Parenteral nutrition associated with increased infection rate in children with cancer. Cancer 72:2732–2738

    Article  CAS  PubMed  Google Scholar 

  • Couluris M, Mayer JL, Freyer DR et al (2008) The effect of cyproheptadine hydrochloride (Periactin®) and megestrol acetate (Megace®) on weight in children with cancer/treatment-related cachexia. J Pediatr Hematol Oncol 30:791–797

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Cuvelier GD, Baker TJ, Peddie EF et al (2013) A randomized, double-blind, placebo-controlled clinical trial of megestrol acetate as an appetite stimulant in children with weight loss due to cancer and/or cancer therapy. Pediatr Blood Cancer 61:672–679

    Article  PubMed  Google Scholar 

  • Demark-Wahnefried W, Werner C, Clipp EC et al (2005) Survivors of childhood cancer and their guardians. Cancer 103:2171–2180

    Article  PubMed  Google Scholar 

  • den Broeder E, Lippens RJ, van’t Hof MA et al (1998) Effects of naso-gastric tube feeding on the nutritional status of children with cancer. Eur J Clin Nutr 52:494–500

    Article  Google Scholar 

  • den Broeder E, Lippens RJ, van’t Hof MA et al (2000) Association between the change in nutritional status in response to tube feeding and the occurrence of infections in children with a solid tumor. Pediatr Hematol Oncol 17:567–575

    Article  Google Scholar 

  • Deswarte-Wallace J, Firouzbakhsh S, Finklestein JZ (2001) Using research to change practice: enteral feedings for pediatric oncology patients. J Pediatr Oncol Nurs 18:217–223

    Article  CAS  PubMed  Google Scholar 

  • Gardner A, Mattiuzzi G, Faderl S et al (2008) Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. J Clin Oncol 26:5684–5688

    Article  PubMed  Google Scholar 

  • Garofolo A (2012) Enteral nutrition during bone marrow transplantation in patients with pediatric cancer: a prospective cohort study. Sao Paulo Med J 130:159–166

    Article  PubMed  Google Scholar 

  • Guyatt G, Gutterman D, Baumann MH et al (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest 129:174–181

    Article  PubMed  Google Scholar 

  • Henkin RI, Schecter PJ, Friedewald WT et al (1976) A double blind study of the effects of zinc sulfate on taste and smell dysfunction. Am J Med Sci 272:285–299

    Article  CAS  PubMed  Google Scholar 

  • Hingorani P, Seidel K, Krailo M et al (2011) Body mass index (BMI) at diagnosis is associated with surgical wound complications in patients with localized osteosarcoma: a report from the Children’s Oncology Group. Pediatr Blood Cancer 57:939–942

    Article  PubMed Central  PubMed  Google Scholar 

  • Hudson MM, Mertens AC, Yasui Y et al (2003) Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA 290:1583–1592

    Article  CAS  PubMed  Google Scholar 

  • Kennedy D, Tucker K, Ladas EJ et al (2004) Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia. Am J Clin Nutr 79:1029–1036

    CAS  PubMed  Google Scholar 

  • Ladas EJ, Jacobson JS, Kennedy DD et al (2004) Antioxidants and cancer therapy: a systematic review. J Clin Oncol 22:517–528

    Article  CAS  PubMed  Google Scholar 

  • Ladas EJ, Sacks N, Meacham L et al (2005) A multidisciplinary review of nutrition considerations in the pediatric oncology population: a perspective from Children’s Oncology Group. Nutr Clin Pract 20:377–393

    Article  PubMed  Google Scholar 

  • Ladas EJ, Sacks N, Brophy P, Rodgers PC (2006) Standards of nutritional care in pediatric oncology: results from a nationwide survey on the standards of practice in pediatric oncology. A Children’s Oncology Group Study. Pediatr Blood Cancer 46:339–344

    Article  PubMed  Google Scholar 

  • Lange BJ, Gerbing RB, Feusner J et al (2005) Mortality in overweight and underweight children with acute myeloid leukemia. JAMA 293:203–211

    Article  CAS  PubMed  Google Scholar 

  • Lenssen P, Bruemmer BA, Bowden RA et al (1998) Intravenous lipid dose and incidence of bacteremia and fungemia in patients undergoing bone marrow transplantation. Am J Clin Nutr 67:927–933

    CAS  PubMed  Google Scholar 

  • Mahajan SK, Prasad AS, Lambujon J et al (1980) Improvement of uremic hypogeusia by zinc: a double-blind study. Am J Clin Nutr 33:1517–1521

    CAS  PubMed  Google Scholar 

  • Mathew P, Bowman L, Williams R et al (1996) Complications and effectiveness of gastrostomy feedings in pediatric cancer patients. J Pediatr Hematol Oncol 18:81–85

    Article  CAS  PubMed  Google Scholar 

  • Meacham LR, Gurney JG, Mertens AC et al (2005) Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study. Cancer 103:1730–1739

    Article  PubMed  Google Scholar 

  • Mirtallo J, Canada T, Johnson D et al (2004) Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr 28:S39–S70

    Article  PubMed  Google Scholar 

  • Moody K, Charlson ME, Finlay J (2002) The neutropenic diet: what’s the evidence? J Pediatr Hematol Oncol 24:717–721

    Article  PubMed  Google Scholar 

  • Moody K, Finlay J, Mancuso C, Charlson M (2006) Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. J Pediatr Hematol Oncol 28:126–133

    Article  PubMed  Google Scholar 

  • Mosby TT, Barr RD, Pencharz PB (2009) Nutritional assessment of children with cancer. J Pediatr Oncol Nurs 26:186–197

    Article  PubMed  Google Scholar 

  • Mosher CE, Lipkus I, Sloane R et al (2013) Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors’ maintenance of dietary practices and physical activity. Psychooncology 22:876–885

    Article  PubMed Central  PubMed  Google Scholar 

  • Moyer-Mileur LJ, Ransdell L, Bruggers CS (2009) Fitness of children with standard-risk acute lymphoblastic leukemia during maintenance therapy: response to a home-based exercise and nutrition program. J Pediatr Hematol Oncol 31:259–266

    Article  PubMed  Google Scholar 

  • Muscaritoli M, Grieco G, Capria S et al (2002) Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr 75:183–190

    CAS  PubMed  Google Scholar 

  • National Academy of Sciences and Institute of Medicine (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). National Academy Press, Washington, D.C

    Google Scholar 

  • Nevin-Folino N, Miller M (1999) Enteral nutrition. In: Samour PQ, Helm KK, Lang CE (eds) Handbook of pediatric nutrition. Aspen Publishers, Gaithersburg

    Google Scholar 

  • Oeffinger KC, Hudson MM (2004) Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors. CA Cancer J Clin 54:208–236

    Article  PubMed  Google Scholar 

  • Orgel E, Sposto R, Malvar J et al (2014) Impact on survival and toxicity by duration of weight extremes during treatment for pediatric acute lymphoblastic leukemia: a report from the Children’s Oncology Group. J Clin Oncol 32:1331–1337

    Article  PubMed  Google Scholar 

  • Orme LM, Bond JD, Humphrey MS et al (2003) Megestrol acetate in pediatric oncology patients may lead to severe, symptomatic adrenal suppression. Cancer 98:397–405

    Article  CAS  PubMed  Google Scholar 

  • Otten JJ, Hellwig Pitzi J, Meyers LD (2006) Dietary reference intakes: the essential guide to nutrient requirements. National Academy Press, Washington, D.C

    Google Scholar 

  • Ozyurek H, Turker H, Akbalik M et al (2007) Pyridoxine and pyridostigmine treatment in vincristine-induced neuropathy. Pediatr Hematol Oncol 24:447–452

    Article  CAS  PubMed  Google Scholar 

  • Pietsch JB, Ford C, Whitlock JA (1999) Nasogastric tube feedings in children with high-risk cancer: a pilot study. J Pediatr Hematol Oncol 21:111–114

    Article  CAS  PubMed  Google Scholar 

  • Quigley EM, Marsh MN, Shaffer JL, Markin RS (1993) Hepatobiliary complications of total parenteral nutrition. Gastroenterology 104:286–301

    CAS  PubMed  Google Scholar 

  • Robien K, Ness KK, Klesges LM et al (2008) Poor adherence to dietary guidelines among adult survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 30:815–822

    Article  PubMed Central  PubMed  Google Scholar 

  • Sacks N, Ringwald-Smith K, Hale G (2004) Nutritional support. In: Altman A (ed) Supportive care of children with cancer. The Johns Hopkins University Press, Baltimore

    Google Scholar 

  • Sala A, Rossi E, Antillon F et al (2012) Nutritional status at diagnosis is related to clinical outcomes in children and adolescents with cancer: a perspective from Central America. Eur J Cancer 48:243–252

    Article  PubMed  Google Scholar 

  • Sefcick A, Anderton D, Byrne JL et al (2001) Naso-jejunal feeding in allogeneic bone marrow transplant recipients: results of a pilot study. Bone Marrow Transplant 28:1135–1139

    Article  CAS  PubMed  Google Scholar 

  • Tylavsky FA, Smith K, Surprise H et al (2010) Nutritional intake of long-term survivors of childhood acute lymphoblastic leukemia: evidence for bone health interventional opportunities. Pediatr Blood Cancer 55:1362–1369

    Article  PubMed Central  PubMed  Google Scholar 

  • Watson AR, Stuart A, Wells FE et al (1983) Zinc supplementation and its effect on taste acuity in children with chronic renal failure. Hum Nutr Clin Nutr 37:219–225

    CAS  PubMed  Google Scholar 

  • Youssef S, Hachem R, Chemaly RF et al (2008) The role of vitamin B6 in the prevention of haematological toxic effects of linezolid in patients with cancer. J Antimicrob Chemother 61:421–424

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University, 161 Ft. Washington, 7th floor, New York, NY, 10032, USA

    Elena J. Ladas PhD, RD

  2. Division of Pediatric Hematology/Oncology/BMT, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Paul C. Rogers MD

Authors
  1. Elena J. Ladas PhD, RD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul C. Rogers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elena J. Ladas PhD, RD .

Editor information

Editors and Affiliations

  1. Department of Hematology and Oncology, Childrens Hospital & Research Center Oak, Oakland, California, USA

    James H. Feusner

  2. Hematology/Oncology, Children's Hospital and Research Center, Oakland, California, USA

    Caroline A. Hastings

  3. Hematology/Oncology, Children's Hospital and Research Center, Oakland, California, USA

    Anurag K. Agrawal

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Ladas, E.J., Rogers, P.C. (2015). Nutrition. In: Feusner, J., Hastings, C., Agrawal, A. (eds) Supportive Care in Pediatric Oncology. Pediatric Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44317-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-44317-0_12

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44316-3

  • Online ISBN: 978-3-662-44317-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation