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  Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 207-209
 

Nutritional profile of pediatric cancer patients at Cancer Institute, Chennai


Department of Medical Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu, India

Date of Web Publication5-Feb-2016

Correspondence Address:
V Radhakrishnan
Department of Medical Oncology, Cancer Institute, Adyar, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175841

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 » Abstract 

Background: Malnutrition is widely prevalent in the pediatric population in India. There is paucity of data on the prevalence of malnutrition in pediatric cancer patients and the impact of cancer treatment on nutritional status of Indian children. Aims: The study was conducted to look at the prevalence of malnutrition and assess the impact of treatment on nutritional status of pediatric cancer patients. Settings And Design: This was a retrospective study. Materials And Methods: Data on the weight of pediatric cancer patients <16 years of age treated at Cancer Institute, Chennai, from January 2013 to May 2014 were analyzed at systematic time points in therapy. Patients' weight were plotted on the Centre for Disease Control (CDC) growth charts. Patients were defined to be undernourished if their weight for age was ≤3rd centile in CDC growth charts and obese if their weight for age was ≥97th centile on CDC growth charts. RESULTS: A total of 295 patient case records were analyzed. Acute lymphoblastic leukemia was the most common malignancy. At diagnosis, under-nutrition was seen in 44% patients, this increased to 46% midway during treatment (end of induction in acute leukemia and completion of 50% of planned treatment in solid tumors) and decreased to 27% at the end of treatment (beginning of maintenance in acute leukemia and completion of planned treatment in solid tumors) (P = 0.0005). There was no significant difference in nutritional status between patients with hematological malignancies and solid tumors (P = 0.8). Conclusion: Under-nutrition is present in close to half of the pediatric cancer patients presenting to our institute. Active nutritional intervention and education were able to significantly reduce the prevalence of under-nutrition in patients at the end of treatment.


Keywords: Cancer, growth charts, nutrition


How to cite this article:
Radhakrishnan V, Ganesan P, Rajendranath R, Ganesan T S, Sagar T G. Nutritional profile of pediatric cancer patients at Cancer Institute, Chennai. Indian J Cancer 2015;52:207-9

How to cite this URL:
Radhakrishnan V, Ganesan P, Rajendranath R, Ganesan T S, Sagar T G. Nutritional profile of pediatric cancer patients at Cancer Institute, Chennai. Indian J Cancer [serial online] 2015 [cited 2020 Nov 29];52:207-9. Available from: https://www.indianjcancer.com/text.asp?2015/52/2/207/175841



 » Introduction Top


The nutritional status of children with cancer has been found to have an impact on the tolerance to chemotherapy and overall survival.[1],[2],[3],[4],[5],[6] The prevalence of under-nutrition in children in resource-poor countries such as India is very high and accounts for increased infant and child mortality rates.[7] It is important to obtain data on the prevalence of malnutrition in pediatric cancer patients from India so that strategies can be devised for active nutritional intervention thereby improving tolerance to chemotherapy and survival.


 » Materials and Methods Top


The study was conducted at the Cancer Institute, Chennai. Retrospective data of all new pediatric cancer patients <16 years of age treated from January 2013 to May 2014 were analyzed. Details on age, sex, diagnosis, and weight were collected from the case records. Weight records were collected at diagnosis, at the end of induction, and end of consolidation for patients with acute lymphoblastic leukemia (ALL). Weight records were collected at diagnosis, midway of treatment, and end of treatment for patients with solid tumors, lymphomas, and acute myeloid leukemia (AML). Patients' weight were plotted on weight for age Centre for Disease Control (CDC) growth charts.[8] Patients were defined to be undernourished if their weight for age was ≤3rd centile in CDC growth charts and obese if their weight for age was ≥97th centile on CDC growth charts. Patients were provided all meals and nutritional supplements by the hospital during their treatment duration. Categorical variables were compared using Chi-square test. P < 0.05 was considered statistically significant. Statistical analysis was performed using SPSS software version 11 (SPSS for Windows, Version 11.0. Chicago, SPSS Inc.).


 » Results Top


A total of 295 pediatric patients were enrolled in the analysis. Data on weight for age were available for 295 patients at diagnosis, 282 patients at midway through treatment, and 152 patients at the end of treatment. There were 191/295 (65%) male patients and 104/295 (35%) female patients. The median age of the patients was 9 years (range 0.1–16 years). All the patients belonged to the general ward category and their annual family income per family member was < Rs. 5000.

The most common diagnosis was ALL (37%), followed by AML (13%), non-Hodgkin's lymphoma (8%), Ewing's sarcoma (8%), osteosarcoma (7%), Hodgkin's lymphoma (6%) and other cancers such as Wilms tumor, medulloblastoma, retinoblastoma, sarcomas, and germ cell tumor (26%).

The diet was nonvegetarian in 273/295 (93%) patients and vegetarian in 22/295 (7%) patients. The details of the nature of the diet and the calories and proteins consumed prior to hospitalization were not available. During the hospital stay, most of the patients consumed vegetarian diet provided by the hospital.

At diagnosis, 153/295 (52%) of patients had weight for age between 3rd and 97th centile and were therefore considered to be nutritionally normal, 130/295 (44%) patients were undernourished, and 12/295 (4%) patients were obese. The prevalence of under-nutrition among males and females was 44% and 42%, respectively, at admission.

Midway through treatment, 137/282 (49%) patients were nutritionally normal, 130/282 (46%) patients were undernourished, and 15/282 (5%) patients were obese. At the end of treatment, 96/152 (63%) patients were nutritionally normal, 41/152 (27%) patients were undernourished, and 15/152 (10%) patients were obese. The improvement in nutritional status at the end of treatment was statistically significant (P = 0.0005).

There was no significant difference in nutritional status between hematological malignancies and solid tumors at diagnosis, midpoint of treatment, and end of treatment (P = 0.8). [Table 1] provides the data on under-nutrition in various malignancies at admission, mid-point of treatment, and end of treatment.
Table 1: Under-nutrition in various pediatric cancer at different time-points of treatment

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 » Discussion Top


Nutritional status of a child at diagnosis of cancer has significant impact on the overall outcome as shown by studies from Central America.[1],[2],[3],[4],[5],[6] In our study, 44% of patients were undernourished at diagnosis, similar rates have been reported from Guatemala and Malawi.[1],[2],[9],[10] The disparity among the rich and poor in India is increasing. Our hospital primarily caters to patients from the lower socioeconomic strata of the society. The prevalence of under-nutrition in a corporate hospital catering to middle-income and high-income patients may be lesser than that seen in our institute.

We were able to show a significant improvement in nutritional status of our patients during the course of treatment. Our hospital has a comprehensive nutritional intervention program which has active participation by dietitians, social workers, psycho-oncologists, nurses, and doctors. Education on hygiene and nutrition is given to parents and reinforced throughout the treatment course. Parents are encouraged to provide fresh cooked food prepared at home and avoid unhygienic street food. Dietary myths and misconceptions are also allayed. Supplemental proteins and high calorie food are regularly provided to the patients in addition to the hospital food. We believe that the improvement in nutritional status of our patients was because of the above measures.

Weight for age is not the ideal method to identify a child's nutritional status as weight can be influenced by factors such as edema and large tumor volume.[6],[11],[12] Using triceps, skin fold thickness and mid-arm circumference have been reported as more reliable methods for assessing the nutritional status in children.[6],[12] However, in routine clinical practice, weight and height are the most commonly employed anthropometric tools to assess the nutritional status. Skin fold thickness measurement requires Harpenden calipers, which are expensive, and mid upper arm circumference is reliable only up to the age of 5 years.

Our study also shows that prevalence of under-nutrition was not significantly different among males and females and also between solid and hematological malignancies.

The present study has certain limitations; these include its retrospective nature, no availability of weight for many patients at the end of treatment, and use of weight for age as the only modality for assessing nutritional status. However, our study highlights the magnitude of under-nutrition at diagnosis in a tertiary cancer center and the importance of nutritional intervention in improving the nutritional status of the patients.


 » Conclusion Top


Under-nutrition is a common problem in patients presenting to our institute. Active nutritional intervention and education were able to significantly reduce the prevalence of under-nutrition in patients at the end of treatment.

Acknowledgment

The authors thank Dietitians Ms. Srividhya and Ms. Santhanalakshmi and Data Manager Ms. Esther, for their support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Sala A, Rossi E, Antillon F, Molina AL, de Maselli T, Bonilla M, et al. Nutritional status at diagnosis is related to clinical outcomes in children and adolescents with cancer: A perspective from Central America. Eur J Cancer 2012;48:243-52.  Back to cited text no. 1
    
2.
Antillon F, Rossi E, Molina AL, Sala A, Pencharz P, Valsecchi MG, et al. Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr Blood Cancer 2013;60:911-5.  Back to cited text no. 2
    
3.
Mosby T, Day S, Challinor J, Hernández A, García J, Velásquez S. Nutritional issues in pediatric oncology: An international collaboration between the Central American nurses cooperative group and U.S.-based dietary and nursing experts. Pediatr Blood Cancer 2008;50:1298-300.  Back to cited text no. 3
    
4.
Howard SC, Marinoni M, Castillo L, Bonilla M, Tognoni G, Luna-Fineman S, et al. Improving outcomes for children with cancer in low-income countries in Latin America: A report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO) – Part I. Pediatr Blood Cancer 2007;48:364-9.  Back to cited text no. 4
    
5.
Sala A, Antillon F, Pencharz P, Barr R; AHOPCA Consortium. Nutritional status in children with cancer: A report from the AHOPCA Workshop held in Guatemala City, August 31-September 5, 2004. Pediatr Blood Cancer 2005;45:230-6.  Back to cited text no. 5
    
6.
Mosby TT, Barr RD, Pencharz PB. Nutritional assessment of children with cancer. J Pediatr Oncol Nurs 2009;26:186-97.  Back to cited text no. 6
    
7.
Ashworth A, Jackson A, Uauy R. Focusing on malnutrition management to improve child survival in India. Indian Pediatr 2007;44:413-6.  Back to cited text no. 7
[PUBMED]    
8.
CDC Growth Charts. Available from: http://www.cdc.gov/growthcharts/cdc_charts.htm. [Last accessed on 2014 Dec 29].  Back to cited text no. 8
    
9.
Israëls T, Chirambo C, Caron HN, Molyneux EM. Nutritional status at admission of children with cancer in Malawi. Pediatr Blood Cancer 2008;51:626-8.  Back to cited text no. 9
    
10.
Israëls T, Borgstein E, Jamali M, de Kraker J, Caron HN, Molyneux EM. Acute malnutrition is common in Malawian patients with a Wilms tumour: A role for peanut butter. Pediatr Blood Cancer 2009;53:1221-6.  Back to cited text no. 10
    
11.
Barr R, Atkinson S, Pencharz P, Arguelles GR. Nutrition and cancer in children. Pediatr Blood Cancer 2008;50 2 Suppl: 437.  Back to cited text no. 11
    
12.
Webber C, Halton J, Walker S, Young A, Barr RD. The prediction of lean body mass and fat mass from arm anthropometry at diagnosis in children with cancer. J Pediatr Hematol Oncol 2013;35:530-3.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1]

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