ORAL/ENTERAL NUTRITIONAL SUPPLEMENTATION IN CHILDREN TREATED FOR CANCER IN LOW-MIDDLE-INCOME COUNTRIES IS FEASIBLE AND EFFECTIVE: THE EXPERIENCE OF THE CHILDREN'S HOSPITAL MANUEL DE JESUS RIVERA "LA MASCOTA" IN NICARAGUA.
Main Article Content
Keywords
Childhood cancer, nutrition, low-middle-income countries
Abstract
Background and objectives. The prevalence of malnutrition in children diagnosed with malignant tumors in Nicaragua has been reported to be 67%. Thus, a nutritional program for children with cancer has been developed at the Children’s Hospital Manuel de Jesus Rivera (Managua, Nicaragua).
Methods. A qualified nutritionist evaluated all patients and prescribed oral/enteral supplementation. The nutritional assessment was based on weight, height or length, mid upper arm circumference (MUAC) and triceps skin fold thickness (TSFT). In this descriptive study, pre and post-nutritional intervention data were compared and analyzed in terms of event free survival.
Results. 104 patients (median age 7.0 years, 52 with leukemia/lymphoma and 52 with solid tumor) underwent oral/enteral nutritional supplementation; 64 of these patients had pre and post supplementation nutritional assessment. Overall, 55% of patients in the leukemia/lymphoma group and the 35% in the solid tumor group improved their condition or remained in an adequately nourished status.
Conclusion. This experience demonstrates that nutritional supplementation in pediatric cancer patients who are inadequately nourished is feasible also in countries with limited resources and is effective in improving the nutritional conditions.Downloads
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References
[1] Sala, A., Pencharz, P. and Barr, R. D. (2004), Children, cancer, and nutrition-A dynamic triangle in review. Cancer, 100: 677-687. http://dx.doi.org/10.1002/cncr.11833
[2] Huhmann MB, August DA. Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment. Nutr Clin Pract 2008;23 (2):182-188. http://dx.doi.org/10.1177/0884533608314530
[3] Jacqueline Bauer, Heribert Jürgens, Michael C. Frühwald; Important Aspects of Nutrition in Children with Cancer, Advances in Nutrition, Volume 2, Issue 2, 1 March 2011, Pages 67-77, https://doi.org/10.3945/an.110.000141
[4] Schoeman J. Nutritional assessment and intervention in a pediatric oncology unit. Indian J Cancer 2015;52:186-90. http://www.indianjcancer.com/text.asp?2015/52/2/186/175832
[5] Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. Journal of Clinical Oncology. 2015;33(27):3065-3073. http://ascopubs.org/doi/10.1200/JCO.2014.60.6376
[6] Rodriguez-Galindo C, Friedrich P, Morrissey L, Frazier L. Global challenges in pediatric oncology. Curr Opin Pediatr 2013 Feb;25(1):3-15. https://journals.lww.com/co-pediatrics/fulltext/2013/02000/Global_challenges_in_pediatric_oncology.3.aspx
[7] Barr RD, Ribeiro RC, Agarwal BR, Masera G, Hesseling PB, Magrath IT. Pediatric oncology in countries with limited resources. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology, 4th ed. Philadelphia: Lip- ?pincott, Williams and Wilkins, 2002:1541-1552.
[8] UNICEF. The state of the world's children 2012. https://www.unicef.org/sowc2012/
[9] Barr, R. D., Klussmann, F. A., Baez, F., Bonilla, M., Moreno, B., Navarrete, M., Nieves, R., Peña, A., Conter, V., De Alarcón, P., Howard, S. C., Ribeiro, R. C., Rodriguez-Galindo, C., Valsecchi, M. G., Biondi, A., Velez, G., Tognoni, G., Cavalli, F. and Masera, G. (2014), Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): A model for sustainable development in pediatric oncology. Pediatr Blood Cancer, 61: 345-354. http://dx.doi.org/10.1002/pbc.24802
[10] Sala A, Rossi E, Antillon F, 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(2):243-252. https://doi.org/10.1016/j.ejca.2011.06.006
[11] Pribnow AK, Ortiz R, Báez LF, Mendieta, L, Luna-Fineman S. Effects of malnutrition on treatment-related morbidity and survival of children with cancer in Nicaragua. Pediatr Blood Cancer. 2017;64:e26590. http://dx.doi.org/10.1002/pbc.26590
[12] Howard SC, Marinoni M, Castillo L, 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;48:364-369. http://dx.doi.org/10.1002/pbc.21003
[13] Howard SC, Ortiz R, Baez LF. Protocol-based treatment of 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-Part II. Pediatr Blood Cancer 2007;48:486-490. http://dx.doi.org/10.1002/pbc.20989
[14] Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International classification of childhood cancer, third edition. Cancer 2005;103:1457-67. http://dx.doi.org/10.1002/cncr.20910
[15] Quintana Y, Patel AN, Arreola M, et al. POND4Kids: A global web-based database for pediatric ?hematology and oncology outcome evaluation and collaboration. Stud Health Technol Inform ?2013;183:251-256.
[16] Sala A, Antillon F, Pencharz P, Barr B. 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;45:230-236. http://dx.doi.org/10.1002/pbc.20371
[17] 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. https://journals.lww.com/jpho-online/pages/articleviewer.aspx?year=2013&issue=10000&article=00008&type=abstract
[18] Mosby TT, Barr RD, Pencharz PB. Nutritional assessment of children with cancer. J Pediatr Oncol Nurs 2009;26:186-97. https://doi.org/10.1177/1043454209340326
[19] Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34:2540-2545.
[20] https://www.cdc.gov/growthcharts/
[21] Antillon, F., Rossi, E., Molina, A. L., Sala, A., Pencharz, P., Valsecchi, M. G. and Barr, R. (2013), Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr. Blood Cancer, 60: 911-915. http://dx.doi.org/10.1002/pbc.24377
[22] Israëls T, van de Wetering MD, Hesseling P, van Geloven N, Caron HN, Molyneux EM. Malnutrition and neutropenia in children treated for Burkitt lymphoma in Malawi. Pediatr Blood Cancer. 2009;53(1):47-52. http://dx.doi.org/10.1002/pbc.22032
[23] Ladas, E. J., Arora, B., Howard, S. C., Rogers, P. C., Mosby, T. T. and Barr, R. D. (2016), 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. Pediatr Blood Cancer, 63: 1339-1348. http://dx.doi.org/10.1002/pbc.26016
[24] Ward EJ, Henry LM, Friend AJ, Wilkins S, Phillips RS. Nutritional support in children and young people with cancer undergoing chemotherapy. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD003298. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003298.pub3/abstract
[25] Antillón, F. G., Blanco, J. G., Valverde, P. D., Castellanos, M., Garrido, C. P., Girón, V., Letona, T. R., Osorio, E. J., Borrayo, D. A., Mack, R. A., Melgar, M. A., Lorenzana, R., Ribeiro, R. C., Metzger, M., Conter, V., Rossi, E. and Valsecchi, M. G. (2017), The treatment of childhood acute lymphoblastic leukemia in Guatemala: Biologic features, treatment hurdles, and results. Cancer, 123: 436-448. http://dx.doi.org/10.1002/cncr.30257
[26] DeSwarte-Wallace J, Firouzbakhsh S, Finklestein JZ, Using research to change practice: enteral feedings for pediatric oncology patients. J Pediatr Oncol Nurs. 2001 Sep-Oct;18(5):217-23. https://doi.org/10.1053/jpon.2001.26875
[27] Trimpe K, Shaw MR, Wilson M, Haberman MR. Review of the effectiveness of enteral feeding in Pediatric oncology patients. J Pediatr Oncol Nurs. 2017 Nov/Dec;34(6):439-445. https://doi.org/10.1177/1043454217712982
[28] Garófolo, Adriana, Alves, Fernanda Rodrigues, & Rezende, Maria Aurélia do Carmo. (2010). Suplementos orais artesanais desenvolvidos para pacientes com câncer: análise descritiva. Revista de Nutrição, 23(4), 523-533. http://dx.doi.org/10.1590/S1415-52732010000400003
[29] Viani K. Parental and enteral nutrition for pediatric oncology in low- and middle-income countries. Indian J Cancer 2015;52:1824. http://www.indianjcancer.com/text.asp?2015/52/2/182/175837
[2] Huhmann MB, August DA. Review of American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines for Nutrition Support in Cancer Patients: Nutrition Screening and Assessment. Nutr Clin Pract 2008;23 (2):182-188. http://dx.doi.org/10.1177/0884533608314530
[3] Jacqueline Bauer, Heribert Jürgens, Michael C. Frühwald; Important Aspects of Nutrition in Children with Cancer, Advances in Nutrition, Volume 2, Issue 2, 1 March 2011, Pages 67-77, https://doi.org/10.3945/an.110.000141
[4] Schoeman J. Nutritional assessment and intervention in a pediatric oncology unit. Indian J Cancer 2015;52:186-90. http://www.indianjcancer.com/text.asp?2015/52/2/186/175832
[5] Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. Journal of Clinical Oncology. 2015;33(27):3065-3073. http://ascopubs.org/doi/10.1200/JCO.2014.60.6376
[6] Rodriguez-Galindo C, Friedrich P, Morrissey L, Frazier L. Global challenges in pediatric oncology. Curr Opin Pediatr 2013 Feb;25(1):3-15. https://journals.lww.com/co-pediatrics/fulltext/2013/02000/Global_challenges_in_pediatric_oncology.3.aspx
[7] Barr RD, Ribeiro RC, Agarwal BR, Masera G, Hesseling PB, Magrath IT. Pediatric oncology in countries with limited resources. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology, 4th ed. Philadelphia: Lip- ?pincott, Williams and Wilkins, 2002:1541-1552.
[8] UNICEF. The state of the world's children 2012. https://www.unicef.org/sowc2012/
[9] Barr, R. D., Klussmann, F. A., Baez, F., Bonilla, M., Moreno, B., Navarrete, M., Nieves, R., Peña, A., Conter, V., De Alarcón, P., Howard, S. C., Ribeiro, R. C., Rodriguez-Galindo, C., Valsecchi, M. G., Biondi, A., Velez, G., Tognoni, G., Cavalli, F. and Masera, G. (2014), Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): A model for sustainable development in pediatric oncology. Pediatr Blood Cancer, 61: 345-354. http://dx.doi.org/10.1002/pbc.24802
[10] Sala A, Rossi E, Antillon F, 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(2):243-252. https://doi.org/10.1016/j.ejca.2011.06.006
[11] Pribnow AK, Ortiz R, Báez LF, Mendieta, L, Luna-Fineman S. Effects of malnutrition on treatment-related morbidity and survival of children with cancer in Nicaragua. Pediatr Blood Cancer. 2017;64:e26590. http://dx.doi.org/10.1002/pbc.26590
[12] Howard SC, Marinoni M, Castillo L, 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;48:364-369. http://dx.doi.org/10.1002/pbc.21003
[13] Howard SC, Ortiz R, Baez LF. Protocol-based treatment of 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-Part II. Pediatr Blood Cancer 2007;48:486-490. http://dx.doi.org/10.1002/pbc.20989
[14] Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International classification of childhood cancer, third edition. Cancer 2005;103:1457-67. http://dx.doi.org/10.1002/cncr.20910
[15] Quintana Y, Patel AN, Arreola M, et al. POND4Kids: A global web-based database for pediatric ?hematology and oncology outcome evaluation and collaboration. Stud Health Technol Inform ?2013;183:251-256.
[16] Sala A, Antillon F, Pencharz P, Barr B. 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;45:230-236. http://dx.doi.org/10.1002/pbc.20371
[17] 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. https://journals.lww.com/jpho-online/pages/articleviewer.aspx?year=2013&issue=10000&article=00008&type=abstract
[18] Mosby TT, Barr RD, Pencharz PB. Nutritional assessment of children with cancer. J Pediatr Oncol Nurs 2009;26:186-97. https://doi.org/10.1177/1043454209340326
[19] Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34:2540-2545.
[20] https://www.cdc.gov/growthcharts/
[21] Antillon, F., Rossi, E., Molina, A. L., Sala, A., Pencharz, P., Valsecchi, M. G. and Barr, R. (2013), Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr. Blood Cancer, 60: 911-915. http://dx.doi.org/10.1002/pbc.24377
[22] Israëls T, van de Wetering MD, Hesseling P, van Geloven N, Caron HN, Molyneux EM. Malnutrition and neutropenia in children treated for Burkitt lymphoma in Malawi. Pediatr Blood Cancer. 2009;53(1):47-52. http://dx.doi.org/10.1002/pbc.22032
[23] Ladas, E. J., Arora, B., Howard, S. C., Rogers, P. C., Mosby, T. T. and Barr, R. D. (2016), 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. Pediatr Blood Cancer, 63: 1339-1348. http://dx.doi.org/10.1002/pbc.26016
[24] Ward EJ, Henry LM, Friend AJ, Wilkins S, Phillips RS. Nutritional support in children and young people with cancer undergoing chemotherapy. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD003298. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003298.pub3/abstract
[25] Antillón, F. G., Blanco, J. G., Valverde, P. D., Castellanos, M., Garrido, C. P., Girón, V., Letona, T. R., Osorio, E. J., Borrayo, D. A., Mack, R. A., Melgar, M. A., Lorenzana, R., Ribeiro, R. C., Metzger, M., Conter, V., Rossi, E. and Valsecchi, M. G. (2017), The treatment of childhood acute lymphoblastic leukemia in Guatemala: Biologic features, treatment hurdles, and results. Cancer, 123: 436-448. http://dx.doi.org/10.1002/cncr.30257
[26] DeSwarte-Wallace J, Firouzbakhsh S, Finklestein JZ, Using research to change practice: enteral feedings for pediatric oncology patients. J Pediatr Oncol Nurs. 2001 Sep-Oct;18(5):217-23. https://doi.org/10.1053/jpon.2001.26875
[27] Trimpe K, Shaw MR, Wilson M, Haberman MR. Review of the effectiveness of enteral feeding in Pediatric oncology patients. J Pediatr Oncol Nurs. 2017 Nov/Dec;34(6):439-445. https://doi.org/10.1177/1043454217712982
[28] Garófolo, Adriana, Alves, Fernanda Rodrigues, & Rezende, Maria Aurélia do Carmo. (2010). Suplementos orais artesanais desenvolvidos para pacientes com câncer: análise descritiva. Revista de Nutrição, 23(4), 523-533. http://dx.doi.org/10.1590/S1415-52732010000400003
[29] Viani K. Parental and enteral nutrition for pediatric oncology in low- and middle-income countries. Indian J Cancer 2015;52:1824. http://www.indianjcancer.com/text.asp?2015/52/2/182/175837