Clinical Implications of Undernutrition in Childhood Cancer: A Single Centre Experience from a Developing Country

Abstract

Introduction: Coexisting malnutrition is one of the known influencing factor of the survival rates in childhood cancer. Malnutrition contributes to poor immune function, altered drug metabolism—thereby causing drug toxicities and adverse clinical outcome. This study was done to assess the impact of undernutrition during treatment for childhood cancer, among the children diagnosed at our center. Methods: All children ≤18 years diagnosed with cancer between June 2011 and June 2019 treated at our institution were included in this study. Nutrition was assessed using body mass index (BMI) Z-score and a Z-score < −2SD was classified as undernourished. Weight loss of more than 10% or a decrease in BMI Z-score by ≥1SD below the previous Z-score was considered significant. All adverse effects and outcomes were compared between malnourished and adequately nourished children. Results: Three hundred six patients were included in this study, 114 (37.2%) were undernourished at diagnosis. One hundred two (33.3%) of 306 had significant weight loss. Malnutrition at diagnosis and significant weight loss was associated with an increased risk of febrile neutropenia, anemia, dosage modifications, and mucositis. Patients undernourished and those with significant weight loss showed a worse outcome (death or relapse) (P < 0.001). Conclusion: Nutritional status represents a modifiable risk factor long suggested to affect survival and treatment-related toxicity in pediatric malignancies and hence early nutritional intervention should be an essential part of the multi-disciplinary treatment protocol.