Cochrane Review: Nutritional support in children and young people with cancer undergoing chemotherapy

Abstract

AbstractBackgroundMalnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment and promote weight gain and growth. The most effective and safe forms of nutritional support in children and young people with cancer are unclear.ObjectivesTo determine the effects of any form of parenteral (PN) or enteral (EN) nutritional support in children and young people with cancer undergoing chemotherapy.Search strategyWe searched the following databases: CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CINAHL (1982 to 2006), the National Research Register (2007) and Dissertations & Theses (2007). We scrutinised reference lists of articles to identify additional trials. We also contacted experts in the field for information on relevant trials.Selection criteriaRandomised or quasi‐randomised controlled trials comparing any form of nutritional support with another, or control, in children or young people with cancer undergoing chemotherapy.Data collection and analysisTwo authors independently selected trials. Three authors independently assessed quality and extracted data. We contacted trialists for missing information.Main resultsWe included eight trials which randomised 159 participants (< 21 years) with leukaemias or solid tumours undergoing chemotherapy. The trials were all of low quality. One small trial found that compared to EN, PN significantly increased weight (mean difference (MD) 4.12; 95% CI 1.91 to 6.33), serum albumin levels (MD 0.70; 95% CI 0.14 to 1.26), calorie intake (MD 22.00; 95% CI 5.12 to 38.88) and protein intake (MD 0.80; 95% CI 0.45 to 1.15). One trial comparing peripheral PN and EN with central PN found that mean daily weight gain (MD ‐27.00; 95% CI ‐43.32 to ‐10.68) and energy intakes (MD ‐15.00; 95% CI ‐26.81 to ‐3.19) were significantly less for the peripheral PN and EN group, whereas mean change in serum albumin was significantly greater for that group(MD 0.47; 95% CI 0.13 to 0.81, P = 0.008). Authors' conclusionsThere is limited evidence from individual trials to suggest that parenteral nutrition is more effective than enteral nutrition in well‐nourished children and young people with cancer undergoing chemotherapy. The evidence for other methods of nutritional support remains unclear. No studies were identified comparing the nutritional content in the PN or EN groups of studies. Further research, incorporating larger sample sizes and rigorous methodology utilising valid and reliable outcome measures, is essential.Plain Language SummaryNutritional support in children and young people with cancer undergoing chemotherapyNutritional support is of great importance in managing children and young people with cancer. It may help to reverse malnutrition seen at diagnosis, prevent malnutrition associated with the cancer treatment and promote weight gain and growth. Nutritional support may be provided by one of two methods: nutritional liquids delivered through a central or peripheral vein which bypass the gut (parenteral nutrition); or nutritional liquids or solids that pass through any part of the gut, regardless of method of delivery (e.g. orally or via a tube) (enteral nutrition).We found some evidence from one small trial to suggest that parenteral nutrition may result in an increase in weight, serum albumin levels, and calorie and protein intake when compared to enteral nutrition (usual food intake). However, the evidence for other methods of delivery of nutritional support remains unclear. No studies were identified that compared the nutritional content in either the PN or EN groups of studies. The trials were all of low quality and very different in terms of outcome measures used. In future much larger, rigorously conducted trials with better defined outcome measures are needed in order to address this important question.