Abstract
The adequate nutritional status of pediatric cancer patients is particularly important to enable them to cope with the demands of the disease and its treatment and to maintain normal growth. Malnutrition and obesity have both been associated with reduced survival and increased drug toxicity. We investigated trends in the age- and sex-adjusted body mass index (ISO-BMI) and the prevalence of malnutrition in a Finnish cohort of 139 consecutive children receiving chemotherapy for cancer, with a follow-up period of 42 months after diagnosis. In total, 28% (39/139) of the patients experienced malnutrition (ISO-BMI < 17 or > 10% weight loss), and 12% (16/139) had a nasogastric tube or underwent gastrostomy. Patients with acute or chronic myeloid leukemia (5/10), central nervous system (CNS) tumors (5/13), or solid tumors (13/31) most frequently suffered from malnutrition. There was a significant increase in the ISO-BMI of patients with acute lymphoblastic leukemia (ALL) (+ 2.1 kg/m2) and lymphomas (+ 2.4 kg/m2) during the first 6 months, and the ISO-BMI of patients with ALL remained higher at 42 months compared to baseline (+ 1.9 kg/m2).Conclusion: The cumulative incidence of malnutrition in Finnish pediatric cancer patients is comparable to that reported in other populations. The nutritional status of patients with acute myeloid leukemia, CNS tumors, or solid tumors should be monitored with extra care to facilitate early intervention in the case of impending malnutrition.What is known:• Both malnutrition and obesity are associated with reduced survival and increased drug toxicity in pediatric cancer patients.What is new:• Overall, 28 % of Finnish children receiving chemotherapy for cancer suffer from malnutrition during the first 42 months following the initial cancer diagnosis. • ISO-BMI curves from initial diagnosis to 42 months after diagnosis are provided for patients with different types of cancer.
Highlights
The prognosis of childhood cancer has improved significantly over the past 40 years, with 5-year survival exceeding 80% [25]
We categorized the subjects into five diagnostic groups: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or chronic myeloid leukemia (CML), lymphoma, solid tumor, and central nervous system (CNS) tumor
Longer follow-up studies on children with a history of ALL or lymphoma have shown that both diseases increase the risk of obesity for years after the cessation of cancer treatment [2, 29], which is in line with the present results
Summary
The prognosis of childhood cancer has improved significantly over the past 40 years, with 5-year survival exceeding 80% [25]. Almost 20% of pediatric cancer patients still die due to the disease itself or to the toxic effects of the treatment. Both the treatment and the disease influence the nutritional status of children with cancer. Adequate nutrition is important for children’s growth, development, and well-being [5], and in childhood cancer, it is important to enable children to cope with the demands of the disease and its treatment and to maintain normal growth [27]. Malnutrition has been associated with reduced survival, increased risk of toxicity, decreased treatment tolerance, and higher risk of infection [7, 17, 20, 22]. Obesity has been linked to reduced survival and increased toxicity-related mortality [17]
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