Paper presentation at the 50th Congress of the International Society of Pediatric Oncology in Kyoto, Japan, 2018
In November 2018 I had the opportunity to present my work on the study, ‘Change of nutritional status during chemotherapy and factors predicting nutritional status at a 6-month interval’ at the 50thCongress of the International Society of Pediatric Oncology (SIOP) in Kyoto, Japan. The above study has been published as an abstract in Pediatric Blood and Cancer journal. I’ve been working on this research for over two and a half years in a project funded by Cuddles Foundation in the cancer centre of All India Institute of Medical Sciences, New Delhi.
Why is this study important?
A poor nutritional status is frequently observed in children with cancer at the time of diagnosis and during treatment due to increased catabolism resulting from the disease and/or its treatment.This study aimed to assess nutritional status and the effects of treatment on children with cancer. We wanted to do this study because there are few such studiesthat have assessed nutritional status at the baseline and through the course of the treatment of cancer.
We collected data regarding height/length, weight and mid-upper arm circumference (MUAC) for all patients at baseline, 3-month and 6-month intervals, along with information regarding literacy status of caretaker and place of residence (rural/urban). With the help of Cuddles Foundation, we provided nutritional intervention in the form of counselling and high protein supplements as per the patient’s requirements.
We included 343 patients whose data was available at all endpoints, of which 215 (62.7%) had hematologic malignancy and 128 (37.3%) solid tumors.
At baseline, 37% (127) patients were undernourished, which decreased to 34% (117) at the 3-month interval and to 25% (86) at the 6-month interval. In the subgroup with hematological alignancies 36.7% (79), 31.6% (68) and 22.3% (48) of children were undernourished at baseline, 3-month and 6-month interval respectively whereas in the subgroup with solid tumors 37.5% (48), 38.2% (49) ,29.6% (38) of children were undernourished at baseline, Thus, both hematological and solid malignancies showed significant reduction in proportion of malnutrition at the 6-month interval. Another key finding is the importance of nutritional and dietary counselling of parents, caregivers and children in rural and semi-urban areas. Malnutrition at 6-month interval was significantly associated with illiteracy and rural background.
It is clear that nutritional support should be a major part of supportive care to prevent or reverse malnutrition and increase well-being of children with cancer. The study suggests that nutritional counseling and supplementation in children while undergoing chemotherapy can improve the nutritional status, and thus it’s desirable to include this in the routine supportive management of these patients.
Also further clinical and basic research programs are needed to establish guidelines for analyzing the efficacy and impact of nutritional interventions on morbidity, mortality, and quality of life and to prevent chronic illnesses for pediatric cancer patients and survivors.The research was supported by Cuddles Foundation through its ‘FoodHeals’ program, which provided supplements, monthly ration, fruits, and diet planning and counseling to patients and families.
Author – Mitika Kashyap is a paediatric-onco nutritionist with Cuddles Foundation at AIIMS, New Delhi