Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
- 1.
- Why would nutritional screening be part of supportive care in children with cancer?
- Votes: 9-8-9-9-9-8-7-9-9-8-9-9-7
- 2.
- When should nutritional screening be done in children with cancer?
- Votes: 9-8-9-9-8-6-7-9-9-8-8-9-9
- 3.
- How should nutritional assessment be done in children with cancer?
- -
- A. Anthropometric measures.
- -
- B. Biochemistry exams.
- -
- C. Clinical evaluation.
- -
- D. Dietary intake.
- Votes: 8-9-9-9-9-9-8-9-9-9-9-8-9
- 4.
- What are the anthropometric measures that should be assessed?
- Votes: 9-8-9-9-8-9-9-9-9-8-9-9-9
- 5.
- What are the biochemistry exams that should be performed?
- Votes: 8-8-9-9-6-8-9-9-9-8-9-7-9
- 6.
- What should be investigated during the clinical evaluation?
- Votes: 9-8-9-9-9-9-8-9-9-9-9-9-8
- 7.
- What is the role of the dietitian and clinical nutritionist?
- Votes: 8-8-9-8-8-8-8-9-9-9-8-8-8
- 8.
- Can the use of screening tools be useful?
- Votes: 7-7-9-9-7-6-7-9-9-7-8-8-7
- 9.
- What are the risk factors for malnutrition related to disease and treatment?
- Votes: 9-7-9-9-8-9-9-9-9-9-8-8-8
- 10.
- What kind of diet should be suggested?
- Votes: 8-8-9-9-9-5-6-9-9-6-8-9-9
- 11.
- What is the role of “alternative” therapies and diets?
- Votes: 9-8-9-9-9-9-9-9-9-9-9-9-9
- 12.
- What is the management for initial starting nutritional support like in children with cancer?
- -
- -
- Nutritional counselling is mandatory also for overweight and obese patients at diagnosis or during treatment, with special attention for children taking long courses of steroids, who are at risk of sarcopenic obesity (ALL patients).
- -
- Nutritional support, starting with oral supplements, is indicated when [48]:
- ○
- The patient has not high-risk features (Table 2).
- ○
- The patient is unable to meet the 50% of the daily requirements orally.
- Votes: 9-8-9-9-7-8-7-9-9-8-9-8-7
- 13.
- When can enteral nutrition (EN) be considered in children with cancer?
- -
- -
- For severely wasted or malnourished patients, as in low BMI for age (<5th percentile or z score less than –1) or the mid upper arm circumference (MUAC; <5th percentile or z score less than –1).
- -
- Votes: 8-8-9-7-8-9-8-9-9-9-9-8-8
- 14.
- Which type of enteral access (nasogastric tube or periendoscopic gastrostomy) is used in children with cancer?
- Votes: 9-8-9-6-8-8-8-9-9-8-9-8-8
- 15.
- Which modalities of EN should be used (bolus/continuous) in children with cancer?
- Votes: 9-8-9-5-9-9-9-9-9-8-8-9-9
- 16.
- How should an enteral formula be chosen in children with cancer?
- Votes: 8-8-9-9-9-9-8-9-9-8-9-8-9
- 17.
- When should parenteral nutrition (PN) be considered in children with cancer?
- Votes: 8-8-9-9-8-8-9-9-9-8-9-9-8
- 18.
- How personalized should PN be in children with cancer?
- Votes: 8-8-9-9-9-8-9-9-9-9-9-8-9
- 19.
- What are the risks related to PN?
- Votes: 8-8-9-9-9-8-9-9-9-8-9-9-9
- 20.
- When should nutritional assessment be performed in cancer survivors?
- Votes: 7-8-9-9-8-8-8-9-9-9-8-9-8
- 21.
- What are the nutritional risks in cancer survivors?
- Votes: 7-8-9-9-9-9-8-9-9-9-9-8-9
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Questions | Recommendations |
---|---|
Why would nutritional screening be part of supportive care in children with cancer? | The main objective of nutritional treatments is not only to avoid malnutrition, but also to support growth in line with genetic target. |
When should nutritional assessment be done in children with cancer? | Assessment of nutritional status should be performed on all patients at diagnosis and repeated periodically during treatment and follow-up. |
How should nutritional screening be done in children with cancer? | A-B-C-D methods could be considered a useful method for nutritional screening in children with cancer. |
What are the anthropometric measures that should be assessed? | Weight, height, body mass index (BMI), and mid-upper arm circumference (MUAC) plotted on WHO growth charts could be considered part of a minimal nutritional screening. |
What are the biochemistry exams that should be performed? | Biochemical exam should include protein status, organ function, bone health, anemia, evidence of inflammation, and specific mineral and vitamin deficiencies. |
What should be investigated during the clinical evaluation? | Clinical evaluation should detect signs of malnutrition and consider conditions that may affect oral food intake. |
What is the role of the dietitian and clinical nutritionist? | Collaboration between dietitians, clinical nutritionists, and oncologist is pivotal. |
Can the use of screening tools be useful? | Screening Tool for Risk of Nutritional Status and Growth (Strong Kids) seem to be balanced and takes into account several aspects. |
Which risk factors for malnutrition are related to disease and treatment? | Some specific tumors and some specific therapies are more at risk of both overnourishment and undernourishment. |
What kind of diet should be suggested? | A diet corresponding to those of children of the same age and sex should be proposed. Counselling on grocery shopping, food hygiene, food storage, cooking, preparation, and serving according to the FDA-approved food safety guidelines should be carried out to families. |
What is the role of “alternative” therapies and diets? | There are no high-quality studies demonstrating the effectiveness of natural health products or special diets in pediatric cancer cures. |
What is the management for initial starting nutritional support like in children with cancer? | Nutritional support, starting with oral supplements, is indicated when the patient has no high-risk features or when they are unable to meet the 50% of the daily requirements orally. If a patient is adequately nourished, does not lose weight, and is consuming at least 50% of the recommended nutritional intake, nutritional counselling by an expert dietician is considered sufficient. Nutritional counselling is mandatory also for overweight and obese patients at diagnosis or during treatment, with special attention to children taking long course of steroids, who are at risk of sarcopenic obesity (ALL patients). |
When can enteral nutrition (EN) be considered in children with cancer? |
|
Which type of enteral access (nasogastric tube or periendoscopic gastrostomy) is used in children with cancer? |
|
Which modalities of EN should be used (bolus/continuous) in children with cancer? | We suggest starting with continuous feeding and, if well tolerated (no vomiting or abdominal distension), switching to bolus feeding. |
How should an enteral formula be chosen in children with cancer? |
|
When should a parenteral nutrition (PN) be considered in children with cancer? | PN should be considered when enteral nutrition is not feasible or inadequate. |
How personalized should PN be in children with cancer? | PN formulations should be prescribed, taking into account age requirements, nutritional status, fluid requirement, and type of venous access. |
What are the risks related to PN? | The possible complications related to the use of PN are mechanical or equipment-related complications, infections and metabolic complications, acid-base or electrolyte imbalance, drug interaction, intestinal failure associated liver disease, and refeeding syndrome. |
When should nutritional assessment be done in cancer survivors? | Nutritional assessment in cancer survivors should be done during the first year of follow-up: Monthly for undernourished patients; Quarterly for obese children and well-nourished patients with nutritional risk factors; Six months for children without risk factors |
High Risk Factors for Undernourishment | High Risk Factors for Overnourishment |
---|---|
Solid tumors with advanced stages at diagnosis | Total body or abdominal or cranial irradiation |
Ewing sarcoma | Craniopharyngioma |
Medulloblastoma and other high grade brain tumors | Administration of prolonged corticosteroid therapy or other drugs increasing body fat stores |
Diencephalic tumors | |
Head and neck tumors | |
Age < 2 months | |
Relapsed disease | |
Administration of highly emetogenic regimens | |
Administration of regimens associated with severe gastrointestinal complications, such as constipation, diarrhea, loss of appetite, mucositis, or enterocolitis | |
Administration of radiation to the oropharynx, esophagus, or abdomen | |
Post-surgical complications, such as prolonged ileus or short gut syndrome | |
Stem cell transplantation with myeloablative conditioning regimens |
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Share and Cite
Fabozzi, F.; Trovato, C.M.; Diamanti, A.; Mastronuzzi, A.; Zecca, M.; Tripodi, S.I.; Masetti, R.; Leardini, D.; Muratore, E.; Barat, V.; et al. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers 2022, 14, 3378. https://doi.org/10.3390/cancers14143378
Fabozzi F, Trovato CM, Diamanti A, Mastronuzzi A, Zecca M, Tripodi SI, Masetti R, Leardini D, Muratore E, Barat V, et al. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers. 2022; 14(14):3378. https://doi.org/10.3390/cancers14143378
Chicago/Turabian StyleFabozzi, Francesco, Chiara Maria Trovato, Antonella Diamanti, Angela Mastronuzzi, Marco Zecca, Serena Ilaria Tripodi, Riccardo Masetti, Davide Leardini, Edoardo Muratore, Veronica Barat, and et al. 2022. "Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement" Cancers 14, no. 14: 3378. https://doi.org/10.3390/cancers14143378
APA StyleFabozzi, F., Trovato, C. M., Diamanti, A., Mastronuzzi, A., Zecca, M., Tripodi, S. I., Masetti, R., Leardini, D., Muratore, E., Barat, V., Lezo, A., De Lorenzo, F., Caccialanza, R., & Pedrazzoli, P. (2022). Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers, 14(14), 3378. https://doi.org/10.3390/cancers14143378