Inger Skolin

Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses

Goals of workThe purpose of this study was to better understand various variables related to food intake and eating problems in children with cancer during their chemotherapy.Patients and methodsTwenty-two consecutively admitted children, diagnosed with cancer and undergoing chemotherapy, participated in this study. Twenty-one of them, their parents and attending nurses participated in semi-structured interviews. Ten of the children underwent a taste acuity test, and recognition thresholds for the four basic tastes were determined.Main resultsThe shared view of both children and parents was that altered taste was the predominant cause of the eating problems. In contrast, the nurses perceived that nausea was the most important cause of the children’s eating problems. In addition, psychological aspects such as learned food aversions and negative attitudes towards hospital food were regarded as important by children, parents and nurses. The taste test showed that the patients had higher thresholds for bitter taste and made more taste recognition errors compared to controls.ConclusionsChanges seem to exist both in the primary gustatory sense as well as in food perception in paediatric cancer patients undergoing chemotherapy. Single solutions, such as efforts to serve “tasty food”, do not suffice alone. A more effective solution may be to combine different strategies and combinations of oral, enteral and parenteral nutrition should be considered to prevent malnutrition.

Nutrient Intake and Weight Development in Children During Chemotherapy for Malignant Disease

The aim of the study was to assess the actual daily oral intake of energy, protein, fat and carbohydrate in relation to current recommendations in children with malignant disease during chemotherapy and to follow their weight development. Dietary information was collected for 21 consecutive days via 7-day recording in 14 children, aged 5-16 years. The number of days with loss of appetite, vomiting, and the number of days on anti-emetic drugs were also recorded. The average daily energy intake decreased from 91% of the recommendation of the Swedish Nutrition Recommendations (SNR), before chemotherapy to 69% after start of chemotherapy. During days spent at home, the energy intake increased to 77% of SNR. Twenty-two per cent of the total energy intake during the hospital days came from sucrose. On average, the children experienced loss of appetite on 50% of the days, vomiting on 12%, and received anti-emetic drugs on 38%. On admission, the average SD score for body weight for the whole group was -0.09. The mean weight reduction after 1 week was 0.19 SD (P = 0.05) compared to the admission weight. The weight reduction 6 weeks (n = 10) and 3 months (n = 13) after the start of chemotherapy was 0.10 SD and 0.37 SD (P = 0.04), respectively.

Are nurses and physicians able to assess which strategies adolescents recently diagnosed with cancer use to cope with disease- and treatment-related distress?

PurposeIt was examined whether nurses and physicians are able to identify whether adolescents with cancer have used certain strategies to cope with disease- and treatment-related distress.MethodAdolescents (N = 48) were asked whether they had used a number of strategies to cope with disease- and treatment-related distress and, if so, the extent to which they had used these. Nurses and physicians were asked to answer the same questions on behalf of a certain adolescent.ResultsNurses overestimate the extent to which adolescents use strategies to cope with distress, and neither nurses nor physicians, physicians somewhat more, are successful in identifying the extent to which certain adolescents use strategies.ConclusionHealth-care staff’s possibilities to assess how patients cope with disease- and treatment-related distress should be increased. A number of changes in education and the organization of clinical care, especially with regard to assessing patients’ needs, are suggested.

ArticlesPercutaneous endoscopic gastrostomy in children with malignant disease

The objective of the study was to assess both the possible complications of percutanous endoscopic gastrostomy (PEG) in pediatric cancer patients and its effect on weight development. The medical records of 18 children with a median age of 2.5 years (range, 0.5–14.2 years) were reviewed. The diagnoses were leukemia, central nervous system tumors, solid tumors, and lymphoma. The indications for PEG were anticipated therapy-related nutritional problems and inadequate food intake, weight loss, swallowing problems in relation to paresis of the pharynx, and relapse of the disease. Ten children received a PEG at treatment start, and eight children received it at a median time of 3.4 months (range, 0.9–27.4 months) after treatment start. The median duration of having a PEG in place was 12.3 months (range, 1.2–24.0 months). At admission the median weight for age expressed as standard deviation (SD) was −0.11 (range, −2.78–2.68). There was a significant (p = .005) decrease in the median SD from admission until PEG installation. There was also a significant increase in the median SD from the start of PEG use until 1 (p = .04) and 2 (p = .039) months after start. The most common complications were episodes of inflammation of the PEG site, which were successfully treated with topically or orally administered antibiotics, and episodes of infection, which required intravenously administered antibiotics. Taking into consideration the medical condition of the children in the study group and the considerable length of time with a PEG in place, we believe that nutrition via PEG in children with cancer has several advantages and is rarely associated with other than minor complications.