Jennifer Cohen

Dietary intake after treatment in child cancer survivors

Childhood cancer survivors (CCS) are at increased risk of complications such as obesity, diabetes, and osteoporosis which have the potential to, in part, be controlled with dietary interventions. To allow the development of appropriate dietary interventions for younger cancer survivors data on their dietary intake as well as information on parental nutrition views and practices need to be assessed.

Smell and taste disorders resulting from cancer and chemotherapy

Malnutrition is common in both adult and pediatric patients undergoing treatment for cancer. Patients commonly attribute difficulties maintaining food intake to an altered taste developed during treatment. This review summarizes what is known about taste and smell dysfunction in patients with undergoing chemotherapy as their main treatment modality. Self-reported taste and smell alterations are prevalent in upwards of 86% of cancer patients. There is some evidence for decreased taste sensitivity in cancer patients when assessed using common gustatory tests. In some patients, taste and smell alterations may continue well after their cancer treatment has been completed. Such disorders can increase distress, reduce appetite and contribute towards poor nutritional status in cancer patients. There remain no effective interventions for improving the appetite or nutritional intake of patients with cancer experiencing taste and smell changes. There is a lack of consistency in assessment methodologies for measuring taste and smell changes in cancer patients and we therefore recommend that future work use well-established methods. Research should also take into account the role of food hedonics, food flavor and texture in assessing the association between taste dysfunction, poor oral intake and malnutrition in cancer patients. Both adult and child cancer patients should be counselled on the potential impact taste and smell dysfunction can have on their appetite and oral intake.

An international survey of nutritional practices in low- and middle-income countries: a report from the International Society of Pediatric Oncology (SIOP) PODC Nutrition Working Group

Background/Objectives:Optimal nutritional status is important in children with cancer, as it can influence clinical outcomes. To improve the nutritional health of children and adolescents receiving treatment for cancer residing in low income and middle-income countries (LMIC), we investigated nutrition practices among these nations’ institutions providing treatment for childhood cancer.Subject/Methods:A cross-sectional survey of nutrition practice was administered to staff members at institutions providing treatment for children with cancer between 2011 and 2012. Countries classified as low income and middle income were divided by geographical region. Final analysis was performed with 96 surveys, which included 27 institutions from Asia, 27 institutions from Latin America and Caribbean, 27 institutions from Africa and 15 institutions from Europe.Results:The study found that 55% of institutions had a dietician available on their service. Access to dieticians, lack of nutrition resources and lack of nutrition education of staff were the main barriers to providing nutrition care in LMIC. Half of the institutions performed nutritional assessment at diagnosis, and the methods used varied widely. Twenty-nine percent of all institutions used complementary and alternate therapies within their clinical practice, and 35% of institutions reported that nutrition education was provided to patients and families.Conclusions:Priority areas for improving the nutritional management in LMIC include the following: (1) improved nutrition education and assessment tools for doctors and nurses; (2) increased availability of nutrition education resources for families and patients; and (3) identification of the role of complementary and alternative therapies in closing gaps in symptom management in these institutions.

Parent feeding interactions and practices during childhood cancer treatment: A qualitative investigation

In the general population it is evident that parent feeding practices can directly shape a childs life long dietary intake. Young children undergoing childhood cancer treatment may experience feeding difficulties and limited food intake, due to the inherent side effects of their anti-cancer treatment. What is not clear is how these treatment side effects are influencing the parent-child feeding relationship during anti-cancer treatment. This retrospective qualitative study collected telephone based interview data from 38 parents of childhood cancer patients who had recently completed cancer treatment (childs mean age: 6.98 years). Parents described a range of treatment side effects that impacted on their childs ability to eat, often resulting in weight loss. Sixty-one percent of parents (n = 23) reported high levels of stress in regard to their childs eating and weight loss during treatment. Parents reported stress, feelings of helplessness, and conflict and/or tension between parent and the child during feeding/eating interactions. Parents described using both positive and negative feeding practices, such as: pressuring their child to eat, threatening the insertion of a nasogastric feeding tube, encouraging the child to eat and providing home cooked meals in hospital. Results indicated that parent stress may lead to the use of coping strategies such as positive or negative feeding practices to entice their child to eat during cancer treatment. Future research is recommended to determine the implication of parent feeding practice on the long term diet quality and food preferences of childhood cancer survivors.

Adequacy of Nutritional Support in Pediatric Blood and Marrow Transplantation

The use of nutrition support has become standard practice in blood and marrow transplantation, but what remains unclear is whether patients receive adequate nutrition supplementation during this time. This study is a retrospective audit of the nutritional supplementation of 34 pediatric patients admitted to a pediatric oncology unit for a blood and marrow transplantation. All patients received parenteral nutrition (PN) as their standard nutritional therapy with an average of 79 ± 10.6% of their estimated requirements given over the transplant period. The glucose/amino acid infusion was inadequate on 40% of PN days mainly because of fluid overload causing a reduction in infusion rates. The lipid infusion was inadequate on 60% of PN days mainly because of stoppages when drugs and/or blood were infused. The mean percentage weight change on discharge was +0.3 ± 4.7%. This had a large range of between −9.9% and +7.9% of body weight and did not seem to be related to adequacy of nutrition during transplant. This study showed that although frequent rate reductions in nutrition infusions did occur, most patients still received the majority of their nutritional requirements.

Changes in body mass index in long-term survivors of childhood acute lymphoblastic leukemia treated without cranial radiation and with reduced glucocorticoid therapy.

Cranial radiation and glucocorticoids are associated with an increase in body mass index (BMI) z‐score in survivors of childhood acute lymphoblastic leukemia (ALL). We aimed to investigate the impact of a contemporary treatment protocol that omitted prophylactic cranial radiation and glucocorticoids from the maintenance phase on longitudinal BMI, height, and weight z‐scores in children with ALL.

Paediatric oncology patient preference for oral nutritional supplements in a clinical setting

PurposeOral nutrition supplements are commonly used to increase the nutrient intake of children who are undergoing treatment for cancer. However, little research has been conducted systematically examining preferences for oral supplements in this population. This study aims to address a gap in the literature by examining taste preferences of oral nutrition supplements routinely recommended for children undergoing treatment for cancer.MethodsTwenty-one children undergoing treatment for cancer and 38 healthy control subjects participated in an acute double-blinded feeding trial. A variety of energy drinks, available both commercially and in the hospital, were sampled. Patients rated the taste of the drinks on a 10-cm coloured analogue scale.ResultsA commercially-based drink (Moove™) rated the highest in the blinded and branded tests for the treatment (mean rating out of 10, 6.44 ± 2.69 and 7.26 ± 2.33, respectively) and control groups (mean rating, 7.61 ± 1.91 and 7.70 ± 2.32, respectively). Taste ratings were significantly higher for commercially available supplements over the hospital-prepared supplements, (p = 0.041), with no main effect for tasting condition (i.e. blinded versus branded, p = 0.902). There was a statistically significant trend such that ratings, when the brand that was known decreased for hospital supplements, while ratings for commercially available supplements increased (p = 0.014).ConclusionFresh milk-based supplements were the preferred type of oral nutrition supplement in a cohort of paediatric oncology patients. The data also suggest that commercially available products are more likely to be accepted than hospital-prepared supplements. This pilot study supports the need for further research in the area of oral nutrition supplements for paediatric oncology patients as a way of determining a reliable way to estimate preferences and therefore maximise compliance. Results from this research could be also used as the basis for designing research to study the effects of flavour fatigue and long-term compliance with oral nutrition supplements in this population.

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study:

Background: Despite the importance of nutrition support in preventing malnutrition in pediatric oncology, the decision to initiate and choose which nutrition support method is most appropriate can be difficult for parents and healthcare professionals. Decision aids are decision-focused patient information materials. They can improve knowledge, reduce decisional conflict, improve patients’ risk perception, and increase patient participation in the decision-making process. They have never been evaluated for pediatric oncology nutrition decisions. We aimed to develop and pilot test a decision aid to assist parents making these decisions in collaboration with their healthcare team. Materials and Methods: The decision aid was developed in accordance with the International Patient Decision Aid Standards guidelines and evaluated in a single-center pilot study. The parents and healthcare professionals of pediatric oncology patients were eligible. Participants read the decision aid and completed a questionnaire assessing acceptability, usability, and improvement in understanding. Results: Thirty-one parents and 15 healthcare professionals participated. Parents found the decision aid balanced, relevant, and satisfactory overall. Some parents reported the decision aid was too long (26%). Healthcare professionals positively rated the development process, usefulness to parents, and content and format of the decision aid. Forty-three percent reported that using the decision aid would save them time. There were no significant associations between health literacy, decisional satisfaction, decisional regret, acceptability, and improvement in understanding. Conclusion: The decision aid appears acceptable and usable for our target population. Decision aid feedback provided critical data to make modifications before evaluating the decision aid in a randomized controlled trial.

Parent, patient and health professional perspectives regarding enteral nutrition in paediatric oncology

AIM Enteral tube feeding (ETF) is an important part of treatment for paediatric cancer patients. Without nutritional therapy, the prevalence of under-nutrition during treatment for childhood cancer may be as high as 50%. To ensure that the appropriate initiation of ETF is optimised, information on the views of key stakeholders regarding ETF is needed. METHODS In total, 48 interviews were conducted with parents of paediatric cancer patients (n = 20), patients (n = 10) and members of the paediatric oncology health-care team (n = 18). Semistructured interviews were used to elicit information from participants, and the data were analysed using a content analysis approach. The interviews focused on views regarding: (i) attitude toward, and impact of, ETF; (ii) information and support regarding ETF; and (iii) clinical management of ETF. RESULTS There was agreement between stakeholders on the impact of ETF on patients, both positive (good nutrition, weight gain and decreased anxiety) and negative (physical appearance, invasive insertion procedure and comfort). There were discordant perceptions regarding the timing and type of information provided on the use of ETF, as well as the decision-making process used. CONCLUSIONS By standardising the information given to parents and enhancing understanding of parent, patient and health-care worker perceptions about ETF, the initiation of tube feeding may be optimised. This may positively impact patient outcomes in the future.