The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low‑middle income countries.

PURPOSE: Despite advances in the field of pediatric oncology, which have contributed to an overall increase in event‑free survival, high rates of malnutrition in low‑middle income countries (LMICs) is still a major concern. This paper aims to describe the multifaceted development process of a nutrition intervention algorithm for pediatric oncology in LMIC. METHODS: The development of evidence‑based algorithm took place over seven developmental phases, utilizing an interdisciplinary process with the clinical review. Phase 1: Collaboration with the International Paediatric Oncology Nutrition Group. Phase 2: Review of peer‑reviewed literature for evidence‑based algorithm. Phase 3: Draft algorithm development. Phase 4: Draft algorithm presented at international meetings for stakeholder feedback. Phase 5: Consultation with LMIC dieticians to identify additional needs and feasibility of the algorithm in resource‑poor settings. Phase 6: Review of the final draft algorithm by an expert panel. Phase 7: Pilot and Preliminary Feasibility. RESULTS: The nutrition algorithm was piloted in three LMIC countries (Brazil, South Africa and India). Overall the LMIC nutrition intervention algorithm was considered feasible for use with a “yes” response to the question “was the algorithm useful to know what nutrition to give the child and when” 90% of the time, rendering to the tool feasible. However, the testing process did identify several limitations that need to be considered in future versions. CONCLUSIONS: This comprehensive collaborative process with interdisciplinary health professionals has successfully developed a pediatric oncology nutrition intervention algorithm for LMIC. Further feasibility testing and a longitudinal study are required.

Nutritional assessment and intervention in a pediatric oncology unit.

Nutritional status in children with cancer is an important prognostic factor. Assessment consisting of anthropometry, biochemistry, clinical, and diet that needs to be done on diagnosis and regularly to ensure that patient’s nutritional status does not deteriorate. In developing countries, assessment will depend on the availability of all resources, but monitoring is essential. The development of malnutrition during treatment is possible and the reasons are multifactorial. Nutrition plays a deciding role and a key factor in children with cancer and can influence their outcome.