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.

Parenteral and enteral nutrition for pediatric oncology in low‑ and middle‑income countries.

Although nutritional therapy is essential for the treatment of childhood cancer, it remains a challenge, especially within the developing world, where there are many barriers to optimizing treatment. The oral route is the first approach to nutritional support, however challenging this might be in children with cancer. Oral supplements are indicated in moderate evaluated nutritional risk patients and its use should consider the family’s social conditions and access to industrialized oral supplements. If unavailable, homemade oral supplements can be used respecting regional accessibility, local foods, and culture. Nonetheless, many patients cannot sustain nutritional status on oral feeding alone and need to be supported by enteral tube feeding. Enteral feeding may be modified to accommodate the financial constraints of institution in low‑ and middle‑income countries (LMICs). In some oncologic situations, however, enteral nutrition is not possible and parenteral nutrition is indicated, although only if the need for nutritional support is anticipated to be longer than 5–7 days. Nutritional support in pediatric oncology remains a challenge, especially in LMICs, however, it can be undertaken by getting the best out of the available resources.