The Effect of Nutritional Support on the Disease Progression and Survival in Pediatric Patients with Solid Tumors.

Cancer is one of the leading causes of death for children; however, appropriate nutritional status can positively affect survival. The aim of this study was to determine to what extent malnutrition risk screening and intensified nutrition support, provided by a professional team, promoted disease progression and survival in pediatric patients with solid tumors. 145 pediatric cancer patients (average age 6.3 ± 5.6 and 6.7 ± 5.4 years) with solid tumors undergoing chemotherapy participated in the study. Two 3-year periods were studied: 2009-2011 and 2012-2014. Patient characteristics and treatment protocols were identical, but in Period 2, with the foundation of our nutrition support team malnutrition risk screening was made mandatory upon every hospital admission. As a result of intensified nutrition support the time from diagnosis to completion of treatment (802 vs. 512 day, p < 0.001) and the need for antimycotic treatment reduced significantly (47.8% vs. 29.1%, p = 0.036). The total percentage of surviving children was 60.3% and 75.0% in Period 1 and 2 respectively. Decrease in weight-for-height percentile during treatment and central nervous system tumors are significant predictors of a less favorable survival. Malnutrition risk screening and intensified nutrition therapy have positive effects on nutritional status and therefore patient survival in pediatric cancer patients.

Different nutritional screening tools and recommended screening algorithm for pediatric oncology patients.

BACKGROUND & AIMS: Cancer is one of the leading causes of death for children; however, appropriate nutritional status can positively affect disease progression and outcome. The aim of this study was to present our self-developed nutritional risk screening method, relate it to another validated tool and to objective bio-impedance measures. We intended to recommend a screening algorithm which can be used in our pediatric oncology facilities. METHODS: We analysed data from 109 pediatric oncology patients (age 3-18) at the 2nd Department of Pediatrics, Semmelweis University between 2017 and 2018. The nutritional status was assessed by the Nutrition screening tool for childhood cancer (SCAN), Nutrition risk screening for pediatric cancer (NRS-PC) our own self-developed screening tool and Bio-impedance analysis (InBody 720 and S10). Classifier properties for low muscle mass measured by Bio-impedance analysis were compared for SCAN and NRS-PC in the overall sample and in the different phases of the disease. RESULTS: The AUC of 0.67 [95% CI:0.58,0.75] of the SCAN was significantly lower (Z = -2.46, p = 0.014) than in the case of the NRS-PC (AUC = 0.75 [95% CI:0.67,0.82]), indicating that NRS-PC has better classifier properties to identify children with lower muscle mass. No significant difference was found in the different phases of the disease. CONCLUSIONS: Based on our results, we suggest screening high BMI patients first with NRS-PC. However, in case of low BMI bio-impedance measures provide more precise information on muscle mass and nutritional risk. Further data are needed to decide whether the NRS-PC is sensitive enough in normal BMI patients.