Impact of Malnutrition on Survival and Treatment Related Morbidity of Cancer in Children

Abstract

Aim: To find out the impact of malnutrition on survival and treatment-related morbidity of cancer in children and to raise awareness among health care professionals to critically address the issues of malnutrition at diagnosis and during various treatment phases of cancer in children.
Methods: This is a retrospective study, all children of age 1 year to 18 years newly diagnosed with cancer presented to the Pediatric Oncology Department SKMCH &RC from January 1, 2021, to June 30, 2021, were included in the study, and their data was collected from the HIS system. The enrolled patients in the study were followed up further for disease outcome from July 1, 2021, till March 31, 2023, through HIS notes with no direct contact with the patients. Newly diagnosed children with cancer having other co-morbidities like HIV, congenital heart disease, chronic lung and liver disease, and others were excluded, and those patients who had not received any chemotherapy or radiotherapy after diagnosis were also excluded from the study.
Results: The sample comprised of one hundred and sixty pediatric cancer patients. On admission, 68 (42.5%) of all the children newly diagnosed with cancer were malnourished using weight for height Z score of < -3 to < -1SD for children below 5 years of age and BMI ≤ -2Z score for children aged 5 to 18 years. The rate of infections (frequency of 3+ hospitalizations for FN episodes and NNF) was enhanced by malnutrition in the initial phase of treatment (6 months after diagnosis) (p.Tag 0.025). Using univariate and multivariate approach, it was revealed that weight loss more than 10 percent and BMI score reduction by more than 1 to 6 months were associated with the survival and infections independently. In addition, analysis of one variable at a time also revealed high correlation between the two variables: treatment interruptions and malnutrition.
Conclusion: The timely intervention of a condition requires a thorough evaluation of nutritional status at diagnosis and close monitoring for malnutrition during the initial treatment phase, which may potentiate the treatment response to chemotherapy and decrease treatment interruptions. This will prevent prolonged hospitalization for infections in childhood cancer patients and will possibly increase the survival rate.
Keywords: Pediatric cancer, Nutritional assessment, Malnutrition, febrile neutropenia, weight/height Z-score, Survival