Reduced tolerance to
intensive therapy/increased
risk of drug toxicity
MANAGING MALNUTRITION IN CHILDREN WITH CANCER
Disease-related malnutrition in paediatric cancer patients is common and can have a significant impact on patient outcomes as well as the disease trajectory.1,2 However, nutrition has a far more fundamental importance with respect to a growing, developing child, meaning the pathology of the disease in children can be very different from that observed in adults.3
Nutrition has a role in most areas and components of the cancer control spectrum, from prevention through to palliation and can impact morbidity and mortality.2 Nutritional assessment is therefore an essential part of clinical care for paediatric cancer patients, especially during and after the completion of treatment.3
Disease-related malnutrition in children with cancer is extremely common and can be caused by a number of factors, including the disease itself as well as the effects of treatments.1,4
DISEASE-RELATED CAUSES
Pro-inflammatory cytokines released by the tumour lead to increased metabolic rate and catabolism, resulting in macro and micronutrient deficiencies
TREATMENT-RELATED CAUSES
Chemotherapy-induced gastrointestinal (GI) symptoms such as vomiting, constipation, diarrhoea, and malabsorption mean that nutrients are lost and may not be replaced
PSYCHOLOGICAL CAUSES
Taste changes and loss of appetite mean that children with cancer often have reduced dietary intake
Disease-related malnutrition can have a devastating impact on treatment outcomes in paediatric cancer patients, including:2,4,5
Reduced tolerance to
intensive therapy/increased
risk of drug toxicity
Increased risk of
infection
Increased frequency and
length of hospital stay
Decreased quality of
life including reduced
physical and social
functioning
Negative impact on
growth and
development
Increased mortality
Disease-related malnutrition in children with cancer can also often impact their daily lives, leaving them feeling too weak and fatigued to take part in physical activities, which can impact their ability to socialise with their peers and they can be more vulnerable to feelings of fear and sadness.6
Identifying malnutrition early is vital in children with cancer to provide timely and appropriate nutritional intervention.5 Early assessment and nutritional intervention can help improve quality of life and completion of treatment.7
Screening and assessment should be performed as early as possible in children with cancer (ideally at diagnosis) and repeated on a regular basis to assess and manage risk.5 It is particularly important as malnutrition may be masked by the weight of the tumour, which can lead to a falsely elevated body weight.8
A validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age.
A validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation.
MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children.
Nutritional interventions are indicated in all children with cancer who are malnourished or at risk of developing malnutrition, to prevent and/or restore abnormalities in growth development before nutritional and general status are severely compromised.8
Studies have shown the benefits of oral nutritional supplement (ONS) treatment in terms of BMI status among paediatric oncology patients.9 Cost-effectiveness data show that additional costs of ONS administration to malnourished or at-risk cancer patients are offset by lower hospitalisation and treatment costs.10
Nutritional interventions should always be tailored to the child. Oral routes should be tried initially but if oral intake is not possible due to underlying disease or treatment, enteral tube feeding should be considered.8
If the patient is experiencing GI symptoms, a peptide-based formula may be the most appropriate intervention. Peptide-based formulas provide protein in shorter parts (peptides) that are absorbed more rapidly by the body. Compared to whole protein feeds, peptide-based feeds have been associated with improved GI symptoms, improved tolerance and a reduced risk of diarrhoea in malnourished children with compromised GI function.11
PaediaSure® Plus
PaediaSure Plus is suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. PaediaSure Plus provides 1.5 kcal/ml and is available both as a 500 ml Ready to Hang tube feed and as a 200 ml oral nutritional supplement.
PaediaSure® Compact
PaediaSure Compact is a 125 ml oral nutritional supplement suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. It has been specifically developed for children who may benefit from a smaller volume, as an alternative to ready-to-drink supplements which are 200 ml in volume. Each bottle provides 301 kcal (2.4 kcal/ml) and 8.4 g of protein. The milkshake style oral nutritional supplement is ready-to-drink and available in three delicious flavours: banana, strawberry and vanilla.
PaediaSure® Peptide
PaediaSure Peptide is suitable for the dietary management of children weighing 8-30 kg with malabsorption or children who experience symptoms of poor feed tolerance.
PaediaSure Peptide is 1.0 kcal/ml, with 100% proteins broken down to peptides*, 50% fat as medium-chain triglycerides (MCT) and clinically lactose free. PaediaSure Peptide is available both as a 500 ml Ready to Hang tube feed and as a 200 ml bottle. It is available in vanilla flavour and is best served chilled.
*Peptides are partially broken down proteins, which makes them easier to digest and absorb in the gut than whole proteins.
In this course, you’ll learn to describe the dietary management of common childhood cancers, identify practical dietary interventions for managing side effects and symptoms associated with childhood cancers, and assess dietary considerations when managing paediatric oncology patients in the community.
In this course, Elena J. Ladas, PhD, RD will describe how under- and overnutrition are important contributors to a paediatric oncology patient’s morbidity, quality of life, and mortality, discuss the consequences of cancer and review the short- and long-term nutritional implications, and explain how to recognise the evaluation of nutritional status as an essential component of oncology care.
References:
1. Joffe L, Ladas EJ. Lancet Child Adolesc Health 2020;4(6):465-475.
2. Rogers PC. Indian Journal of Cancer 2015;52(2):176-8.
3. Rogers PC & Barr RD. Paediatric Blood and Cancer 2020;6(S3):e28213.
4. Triarico S et al. Eur Rev Med Pharmacol Sci. 2019;23(3):1165-1175.
5. Diakatou V and Vassilakou T. Children 2020;7:218.
6. Brinksma A et al. Support Cancer Care 2015;23(10):3043-3052.
7. WHO. WHO report on cancer: setting priorities, investing wisely and providing care for all. 2020. https://www.who.int/publications/i/item/9789240001299 Accessed July 2022.
8. Bauer J et al. Adv. Nutr 2011;2:67-77.
9. Demirsoy U et al. Surg Med 2021;5(3):276-279.
10. Caccialanza R et al. Clinical and economic value of oral nutrition supplements in cancer patients: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Supportive Care in Cancer. Preprint. Available online: https://doi.org/10.21203/rs.3.rs-1357518/v1 Last accessed March 2024.
11. Selimoglu MA et al. Front. Pediatr 2021;9:610275.
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ENSURE PLUS
1 x 220 ml
Flavor: Apple
1,5 kcal / ml
Nutrition Information
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
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