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Malnutrition in pediatric patients with cancer at diagnosis and throughout therapy: A multicenter cohort study

Authors

  • Karin Zimmermann MSc, RN,

    1. Institute of Nursing Science, University of Basel, Basel, Switzerland
    2. Pediatric Hematology/Oncology, Department of Pediatrics, University of Bern, Bern, Switzerland
    3. Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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  • Roland A. Ammann MD,

    1. Pediatric Hematology/Oncology, Department of Pediatrics, University of Bern, Bern, Switzerland
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  • Claudia E. Kuehni MD,

    1. Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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  • Sabina De Geest PhD, RN,

    1. Institute of Nursing Science, University of Basel, Basel, Switzerland
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  • Eva Cignacco PhD, RM

    Corresponding author
    1. Institute of Nursing Science, University of Basel, Basel, Switzerland
    • Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Malnutrition is a common problem in pediatric patients with cancer. Reported prevalence varies widely and has often been assessed only in a subset of childhood types of cancer. This study aimed to describe the prevalence of malnutrition among pediatric patients newly diagnosed with cancer, to describe the occurrence and course of malnutrition during therapy and to identify factors associated with malnutrition during therapy.

Procedure

In a retrospective cohort study of 327 patients diagnosed from 2003 to 2006 in three Swiss tertiary care hospitals, weight and height measures together with patient-, disease-, and treatment-related characteristics were assessed. Malnutrition was defined as body mass index (BMI) below −2 standard deviation scores (SDS) or a weight loss >10% from diagnosis. Malnutrition was assessed at diagnosis and continuously during anticancer therapy.

Results

At diagnosis, 5.8% of the patients (19) were malnourished based on BMI. During anticancer therapy, the cumulative incidence of malnutrition rose to 22% (70 patients) after 30 days, to 36% (116 patients) after 60 days, and finally to 47% (155 patients). In these 155 patients, the median duration of malnutrition was 60 days (interquartile range, 21–122). Age above 10 years at diagnosis, BMI ≤ −1.0 SDS at diagnosis, and a diagnosis of medulloblastoma were positively associated with a higher proportion of malnutrition time during therapy.

Conclusions

The rapid increase of malnutrition after the start of treatment underlines the need to develop evidence-based and efficient methods to provide nutritional support for children with cancer. Pediatr Blood Cancer 2013; 60: 642–649. © 2012 Wiley Periodicals, Inc.

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