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Effects of malnutrition on treatment‐related morbidity and survival of children with cancer in Nicaragua
Author(s) -
Pribnow Allison K.,
Ortiz Roberta,
Báez Luis Fulgencio,
Mendieta Luvy,
LunaFineman Sandra
Publication year - 2017
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26590
Subject(s) - medicine , malnutrition , pediatrics , cancer , wilms' tumor , malnutrition in children , pediatric cancer , psychological intervention , psychiatry
Background Most children with cancer live in resource‐limited countries where malnutrition is often prevalent. We identified the relationship between malnutrition and treatment‐related morbidity (TRM), abandonment of therapy, and survival of children with cancer in Nicaragua to better inform targeted nutritional interventions. Procedure We conducted a retrospective review of patients aged 6 months to 18 years with newly diagnosed acute lymphoblastic leukemia, acute myeloid leukemia (AML), Wilms tumor, Hodgkin lymphoma, or Burkitt lymphoma (BL) who were treated between January 1, 2004, and December 31, 2007 at Children's Hospital Manuel de Jesus Rivera in Managua, Nicaragua. Statistical analysis examined the relations among nutritional status and cancer type, risk category, TRM, and event‐free survival (EFS). Results Sixty‐seven percent of patients (189/282) were malnourished at diagnosis. Malnutrition was highest among patients with Wilms tumor (85.7%), BL (75%), and AML (74.3%). A total of 92.2% of patients (225/244) experienced morbidity during the first 90 days. Malnutrition was associated with severe infection ( P = 0.033). Severely malnourished patients had ≥grade 3 TRM on more days ( P = 0.023) and were more likely to experience severe TRM on >50% of days ( P = 0.032; OR, 3.27 [95% CI, 1.05–10.16]). Malnourished patients had inferior median EFS (2.25 vs. 5.58 years; P = 0.049), and abandoned therapy more frequently ( P = 0.015). Conclusions In Nicaragua, pediatric oncology patients with malnutrition at diagnosis experienced increased TRM, abandoned therapy more frequently, and had inferior EFS. Standardized nutritional evaluation of patients with newly diagnosed cancer and targeted provision of nutritional support are essential to decrease TRM and improve outcomes.