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Nutritional consequences in children undergoing chemotherapy for malignant disease
Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chemotherapy has side effects that may interfere with food intake. Children suffering from a malignant disease are subjected to treatment with chemotherapy. They may therefore become at risk of undernutrition during the period of treatment. This in turn may increase the risk of infections, delayed therapy and influence the outcome of treatment. Few studies have investigated how children undergoing chemotherapy for cancer perceive food and eating. Attempts to improve food intake and the nutritional status require an understand-ing of how eating patterns are altered during chemotherapy in children.

Study design: Dietary information and anthropometric data were collected after the initiation of chemotherapy in 14 children, consecutively admitted to the Paediatric Haematology and Oncology Unit at Umeå University Hospital. This initial study resulted in the establishment of more flexible mealtime routines on the ward. A follow-up study was conducted with another group of 11 children. Interviews were performed with a third group of 21 consecutively ad-mitted children, their parents and attending nurses. The focus was on the children’s own per-ception of and their parents’ and nurses’ attitudes to their food intake during hospitalisation. Recognition thresholds for the basic tastes were determined with 10 of the oldest of these children and 10 healthy controls.

Results: Before introduction of new mealtime routines, the average daily oral energy intake during hospitalisation was 58% of the Swedish Nutrition Recommendations, SNR. The chil-dren had a significant weight loss up to three months after onset of chemotherapy. After the introduction of new mealtime routines, the average daily oral intake on hospital days was 61% of SNR and thus still lower than recommended despite efforts to serve palatable food on the ward. When enteral and parenteral nutrition was included, the energy intake came close to that recommended for healthy children, 91% of SNR. Both children and parents perceived that altered taste was an important cause of the children’s eating problems. The children also viewed food aversions, nausea and vomiting and pain as important causes, while the parents perceived nausea, food aversions and altered smell as significant factors. The nurses on the other hand, viewed nausea, the ward environment, and food rejection as a way of gaining some influence over the situation as important factors. The patients had significantly higher thresholds for bitter taste and significantly more patients made mistakes in taste recognition compared with controls.

Conclusion and clinical implication: There seem to be changes both in the sense of taste as well as in the perception of food in children undergoing chemotherapy for malignant disease. Thus, single solutions such as providing a variety of “tasty food” in the hospital setting in order to improve food intake does not suffice for many paediatric cancer patients. The indi-vidual’s food preferences and aversions should be considered and combinations of oral, en-teral and parenteral nutrition support should be provided.

Place, publisher, year, edition, pages
Klinisk vetenskap, pediatrik , 2005. , 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 985
Keyword [en]
paediatric oncology, chemotherapy, food intake, taste alteration
Identifiers
URN: urn:nbn:se:umu:diva-617ISBN: 91-7305-943-9 (print)OAI: oai:DiVA.org:umu-617DiVA: diva2:144002
Public defence
2005-12-02, sal 135, Allmän medicin, BY 9A, NUS, Umeå, 13:00 (English)
Opponent
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2009-11-27Bibliographically approved
List of papers
1. Nutrient intake and weight development in children during chemotherapy for malignant disease
Open this publication in new window or tab >>Nutrient intake and weight development in children during chemotherapy for malignant disease
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1997 (English)In: Oral Oncology, ISSN 1368-8375, E-ISSN 1879-0593, Vol. 33, no 5, 364-368 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to assess the actual daily oral intake of energy, protein, fat and carbohydrate in relation to current recommendations in children with malignant disease during chemotherapy and to follow their weight development. Dietary information was collected for 21 consecutive days via 7-day recording in 14 children, aged 5-16 years. The number of days with loss of appetite, vomiting, and the number of days on anti-emetic drugs were also recorded. The average daily energy intake decreased from 91% of the recommendation of the Swedish Nutrition Recommendations (SNR), before chemotherapy to 69% after start of chemotherapy. During days spent at home, the energy intake increased to 77% of SNR. Twenty-two per cent of the total energy intake during the hospital days came from sucrose. On average, the children experienced loss of appetite on 50% of the days, vomiting on 12%, and received anti-emetic drugs on 38%. On admission, the average SD score for body weight for the whole group was -0.09. The mean weight reduction after 1 week was 0.19 SD (P = 0.05) compared to the admission weight. The weight reduction 6 weeks (n = 10) and 3 months (n = 13) after the start of chemotherapy was 0.10 SD and 0.37 SD (P = 0.04), respectively.

Identifiers
urn:nbn:se:umu:diva-4765 (URN)10.1016/S1368-8375(97)00015-8 (DOI)9415338 (PubMedID)
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2017-12-14Bibliographically approved
2. Energy and nutrient intake and nutritional status of children with malignant disease during chemotherapy after the introduction of new mealtime routines
Open this publication in new window or tab >>Energy and nutrient intake and nutritional status of children with malignant disease during chemotherapy after the introduction of new mealtime routines
2001 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 15, no 1, 82-91 p.Article in journal (Refereed) Published
Abstract [en]

A previous study at the Paediatric Haematology and Oncology unit at the University hospital of Northern Sweden, Uneå, showed that children with malignant disease had an average daily energy intake below that recommended, and negative weight development after start of chemotherapy. New mealtime routines were introduced. During 7 months in 1995–1996, 11 consecutive children, 2–15 yrs of age, participated in prospective dietary recording for21 consecutive days during their first induction therapy. Daily energy and macronutrient intakes were related to the recommended daily intakes (RDIs) according to the Swedish Nutrition Recommendations, (SNR). ANthropometric data were expressed as SD-score and related to National Centre for Wealth Statistics (NCHS) growth curves. The average daily oral energy intake during days spent at the hospital was 63% of RDI and thus still lower than that recommended. Inclusion of enteral and parenteral nutrition support increased the average daily energy intake to 88% of RDI. After an initial weight loss, a catch-up was seen at 6 months.

Identifiers
urn:nbn:se:umu:diva-4766 (URN)10.1046/j.1471-6712.2001.1510082.x (DOI)
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2017-12-14Bibliographically approved
3. Parents' perception of their child's food intake after the start of chemotherapy
Open this publication in new window or tab >>Parents' perception of their child's food intake after the start of chemotherapy
2001 (English)In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 18, no 3, 124-136 p.Article in journal (Refereed) Published
Abstract [en]

Adequate nutrition is an important part of supportive therapy for the pediatric cancer patient. The aim of this study was to assess parents' perceptions of their child's eating pattern after onset of chemotherapy and the strategies they used to cope when eating problems arose. A semistructured interview was performed with parents of 11 consecutively admitted children. The results showed that parents have a realistic perception of their child's food intake and that they are able to recognize reasons for poor food intake that may be unknown to the staff. The individual responses of the parents and the mechanisms of coping were unique for each individual. The responsibility of getting the child to eat was distressing for many parents. The study indicates that parents need continuous support to serve an optimal role in the nutritional care of their child. Copyright 2001 by Association of Pediatric Oncology Nurses

Identifiers
urn:nbn:se:umu:diva-4767 (URN)10.1053/jpon.2001.20402 (DOI)11373718 (PubMedID)
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2017-12-14Bibliographically approved
4. Percutaneous endoscopic gastrostomy in children with malignant disease
Open this publication in new window or tab >>Percutaneous endoscopic gastrostomy in children with malignant disease
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2002 (English)In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 19, no 5, 154-163 p.Article in journal (Refereed) Published
Abstract [en]

The objective of the study was to assess both the possible complications of percutaneous endoscopic gastrostomy (PEG) in pediatric cancer patients and its effect on weight development. The medical records of 18 children with a median age of 2.5 years (range, 0.5-14.2 years) were reviewed. The diagnoses were leukemia, central nervous system tumors, solid tumors, and lymphoma. The indications for PEG were anticipated therapy-related nutritional problems and inadequate food intake, weight loss, swallowing problems in relation to paresis of the pharynx, and relapse of the disease. Ten children received a PEG at treatment start, and eight children received it at a median time of 3.4 months (range, 0.9-27.4 months) after treatment start. The median duration of having a PEG in place was 12.3 months (range, 1.2-24.0 months). At admission the median weight for age expressed as standard deviation (SD) was -0.11 (range, -2.78-2.68). There was a significant (p =.005) decrease in the median SD from admission until PEG installation. There was also a significant increase in the median SD from the start of PEG use until 1 (p =.04) and 2 (p =.039) months after start. The most common complications were episodes of inflammation of the PEG site, which were successfully treated with topically or orally administered antibiotics, and episodes of infection, which required intravenously administered antibiotics. Taking into consideration the medical condition of the children in the study group and the considerable length of time with a PEG in place, we believe that nutrition via PEG in children with cancer has several advantages and is rarely associated with other than minor complications. Copyright 2002 by Association of Pediatric Oncology Nurses

Identifiers
urn:nbn:se:umu:diva-4768 (URN)10.1016/S1043-4542(02)00008-5 (DOI)12244527 (PubMedID)
Available from: 2005-10-21 Created: 2005-10-21 Last updated: 2017-12-14Bibliographically approved
5. Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses.
Open this publication in new window or tab >>Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses.
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2006 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 14, no 4, 369-378 p.Article in journal (Refereed) Published
Abstract [en]

GOALS OF WORK: The purpose of this study was to better understand various variables related to food intake and eating problems in children with cancer during their chemotherapy. PATIENTS AND METHODS: Twenty-two consecutively admitted children, diagnosed with cancer and undergoing chemotherapy, participated in this study. Twenty-one of them, their parents and attending nurses participated in semi-structured interviews. Ten of the children underwent a taste acuity test, and recognition thresholds for the four basic tastes were determined. MAIN RESULTS: The shared view of both children and parents was that altered taste was the predominant cause of the eating problems. In contrast, the nurses perceived that nausea was the most important cause of the children's eating problems. In addition, psychological aspects such as learned food aversions and negative attitudes towards hospital food were regarded as important by children, parents and nurses. The taste test showed that the patients had higher thresholds for bitter taste and made more taste recognition errors compared to controls. CONCLUSIONS: Changes seem to exist both in the primary gustatory sense as well as in food perception in paediatric cancer patients undergoing chemotherapy. Single solutions, such as efforts to serve "tasty food", do not suffice alone. A more effective solution may be to combine different strategies and combinations of oral, enteral and parenteral nutrition should be considered to prevent malnutrition.

Keyword
Adolescent, Adult, Attitude, Child, Child; Preschool, Eating, Female, Humans, Infant, Interviews as Topic, Male, Middle Aged, Neoplasms/*drug therapy, Pediatrics, Sweden, Taste/*drug effects
Identifiers
urn:nbn:se:umu:diva-6997 (URN)10.1007/s00520-005-0904-6 (DOI)16633841 (PubMedID)
Available from: 2008-02-01 Created: 2008-02-01 Last updated: 2017-12-14Bibliographically approved

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