Clinical implications of malnutrition in children with cancer

Abstract

To the editor,We thank Barr for the interest in our recent research article regarding the clinical implications of malnutrition in childhood cancer patients [1]. In his letter, Barr states that the plea in our article-to undertake larger prospective case-control studies to further investigate the role of malnutrition in childhood cancer-has been preempted and acted upon already [2]. However, we cannot agree with this statement, for reasons stated below. Also, in our opinion, Barr's points of critic do not touch the fundaments of our study, among other things correcting for the variety of diseases and corresponding prognoses, and therefore do not decrease the scientific value of our findings and conclusions.The study Barr is referring to from Sala et al. is a very nice study which indeed included far more patients than we did [3]. We agree with Barr that the reference to this study is not accompanied by the correct text, for which we apologize. Also, in retrospect, it would have strengthened our paper to discuss the results from the study of Sala et al. in more detail and compare these with our results. Also, incorporation of results of the study of Antillon et al., as suggested by Barr in his letter, would have been a valuable addition [4].However, focusing on the results of Sala et al., there are two vital differences between our study and Sala's study, apart from the previously mentioned difference in sample size. First, economical differences and corresponding health care situation. The referred study by Sala et al. was performed in Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. All these countries are categorized as developing counties (gross national income per capita lower than $12,746) by the World Bank [5]. Our study was performed in the Netherlands, which is categorized as a developed country. Large differences between developed and developing countries exist in prevalence of malnutrition, which for example is shown in prevalence of severe malnutrition in the mentioned studies; 17.1 % in the study of Sala et al. versus 5.2 % in our study. However, it should be noted that different cutoff points and reference values for malnutrition hinder a one-to-one comparison of our results. Geographical differences in our studies are not limited to malnutrition alone, as prognosis of childhood cancer also differs substantially, with a 3-year overall survival of 48 % in Central America and Caribbean countries (where the study of Sala et al. took place) versus a 3-year overall survival of 81 % in Central Europe (where our study took place) [6,7]. In our opinion, the previously mentioned differences make it impossible to compare these studies.Second, although Sala et al. did include an unselected variety of cancers in their study, they have not attempted to correct for this variety. As there are many different cancer types, prognosis and severity of treatment can vary greatly. We corrected for expected prognosis based on diagnosis and intensity of treatment in our analyses. Ther...

AYA survivorship: The next challenge

“…Another factor influencing mortality is nutrition. A poor nutritional state is known to compromise cancer survival outcomes . Eating disorders may complicate the pre‐existing nutritional challenges associated with cancer care.…”

“…A poor nutritional state is known to compromise cancer survival outcomes. 19 Eating disorders may complicate the pre-existing nutritional challenges associated with cancer care. The onset of eating disorders is usually seen during adolescence and young adulthood and carries with it significant medical sequelae and a high mortality rate in its own right.…”