Effect of nutrition staging on treatment delays and outcome in stage IV neuroblastoma

Abstract

The effect of the state of nutrition of 18 children with Stage IV neuroblastoma at diagnosis and during initial therapy, was evaluated with respect to treatment delays, drug dosage alterations, tumor response, days to first event (relapse or death), and survival. All patients received similar therapy (CCSG protocol CCG 371). Based on nutrition staging at diagnosis, nine were classified as malnourished; four were randomized to receive total parenteral nutrition (TPN) and four peripheral parenteral nutrition plus enteral nutrition for 28 days (through 2 chemotherapy courses), and one died before randomization. Nine were nourished at diagnosis; seven received a comprehensive enteral nutrition program and two received TPN. By life‐table analysis, the duration of remission was significantly greater in the nourished than the malnourished (P < 0.01) and a trend towards improved survival was evident at one year (P = 0.08). The median length of survival for children nourished at diagnosis was approximately 12 months, whereas those malnourished had a median survival of only 5 months. Nine children remained nourished or were becoming renourished during the first 21 days of therapy, and one of these had treatment delays and decreased drug dosages. Seven were becoming malnourished or remained malnourished during this period and six had treatment delays (P < 0.01). These data support the idea that nutrition staging at diagnosis and during initial treatment should be an integral part of protocol design and initial evaluation of children with Stage IV neuroblastoma.

Effects of naso-gastric tube feeding on the nutritional status of children with cancer

“…Furthermore, a poor nutritional status has been associated with an impaired tumour response to treatment and outcome of disease (Donaldson et al, 1981;van Eys, 1982;Rickard et al, 1983a), reduced therapy tolerance van Eys, 1979;Filler et al, 1977;Hays et al, 1983;Rickard et al, 1983aRickard et al, , 1985, impaired immunological function (van Eys, 1979;van Eys et al, 1980) and a reduced state of well-being and performance (Donaldson et al, 1981;van Eys, 1979;Mauer et al, 1990). The aim of nutritional intervention must therefore be the prevention of therapy-related malnutrition and the added effects of protein energy malnutrition (PEM).…”

“…Naso-gastric tube feeding in children with cancer E den Broeder et al Several factors might have contributed to this: (1) The improved availability and ef®cacy of anti-emetics over the past few years has obviously led to better control of the adverse side-effects during courses of chemotherapy; (2) A poor nutritional status of a child with cancer leads to reduced therapy tolerance van Eys, 1979;Filler et al, 1977;Hays et al, 1983;Rickard et al, 1983aRickard et al, , 1985. The nutritional status of the children in the retrospective group was poorer than that in the experimental group at the same point during treatment, which might account for the difference in severity and frequency of vomiting; (3) Protocolized administration of tube feeding leads to optimisation of anti-emetic protocols, as the goal is to be able to administer suf®cient amounts of energy to provide the child's TDER.…”

“…The incidence of malnutrition at diagnosis, caused by the presence of the tumour and several tumour related factors, varies from 6± 50% or even more depending on the tumour type, stage of disease and the criteria used to de®ne malnutrition (Donaldson, 1982;van Eys, 1979;Rickard et al, 1982Rickard et al, , 1983a. Due to aggressive oncological treatment modalities, the nutritional status of a child with cancer will deteriorate rapidly, especially during the initial intensive phase of treatment, if no nutritional intervention is applied .…”

Evaluation of muscle protein mass in children with solid tumors by muscle thickness measurement with ultrasonography, as compared with anthropometric methods and visceral protein concentrations

“…Malignant diseases and their treatment are commonly associated with protein-energy malnutrition (Donaldson et al, 1981;Rickard et al, 1983;Donaldson, 1982). At diagnosis of pediatric solid tumors, the incidence of malnutrition ranges up to 50% (Rickard et al, 1983).…”

“…At diagnosis of pediatric solid tumors, the incidence of malnutrition ranges up to 50% (Rickard et al, 1983). Especially at the beginning of treatment, protein energy reserves are of clinical importance for the outcome: in children with solid tumors, poor nutritional status at presentation is associated with increased relapse rates (Donaldson et al, 1981).…”