Linc-08. Increased Treatment Toxicities and Inferior Outcomes in Undernourished Children With Brain Tumours

Abstract

BACKGROUND Children on treatment for brain tumours are known to be at high risk of undernutrition, the impact on outcome and toxicity is not well understood. METHODS Retrospective audit of children(<18 years)diagnosed January 2017-December 2018 with embryonal brain tumours (medulloblastoma, primitive neuro-ectodermal tumors, pinealoblastoma, atypical teratoid/rhabdoid tumour) and treated at our centre. Data was retrieved from case records and electronic medical records. Nutritional status(NS) was defined as per World Health Organization (WHO) into severe malnutrition (SAM),moderate malnutrition (MAM),well nourished (WN) and overweight. Undernutrition(UN) was defined as SAM/MAM.Toxicity was documented till end of treatment,defined as treatment delay>1week,significant infection or toxic death. RESULTS Of 124 eligible patients who received entire chemotherapy at our centre, NS data was available in 73 at diagnosis and 58 at follow-up. At diagnosis-29,16,26 and 2 and at follow-up-20,16,22 and 0 were SAM,MAM,WN and overweight. During treatment, weight gain was documented in 26%, stable weight in 55% and weight loss in 19%. Those UN at diagnosis had worse outcomes at follow-up with 70% alive in remission compared to 88% of WN(p-0.14). There was increased toxicity in UN group(50%) compared to WN(24%),p-0.04.All 3 toxic deaths were in UN. Those who lost weight during treatment had higher toxicities(70%) compared to those with stable weight (30%)or weight gain(20%),p-0.02. CONCLUSIONS In spite of nutritional intervention, children on treatment for brain tumours tend to lose weight. Increased treatment toxicities and inferior outcomes in undernourished children with brain tumours necessitates proactive and aggressive nutritional monitoring and intervention.

Impact of a pediatric oncology nutrition program: Lessons learnt over a decade

“…Studies in children with acute lymphoblastic leukemia, embryonal brain tumors, and high‐risk febrile neutropenia have demonstrated poorer clinical outcomes in undernourished children 21–23 . An audit of 2110 children between 2017 and 2019 found that children with bone tumors, acute myeloid leukemia, abdominal solid tumors, and brain tumors had the highest prevalence of undernutrition at diagnosis (70%), with brain tumors continuing to lose weight while on treatment and proactive nutritional management 24 .…”