Short- and long-term effectiveness of enteral and parenteral nutrition in reversing or preventing protein-energy malnutrition in advanced neuroblastoma a prospective randomized study

Abstract

The effectiveness of enteral and parenteral nutrition regimens in preventing or reversing protein-energy malnutrition (PEM) and in preventing treatment delays was evaluated in 32 children receiving treatment for newly diagnosed Stage 111 (3 patients) and IV (29 patients) neuroblastoma. Ten of 18 malnourished patients were randomized to central parenteral nutrition (CPN) and 8 to peripheral parenteral nutrition (PPN) plus enteral nutrition for 4 weeks and then received enteral nutrition (EN: intense nutrition counselling, oral foods and supplements) for weeks 5 through 10. Ten of 14 nourished patients received EN and 4 CPN for 4 weeks and EN thereafter. Dietary, anthropometric and biochemical measurements were determined for weeks 0, 1,2,3,4,7, and 10 for 24 patients who completed the protocols. In malnourished patients, both CPN (seven patients) and P P N (seven patients) were effective in reversing P E M in the first 4 weeks; thereafter, EN effectively maintained nutritional gains in both groups. In nourished patients, EN (seven patients) was not as effective as CPN (three patients) in preventing P E M during the first 4 weeks; afterwards, EN maintained gains in the CPN group but did not promote needed increases in weight nor fat reserves in the EN group. Patients supported by parenteral nutrition (PN, weeks 1-4) had fewer treatment delays (2/17, 12%) than EN patients (4/7,57%, P < 0.05). These data indicate that PN reverses or prevents P E M and prevents treatment delays during the first 4 weeks of intense oncologic treatment and provides nutritional benefits which can be maintained with EN thereafter.Cancer 56:2881-2897. 1985.lTHIN the last decade, multimodal treatment has W vastly improved the outcome of many children with cancer. Prognosis for children with advanced neuroblastoma, however, continues to be discouragingly poor.

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.…”

“…Intensive nutritional counselling was unable to achieve this van Eys et al, 1979van Eys et al, , 1980Filler et al, 1977Filler et al, , 1979Ghavimi et al, 1982;Hays et al, 1983;Rickard et al, 1979Rickard et al, , 1980Rickard et al, , 1983bRickard et al, , 1985Szeluga et al, 1987). Nutritional counselling, with the aim of increasing oral energy intake, was only successful in maintaining an adequate nutritional status after the initial phase of treatment and during maintenance therapy (Rickard et al, 1980(Rickard et al, , 1985. So far, the use of nasogastric tube feeding, another well-known means of providing nutritional support, has received little attention in children with cancer, even though the enteral route is more physiological, cheaper, safer and easier than the parenteral route (Lukens, 1984).…”

The prognostic significance of basic anthropometric data in children with advanced solid tumors

“…In this study, three of the Wilms' tumor patients and five children with neuroblastoma had weights or heights below the 10th percentile at the time of diagnosis. The poor prognosis associated wilh nutritional depletion prior to the initiation of chemotherapy has been well documented in previous studies (8,21,22). Rickard and co-workers (21) reported a decreased number of days to tumor relapse or death in children who were malnourished at diagnosis.…”

Nutritional considerations in children undergoing bone marrow transplantation

“…The role of conventional diet in maintaining nutritional status during insult A number of studies have shown that conventional feeding with added supplements is insuf®cient in preventing or reversing weight loss in children with leukaemia ± lymphoma (Hays et al, 1983), Wilms' tumours (Rickard et al, 1980), advanced neuroblastoma (Rickard et al, 1985), and a variety of tumours requiring abdominal irradiation (Donaldson et al, 1984). Rickard et al reported a deterioration in the nutritional status of children with Wilm's tumour who did not receive PN compared with those who did (Rickard et al, 1980).…”