Çocukluk Çağı Kanserlerinde Diyetisyenin Tedavi Sürecindeki Rolü

Çocukluk çağı kanserlerinde son on yılda teşhis ve tedavi süreci, gelişen teknoloji ve alt yapı sayesinde daha kolay ilerlemektedir. Bununla birlikte tedavi sırasında veya tedaviden sonra kanserin kendisine, tedavi yöntemine, bireysel özelliklere ve beslenme durumuna bağlı olarak hastalarda ciddi komplikasyonlar gelişebilmektedir. Hastalarda gözlenen iştahsızlık, bulantı, kusma, tat-koku duyusunda değişiklikler, sağlıksız besin tercihleri, ailelerin beslenme konusunda yeterli bilgiye sahip olmaması gibi etmenlerden dolayı malnütrisyon riski altındadırlar. Yetersiz beslenme ile birlikte hastalık sürecinde önemli etken olan bağışıklık sisteminde de bozulmalar meydana gelebilir. Özellikle beslenme ile ilgili yapılan çalışmalarda, uzman bir diyetisyen tarafından doğru yaklaşımlarla yapılan beslenme müdahelesi sonucunda hastalık sürecinde malnütrisyonun, enfeksiyon riskinin, beslenmeyle ilişkili diğer komplikasyonların ve hastalıktan sonra gelişme riski yüksek olan metabolik sendrom gibi komplikasyonların prevelansında azalmalar yaşandığı görülmüştür. Bu derlemenin amacı, çocukluk çağı kanserlerinde beslenmeye bağlı meydana gelebilecek komplikasyon riskini en aza indirmek için diyetisyenlerin bireylere uygulayabilecekleri beslenme durum değerlendirmelerini güncel literatüre dayanarak incelemektir.

Anahtar Kelimeler:

Beslenme durum değerlendirmesi, beslenme müdahelesi, çocukluk çağı kanserleri, yetersiz beslenme, Nutrition status assessment, nutrition intervention, childhood cancer, malnutrition

Role of Dietitian in Childhood Cancers in the Treatment Process

In the last years, the diagnosis and treatment process in childhood cancers has been progressing more easily thanks to the developing technology and infrastructure. However, during or after treatment, patients may develop serious complications depending on the cancer itself, the treatment method, individual characteristics and nutritional status. The risk of malnutrition is inevitable due to factors such as loss of appetite, nausea, vomiting, changes in the sense of taste and smell in patients, unhealthy food choices, and families' lack of adequate knowledge about nutrition. As a result of malnutrition, deterioration in the immune system, which is an important factor in the disease process, may occur. Especially in the studies on nutrition, it has been observed that as a result of the nutritional intervention made by a specialist dietitian with the right approaches, there is a decrease in the prevalence of malnutrition, risk of infection, other complications related to nutrition, and complications such as metabolic syndrome, which has a high risk of developing after the disease. The aim of this review is to examine the nutritional status assessments that dietitians can apply to individuals in order to minimize the risk of complications that may occur due to nutrition in childhood cancers, based on the current literature.

Keywords:

Nutrition status assessment, nutrition intervention, childhood cancer, malnutrition,

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1. Mathur G, Nain S, Sharma PK. Cancer: An Overview. Acad J Cancer Res. 2015;8(1):1–09.
2. Global Cancer Observatory [Internet]. [cited 2022 Jun 20]. Available from: https://gco.iarc.fr/
3. Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, et al. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. Journal of Clinical Oncology. 2015;33(27), 3065.
4. Health Organization Regional Office for Europe W. Good Maternal Nutrition The best start in life. 2016 [cited 2022 May 10]; Available from: http://www.euro.who.int/pubrequest
5. Moradi S, Hosseinikia M, Mostafa Nachvak S, Moradi S, Pasdar Y, Shabanpur M, et al. Maternal Nutrıtıon Factors And Socıo-Economıc Status In Chıldhood Cancer.
6. Wang S, Maxwell CA, Akella NM. Diet as a Potential Moderator for Genome Stability and Immune Response in Pediatric Leukemia. Cancers. 2021;13(3):1–17.
7. Dessypris N, Karalexi MA, Ntouvelis E, Diamantaras AA, Papadakis V, Baka M, et al. Association of maternal and index child’s diet with subsequent leukemia risk: A systematic review and meta analysis. Cancer Epidemiol. 2017;47:64–75.
8. Antillon F, Rossi E, Lucia Molina A, Sala A, Pencharz P, Grazia Valsecchi M, et al. Nutritional Status of Children During Treatment for Acute Lymphoblastic Leukemia in Guatemala. Pediatr Blood Cancer. 2013;60:911–5.
9. Israels T, Renner L, Hendricks M, Hesseling P, Howard S, Molyneux E. SIOP PODC: Recommendations for Supportive Care of Children With Cancer in a Low-Income Setting. Pediatr Blood Cancer. 2013;60:899–904.
10. Ladas EJ, Arora B, Howard SC, Rogers PC, Mosby TT, Barr RD, et al. A Framework for Adapted Nutritional Therapy for Children With Cancer in Low-and Middle-Income Countries: A Report From the SIOP PODC Nutrition Working Group. Pediatr Blood Cancer. 2016;63:1339–48.
11. Nishikawa H, Goto M, Fukunishi S, Asai A, Nishiguchi S, Higuchi K, et al. Cancer Cachexia: Its Mechanism and Clinical Significance. Int J Mol Sci 2021, Vol 22, Page 8491. 2021;22(16):8491.
12. Bouma S. Diagnosing Pediatric Malnutrition. Nutr Clin Pract. 2017;32(1):52–67.
13. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for- height and body mass index-forage: methods and development. World Heal Organ. 2006;1–312.
14. Blackwell N, Myatt M, Allafort-Duverger T, Balogoun A, Ibrahim A, Briend A. Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6 months to 5 years. Arch Public Health. 2015;73(1):1-7.
15. Barr R, Collins L, Nayiager T, Doring N, Kennedy C, Halton J, et al. Nutritional status at diagnosis in children with cancer. 2.: An assessment by arm anthropometry. J Pediatr Hematol Oncol. 2011;33(3):e101-e104.
16. Glatt D, Hughes C, McCarthy O, O’Shea F, Brougham MFH, Wilson DC, et al. Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results). Clin Nutr ESPEN. 2020;38:242–52.
17. Darcy L, Granlund M, Enskär K, Björk M. The development of the clinical assessment tool “Health and Everyday Functioning in Young Children with Cancer.” 2020;46(4),445-456.
18. Viani K, Trehan A, Manzoli B, Schoeman J. Assessment of nutritional status in children with cancer: A narrative review. Pediatr Blood Cancer. 2020;67(S3):e28211.
19. Arpaci T, Toruner E, Altay N. Assessment of Nutritional Problems in Pediatric Patients with Cancer and the Information Needs of Their Parents: A Parental Perspective. Asia-Pacific J Oncol Nurs. 2018;5(2):231.
20. Fleming CAK, Cohen J, Murphy A, Wakefield CE, Cohn RJ, Naumann FL. Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation. Appetite. 2015;89:219–25.
21. Faizan U, Rouster AS. Nutrition and Hydration Requirements In Children and Adults. StatPearls [Internet]. 2021 Sep 2 [cited 2022 Sep 22]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK562207/
22. Morrell MBG, Baker R, Johnson A, Santizo R, Liu D, Moody K. Dietary Intake and Micronutrient Deficiency in Children with Cancer. 2019;66(10), e27895.
23. Trehan A, Viani K, da Cruz LB, Sagastizado SZ, Ladas EJ. The importance of enteral nutrition to prevent or treat undernutrition in children undergoing treatment for cancer. Pediatr Blood Cancer. 2020;67(S3).
24. Fabozzi F, Maria Trovato C, Diamanti A, Mastronuzzi A, Zecca M, Ilaria Tripodi S, et al. Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers. 2022;2022:3378.
25. McGrath KH. Parenteral nutrition use in children with cancer. Pediatr Blood Cancer. 2019;66(12):e28000.
26. Steele C, Salazar A, Rypkema L. Utilization of a Nutrition Support Algorithm Reduces Unnecessary Parenteral Nutrition Use in Pediatric Oncology Inpatients. J Acad Nutr Diet. 2016;116(8):1235–8.
27. Chan YK, Estaki M, Gibson DL. Clinical consequences of diet-induced dysbiosis. Ann Nutr Metab. 2013;63 Suppl 2(SUPPL.2):28–40.
28. Castagnola E, Ruberto E, Guarino A. Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000. World J Gastroenterol. 2016;22(25):5853–66.
29. Sonbol MB, Jain T, Firwana B, Hilal T, Deleon T, Murad A, et al. Neutropenic diets to prevent cancer infections: Updated systematic review and meta-analysis. BMJ Support Palliat Care. 2019; 9(4), 425-433.
30. Tramsen L, Salzmann-Manrique E, Bochennek K, Klingebiel T, Reinhardt D, Creutzig U, et al. Lack of Effectiveness of Neutropenic Diet and Social Restrictions as Anti-Infective Measures in Children With Acute Myeloid Leukemia: An Analysis of the AML-BFM 2004 Trial. J Clin Oncol. 2016;34(23):2776–83.
31. Food Safety for Older Adults and People with Cancer, Diabetes, HIV/AIDS, Organ Transplants, and Autoimmune Diseases | FDA [Internet]. [cited 2022 Oct 19]. Available from: https://www.fda.gov/food/people-risk-foodborne-illness/food-safety-older-adults-and-people-cancer-diabetes-hivaids-organ-transplants-and-autoimmune
32. Phillips SM, Padgett LS, Leisenring WM, Stratton KK, Bishop K, Krull KR, et al. Survivors of Childhood Cancer in the United States: Prevalence and Burden of Morbidity. Cancer Epidemiol Biomarkers Prev. 2015;24(4):653–63.
33. Viscardi S. Artículo Original / Original Article Nutrition education intervention for children with cancer and their parents Intervención nutricional educativa para niños con cáncer y sus padres. Rev Chil Nutr. 2021;48(5):782–8.
34. Zhang FF, Kelly MJ, Must A. Early Nutrition and Physical Activity Interventions in Childhood Cancer Survivors HHS Public Access. 2017;6(2):168–77.
35. Schadler KL, Kleinerman ES, Chandra J. Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes. Pediatr Res. 2018;83(1):50–6.
36. Chaput C, Beaulieu-Gagnon S, Bélanger V, Drouin S, Bertout L, Lafrance L, et al. Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum. JMIR Res Protoc. 2018;7(1):e8302.
37. Khamoui A V., Park BS, Kim DH, Yeh MC, Oh SL, Elam ML, et al. Aerobic and resistance training dependent skeletal muscle plasticity in the colon-26 murine model of cancer cachexia. Metab - Clin Exp. 2016;65(5):685–98.
38. Wu YP, Yi J, Mcclellan J, Kim J, Tian T, Grahmann B, et al. Barriers and facilitators of healthy diet and exercise among adolescent and young adult cancer survivors: Implications for behavioral interventions. J Adolesc Young Adult Oncol. 2015;4(4):184–91.
39. Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes. 2016;9(1):1–13.
40. Barr RD, Stevens MCG. The influence of nutrition on clinical outcomes in children with cancer. Pediatr Blood Cancer. 2020;67(S3):e28117.
41. Triarico S, Rinninella E, Cintoni M, Capozza MA, Mastrangelo S, Mele MC, Ruggiero A. Impact of malnutrition on survival and infections among pediatric patients with cancer: a retrospective study. Eur Rev Med Pharmacol Sci. 23(3),1165-1175.
42. Davidovics ZH, Michail S, Nicholson MR, Kociolek LK, Pai N, Hansen R, et al. Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection and Other Conditions in Children: A Joint Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition HHS Public Access. J Pediatr Gastroenterol Nutr. 2019;68(1):130–43.
43. Cammarota G, Ianiro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of clostridium difficile infection: A systematic review. J Clin Gastroenterol. 2014;48(8):693–702.
44. Gehrig JL, Venkatesh S, Chang H-W, Hibberd MC, Kung VL, Cheng J, et al. Supplementary Material for Effects of microbiota-directed foods in gnotobiotic animals and undernourished children. Science. 2019;365:4732.
45. Weber DD, Aminzadeh-Gohari S, Tulipan J, Catalano L, Feichtinger RG, Kofler B. Ketogenic diet in the treatment of cancer – Where do we stand? Mol Metab. 2020;33:102–21.
46. Aminzadeh-Gohari S, Feichtinger RG, Vidali S, Sternberg F, Rutherford T, O’Donnel M, et al. A ketogenic diet supplemented with medium-chain triglycerides enhances the anti-tumor and anti-angiogenic efficacy of chemotherapy on neuroblastoma xenografts in a CD1-nu mouse model. Oncotarget. 2017;8(39), 64728.
47. Zahra A, Fath MA, Opat E, Mapuskar KA, Bhatia SK, Ma DC, et al. Consuming a Ketogenic Diet while Receiving Radiation and Chemotherapy for Locally Advanced Lung Cancer and Pancreatic Cancer: The University of Iowa Experience of Two Phase 1 Clinical Trials. Radiat Res. 2017;187(6):743–54.
48. van der Louw EJTM, Reddingius RE, Olieman JF, Neuteboom RF, Catsman-Berrevoets CE. Ketogenic diet treatment in recurrent diffuse intrinsic pontine glioma in children: A safety and feasibility study. Pediatr Blood Cancer. 2019;66(3):e27561.