Nutritional Assessment of the Child with Cancer1

Children with cancer are in need of nutritional support to combat the catabolic effects of malignant tumors and debilita tion from surgical or other treatment and complicating infec tions and to maintain their immune system and other host defenses to combat cancer and infection. Also, growth must be supported in the child. Nutritional assessment should be an integral part of the care of the hospitalized and the ambulatory child. The main components of nutritional assessment are described: medical history; psychocultural history; dietary as sessment; clinical examination for signs of deficiency; anthro pometry; and biochemical and hematological assessment. Pa rameters of cell-mediated immunity, often depressed by mal nutrition, are also part of the assessment. Appropriate refer ence data for children are included. Assessment is the first step in nutritional support. Many cancer patients are in need of nutritional support, not only to combat the catabolic effects of malignancy, debilitation from surgical and other modes of treatment, and complicating infections but also as a major adjunct to maintain their immune system and other host defenses to combat malignancy and infection. Malnutrition has been amply documented to reduce CMI,3 a major defense in malignancy, as well as humoral immunity, phagocytic function, and nonspecific host factors to infection (6, 28, 34). Nutritional support becomes all the more pressing a need for the child who is growing rapidly and whose requirements are relatively high in order to maintain normal or near normal growth. Adequate food intake is needed not only for its nutrient value but also for the improved morale and comfort that come from familiar foods. Children at particular risk for malnutrition are those whose malignant disease involves the gastrointestinal tract, those with rapidly growing tumors, and those having constitutional symp toms. Also included are children whose treatments are known to interact adversely with nutrients, those who undergo major surgery, and those who develop a serious infection. Radiation treatment, particularly around the head, neck, and esophagus, impairs appetite and swallowing, and treatment targeted for the abdomen may cause enteritis (23). Emotional problems, attrib uted to painful and frightening procedures and separation from parents and siblings in unfamiliar surroundings, can also con tribute to diminished food intake. Not only should nutritional assessment be included ¡nthe care of the hospitalized patient but it should continue in the ambulatory care of that patient as well. This can serve as a 1 Presented at the Pediatrie Cancer and Nutrition Workshop, December 11 and 12, 1980, Bethesda, Md. 2 To whom requests for reprints should be addressed. 3 The abbreviations used are: CMI, cell-mediated immunity; PEM, protein energy malnutrition; NCHS, National Center for Health Statistics; MUAC, midupper arm circumference; TSNS, Ten State Nutrition Survey; MAMC, midarm muscle circumference. base line prior to instituting or changing therapy and monitoring its effect on the overall condition of the child. Assessment can be used to monitor growth in the child with cancer if carried on in serial fashion. Ongoing nutritional assessment can prevent malnutrition from going undetected or from progressing to severe malnutrition. The techniques of nutritional assessment are not complicated and can readily be incorporated into the ongoing activities of the oncologist, using ancillary and con sultative personnel as appropriate. The main components of nutritional assessment are medical history, psychosocial-cultural history, dietary assessment, clin ical examination, anthropometry, and biochemical and hema tological assessment (17). Because CMI is so readily de pressed by malnutrition, certain parameters of CMI are now included as part of nutritional assessment (6, 28, 34). No single component of assessment is considered by itself but must bç interpreted in conjunction with other assessment components; e.g., biochemical data may corroborate clinical findings or document problems suspected on dietary assessment.