Nutritional support for children with cancer.

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enteral nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enteral nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enteral nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.