Daniel V Runco1, Karen Wasilewski-Masker2, Courtney E McCracken3, Martha Wetzel3, Claire M Mazewski2, Briana C Patterson4, Ann C Mertens2. 1. Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA. Electronic address: drunco@iupui.edu. 2. Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. 4. Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Division of Endocrinology & Diabetes, Emory University School of Medicine, Atlanta, GA, USA.
Abstract
BACKGROUND: Various measures and definitions for undernutrition are used in pediatrics. Younger children treated for cancer are at high risk, but lack well-defined risk-based screening and intervention. METHODS: A retrospective study collected weight longitudinally for patients less than three years-old over two years after initiating cancer treatment. We included those diagnosed 2007-2015 at a large pediatric cancer center. Exclusion criteria included treatment starting outside our system, secondary or relapsed malignancy, or incomplete information. A decrease ≥1 in weight-for-age or weight-for-height z-score signified clinically significant weight loss. Univariate and multivariate models assessed hazards for developing first episode of clinically significant weight loss. RESULTS: Of 372 patients, only 24.6% of patients lost 10% of weight, but 58.6% lost weight-for-age z-score ≥1 and 64.8% lost ≥1 weight-for-height z-score within two years of treatment initiation. Patients who lost weight were younger (median age 15 vs. 24 months, p < 0.001). Compared to patients diagnosed in the first year of life, those diagnosed 24-35 months were less likely to lose weight (HR 0.62, p < 0.001) and lost weight later (median time to weight loss 144 vs. 35 days). Higher treatment intensity increased weight loss risk (HR 2.30, p < 0.001) and decreased time to weight loss (35 vs. 154 days). No differences were found based on sex, diagnosis, enteral or parenteral nutrition, gastroenterology consults, or intensive care admissions. CONCLUSIONS: Using normalized z-scores is more sensitive for identifying weight loss. Younger children are more likely to lose weight with higher intensity cancer therapy. Patient and treatment specific information should be used in risk stratifying weight loss screening and nutritional interventions.
BACKGROUND: Various measures and definitions for undernutrition are used in pediatrics. Younger children treated for cancer are at high risk, but lack well-defined risk-based screening and intervention. METHODS: A retrospective study collected weight longitudinally for patients less than three years-old over two years after initiating cancer treatment. We included those diagnosed 2007-2015 at a large pediatric cancer center. Exclusion criteria included treatment starting outside our system, secondary or relapsed malignancy, or incomplete information. A decrease ≥1 in weight-for-age or weight-for-height z-score signified clinically significant weight loss. Univariate and multivariate models assessed hazards for developing first episode of clinically significant weight loss. RESULTS: Of 372 patients, only 24.6% of patients lost 10% of weight, but 58.6% lost weight-for-age z-score ≥1 and 64.8% lost ≥1 weight-for-height z-score within two years of treatment initiation. Patients who lost weight were younger (median age 15 vs. 24 months, p < 0.001). Compared to patients diagnosed in the first year of life, those diagnosed 24-35 months were less likely to lose weight (HR 0.62, p < 0.001) and lost weight later (median time to weight loss 144 vs. 35 days). Higher treatment intensity increased weight loss risk (HR 2.30, p < 0.001) and decreased time to weight loss (35 vs. 154 days). No differences were found based on sex, diagnosis, enteral or parenteral nutrition, gastroenterology consults, or intensive care admissions. CONCLUSIONS: Using normalized z-scores is more sensitive for identifying weight loss. Younger children are more likely to lose weight with higher intensity cancer therapy. Patient and treatment specific information should be used in risk stratifying weight loss screening and nutritional interventions.
Authors: Nancy Sacks; Wei-Ting Hwang; Beverly J Lange; Kay-See Tan; Eric S Sandler; Paul C Rogers; Richard B Womer; John B Pietsch; Susan R Rheingold Journal: Pediatr Blood Cancer Date: 2013-09-09 Impact factor: 3.167
Authors: Natália F Pena; Sílvia F Mauricio; Ana M S Rodrigues; Ariene S Carmo; Nayara C Coury; Maria I T D Correia; Simone V Generoso Journal: Nutr Clin Pract Date: 2018-06-05 Impact factor: 3.080
Authors: Patricia Becker; Liesje Nieman Carney; Mark R Corkins; Jessica Monczka; Elizabeth Smith; Susan E Smith; Bonnie A Spear; Jane V White Journal: Nutr Clin Pract Date: 2014-11-24 Impact factor: 3.080
Authors: Daniel V Runco; Karen Wasilewski-Masker; Claire M Mazewski; Briana C Patterson; Ann C Mertens Journal: J Pediatr Hematol Oncol Date: 2021-11-01 Impact factor: 1.170
Authors: Daniel V Runco; Joseph R Stanek; Nicholas D Yeager; Jennifer A Belsky Journal: JPEN J Parenter Enteral Nutr Date: 2022-02-10 Impact factor: 3.896