Disease-related malnutrition in children with cancer: What’s the risk and the impact on patient's outcome?

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Bambang Sudarmanto
Citra Primavita


Background: Malnutrition in children with cancer is a common problem, particularly in low-income countries. Risk factors, effects on outcome, and feasible interventions are important to comprehend in managing patients.
Objectives: To know the risk and impact of malnutrition in children with patients.
Discusion: Children with cancer are at risk of suffering from malnutrition. Malnutrition occurs due to energy imbalance and results from multifactorial interactions, including type of tumors and therapy. Malnutrition can contribute to poor clinical outcome and decreased quality of life. Management of malnutrition in pediatric patients with cancer include screening and nutritional interventions with suitable route of administration based on patient condition.


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Author Biographies

Bambang Sudarmanto, Faculty of Medicine, Universitas Diponegoro, Dr. Kariadi General Hospital

Hematology-oncology division, pediatric department

Citra Primavita, Medical Faculty Sultan Agung University / Sultan Agung Islamic Hospital Semarang

Child Health Department


1. World Health Organization. Childhood cancer. (2021). Available from: https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.
2. United Nations. Sustainable development goals (2021). Available from: https://sdgs.un.org/goals.
3. Joffe L, Ladas EJ. Nutrition during childhood cancer treatment: current understanding and a path for future research. Lancet Child Adolesc Health. 2020 Jun;4(6):465-75.
4. Viani K, Trehan A, Manzoli B, Schoeman J. Assessment of nutritional status in children with cancer: A narrative review. Pediatr Blood Cancer. 2020 Jun;67 Suppl 3:e28211.
5. Bauer J, Jurgens H, Fruhwald MC. Important aspects of nutrition in children with cancer. Adv Nutr. 2011 Mar;2(2):67-77.
6. Cohen J, Collins L, Gregerson L, Chandra J, Cohn RJ. Nutritional concerns of survivors of childhood cancer: A "First World" perspective. Pediatr Blood Cancer. 2020 Jun;67 Suppl 3:e28193.
7. Lemos Pdos S, de Oliveira FL, Caran EM. Nutritional status of children and adolescents at diagnosis of hematological and solid malignancies. Rev Bras Hematol Hemoter. 2014 Nov-Dec;36(6):420-3.
8. Viani K, Trehan A, Manzoli B, Schoeman J. Assessment of nutritional status in children with cancer: A narrative review. Pediatr Blood Cancer.2020;67(Suppl.3):e28211.
9. Murphy AJ, White M, Viani K, Mosby TT. Evaluation of the nutrition screening tool for childhood cancer (SCAN). Clin Nutr. 2016 Feb;35(1):219-24.
10. Barr RD, Mosby TT. Nutritional status in children and adolescents with leukemia: An emphasis on clinical outcomes in low and middle income countries. Hematology. 2016 May;21(4):199-205.
11. Srivastava R, Pushpam D, Dhawan D, Bakhshi S. Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center. Indian J Cancer. 2015 Apr-Jun;52(2):199-201.
12. Brinksma A, Sanderman R, Roodbol PF, Sulkers E, Burgerhof JG, de Bont ES, et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer. 2015 Oct;23(10):3043-52.
13. Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. Children (Basel). 2020 Nov 7;7(11).
14. Pribnow AK, Ortiz R, Baez LF, Mendieta L, Luna-Fineman S. Effects of malnutrition on treatment-related morbidity and survival of children with cancer in Nicaragua. Pediatr Blood Cancer. 2017 Nov;64(11).
15. Agnes M, Widjajanto PH, W D. Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy Paediatr Indones,. 2018;58:298-304
16. Ramamoorthy JG, Radhakrishnan V, Ganesan P, Dhanushkodi M, Ganesan TS, TD S. Malnutrition is a predisposing factor for developing recurrent fever following febrile neutropenia in children with acute lymphoblastic leukemia. Pediatric Hematology Oncology Journal. 2020;5:75-9.
17. Iniesta RR, Paciarotti I, Brougham MF, McKenzie JM, Wilson DC. Effects of pediatric cancer and its treatment on nutritional status: a systematic review. Nutr Rev. 2015 May;73(5):276-95.
18. Mejia-Arangure JM, Fajardo-Gutierrez A, Reyes-Ruiz NI, Bernaldez-Rios R, Mejia-Dominguez AM, Navarrete-Navarro S, et al. Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment. Arch Med Res. 1999 Mar-Apr;30(2):150-3.
19. Akbulut G. New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition. Exp Ther Med. 2011 Jul;2(4):675-84.
20. Israels T, Borgstein E, Jamali M, de Kraker J, Caron HN, Molyneux EM. Acute malnutrition is common in Malawian patients with a Wilms tumour: A role for peanut butter. Pediatr Blood Cancer. 2009 Dec 15;53(7):1221-6.
21. Antillon F, Rossi E, Molina AL, Sala A, Pencharz P, Valsecchi MG, et al. Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr Blood Cancer. 2013 Jun;60(6):911-5.
22. den Broeder E, Lippens RJ, van 't Hof MA, Tolboom JJ, Sengers RC, van den Berg AM, et al. Nasogastric tube feeding in children with cancer: the effect of two different formulas on weight, body composition, and serum protein concentrations. JPEN J Parenter Enteral Nutr. 2000 Nov-Dec;24(6):351-60.
23. den Broeder E, Lippens RJ, van't Hof MA, Tolboom JJ, van Staveren WA, Hofman Z, et al. Effects of naso-gastric tube feeding on the nutritional status of children with cancer. Eur J Clin Nutr. 1998 Jul;52(7):494-500.
24. Triarico, R., et al. Impact of malnutrition on survival and infections among pediatric patients with cancer: A retrospective study. European Review for Medical and Pharmacological Sciences. 2019;23(3):1165-1175.
25. Sudersanadas K, Alsharidah AS, Al Harthy N, Philip W, Qureshi S. Effect of Chemotherapy on Nutritional Status of Pediatric Subjects with Hematological Malignancies - A Retrospective Longitudinal Study. Journal of Medical Science and Clinical Research. 2017;05(05):21201-21215.
26. Sakthikumar, Lakshmanan, Latha M. Sneha, Shobana Chandran, and Et Al, ‘Clinical Implications of Undernutrition in Childhood Cancer: A Single Centre Experience from a Developing Country’, International Journal of Nutrition, Pharmacology, Neurological Diseases |, 11.2 (2021) https://doi.org/10.4103/ijnpnd.ijnpnd_112_20
27. Galler, Janina R., Maria L. Bringas-Vega, Qin Tang, Arielle G. Rabinowitz, Kamarul Imran Musa, Wen Jia Chai, and others, ‘Neurodevelopmental Effects of Childhood Malnutrition: A Neuroimaging Perspective’, NeuroImage, 231.October 2020 (2021), 117828
28. Yazbeck N, Samia L, Saab R, Abboud MR, Solh H, Muwakkit S. Effect of malnutrition at diagnosis on clinical outcomes of children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2016;38:107-10.
29. Goldstein G, Shemesh E, Frenkel T, Jacobson JM, Toren A. Abnormal body mass index at diagnois in patients with Ewing Sarcoma is associated with inferior tumor necrosis. Pediatr Blood Cancer 2015;62:1982-6.
30. Han WM, Koo JY, Lim YY, et al Implementation of a nutrition screening tool to improve nutritional status of children with cancer in Singapore’s largest paediatric hospital BMJ Open Quality 2021;10:e000944. doi: 10.1136/bmjoq-2020-000944
31. Magri Teles ND, Silva DCBD, Araujo OR, Maia Lemos PDS, Oliveira FLC. Undernutrition as an Aggravating Risk for Hospital Death in Critically Ill Children with Cancer. Nutr Cancer. 2021;73(11-12):2627-2632. doi: 10.1080/01635581.2020.1844244. Epub 2020 Nov 5. PMID: 33153333.
32. Sacks N, Hwang WT, Lange BJ, Tan KS, Sandler ES, Rogers PC, et al. Proactive enteral tube feeding in pediatric patients undergoing chemotherapy. Pediatr Blood Cancer. 2014 Feb;61(2):281-5.