Incidence and Risk Factors Associated with Undernutrition and Weight Loss in Infants and Young Children Undergoing Cancer Treatment Public
Runco, Daniel (Spring 2019)
Published
Abstract
Background: Brain tumors are the most common pediatric solid tumor and leading cause of pediatric cancer deaths. Malnutrition increases morbidity and mortality during treatment especially with brain tumors. Unfortunately, definitions and risks for undernutrition in infants and young children during treatment are variable.
Objectives: We created an observational, retrospective cohort to evaluate weight trajectories for pediatric cancer patients less than 3 years old at diagnosis, examining characteristics associated with lower weight-for-age z-scores.
Methods: A chart review included patients diagnosed 2007-2015 at the largest pediatric cancer center in the US. Patients less than 3 years of age at diagnosis, starting treatment at our center, with accurate height and weight measurements prior to treatment initiation, and had sufficient information to classify treatment intensity were included. Treatment intensity was classified using Intensity of Treatment Rating Scale (ITR-3). Exposures included age at diagnosis, tumor type, and treatment intensity and effect on weight-for-age z-score. Clinically significant weight loss was defined as a change in z-score of ≥ 1 with odds of developing significant weight loss examined.
Results: Chart review yielded 434 included patients. Most patients began treatment below the 50th percentile for weight-for-age with mean z-score of -0.14 (44th percentile). No difference in mean weight-for-age z-score was observed between patients with brain tumors versus other malignancies at treatment initiation, 6, 12, or 24 months. Higher treatment intensity caused lower mean weight-for-age z-scores at 12 and 24 months following treatment initiation (p<0.01) and higher odds for weight loss (aOR = 2.83, p<0.001). Patients less than 1 year old had lower weight-for-age z-scores at 6, 12, and 24 months (p<0.01) and higher odds of significant weight loss than 1-2 (aOR=2.73, p<0.001) or 2-3 year olds (aOR=2.27, p<0.001). The first episode of significant weight loss occurred most frequently within 6 months of treatment initiation.
Conclusion: Younger patients and higher treatment intensity resulted in lower weight and higher odds of significant weight loss following cancer treatment initiation. Future study on effective interventions for high-risk patient is needed focusing on morbidity, mortality, cost, and patient-reported outcomes.
Table of Contents
A. INTRODUCTION.……………………………………………………………….….………………………...1
B. BACKGROUND……………………………………………………………….………………………………..3
C. METHODS………………………………………………………………..……………………………………..6
D. RESULTS……………………………………………………………..…….…………………………………..10
E. DISCUSSION……………………………………………………….…….……………………………………15
F. REFERENCES……………………………………………………………….…………………….………….22
G. TABLES/FIGURES………………………………………………………….…………………….………..27
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Incidence and Risk Factors Associated with Undernutrition and Weight Loss in Infants and Young Children Undergoing Cancer Treatment () | 2019-03-29 15:13:07 -0400 |
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