Nutritional Interventions to Improve Outcomes in Children Undergoing Cancer Therapy-A 50 Case Study

Background: Malnutrition is common in pediatric oncology and is associated with increased treatment toxicity, infections, treatment interruptions, and poorer quality of life. Early nutritional assessment and targeted interventions (dietary counseling, oral nutritional supplements (ONS), enteral and parenteral support) may improve biochemical/nutritional status and clinical outcomes.

Objective: To evaluate the effect of a structured nutritional intervention program on nutritional and clinical outcomes in 50 children receiving cancer therapy.

Methods: We performed a prospective single-center cohort study of 50 consecutive pediatric oncology patients (age 1–17 years) enrolled into a nutrition program at diagnosis or early during therapy. Interventions included standardized nutritional assessment, individualized dietary counseling, ONS, proactive enteral feeding for high-risk patients, reactive enteral feeding for those with progressive weight loss, and parenteral nutrition when enteral routes were not feasible. Primary outcome was change in BMI/weight-for-age z-score at 3 months. Secondary outcomes included infection rate (grade ≥3), chemotherapy delays (>7 days), hospital length of stay (LOS), and patient/caregiver-reported feeding-related quality of life (QoL). Paired comparisons (baseline vs 3 months) were performed.

Results: Mean age was 7.2 years (SD 4.1); 28 (56%) male. Cancer types: leukemia 22 (44%), solid tumors 18 (36%), brain tumors 10 (20%). Interventions: ONS + counseling 30 (60%); proactive enteral 10 (20%); reactive enteral 5 (10%); parenteral nutrition 5 (10%). Mean baseline BMI z-score was −0.97 (SD 0.68) and improved to −0.59 (SD 0.64) at 3 months (mean change +0.38, paired t-test p<0.001). Forty-nine patients (98%) had measurable improvement or stabilization of z-score; 32 (64%) gained ≥0.5 z-score. Grade ≥3 infections occurred in 12/50 (24%); chemotherapy delays >7 days occurred in 8/50 (16%). Median hospital LOS per major admission was 7 days (IQR 5–12). Caregiver-reported feeding QoL improved in 68% of families.

Conclusions: In this 50-case cohort, structured nutritional interventions were associated with significant improvement in anthropometric indices at 3 months and acceptable clinical outcomes. These data support early, proactive nutritional support as an integral part of pediatric oncology care. Larger, controlled trials are needed to confirm impact on long-term survival and event-free outcomes.

Keywords: Pediatric Oncology, Nutrition, Enteral Feeding, Oral Nutritional Supplements, Malnutrition, Supportive Care.