Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Pediatr Blood Cancer. 2022 Jul;69(7):e29728. doi: 10.1002/pbc.29728. Epub 2022 Apr 20.
The management of malnutrition in children with cancer remains a challenge in low-middle-income countries (LMICs). We describe our pediatric oncology nutrition program and its impact over the past decade.
We evaluated the impact of our nutrition program in accordance with the International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP PODC) Nutritional Program Evaluation in the areas of service delivery (number served, increments in delivery, number of trained care providers), patients at-risk (proportion identified with malnutrition at diagnosis/follow-up), and efficiency of nutritional interventions (proportion assessed, proportion achieved healthy weight, clinicians trained). We analyzed available data for trends between 2009 and 2020, and comparisons were made using the Fisher t test. This study was approved by our institutional ethics committee.
From 2010 to 2020, 17 749 children treated at our center were beneficiaries of the nutritional program, including assessment and intervention. During this period, trained pediatric nutritionists increased from 2 to 8; SIOP PODC level from 2 to 3-4, and nutrition budget increased 15-fold. At diagnosis (n = 5618) and six-month follow-up (n = 2674), 59.6% and 51.2% children were undernourished, 34.8% and 43% well nourished, and 4.7% and 5.7% overnourished. From 2016 onward, fewer children were undernourished at follow-up-69.5% (2016), 60% (2018), 54% (2019), and 55% (2020, P < 0.001). The program helped train over 500 clinicians in nutrition.
Improved financial support and capacity building have helped build and sustain an effective nutrition program. Priority areas include implementation of best practices, early nutritional intervention, continued education, and locally relevant research.
在中低收入国家（LMICs），癌症患儿的营养不良管理仍然是一个挑战。我们描述了过去十年中我们的儿科肿瘤营养计划及其影响。
我们根据国际儿科肿瘤学会-发展中国家儿科肿瘤学（SIOP PODC）营养计划评估标准，评估了营养计划在服务提供（服务人数、提供量增加、受过培训的护理提供者人数）、高危患者（诊断/随访时营养不良识别比例）和营养干预效率（评估比例、达到健康体重比例、培训临床医生）方面的影响。我们分析了 2009 年至 2020 年期间的可用数据，使用 Fisher t 检验进行比较。本研究得到了我们机构伦理委员会的批准。
2010 年至 2020 年，中心 17749 名患儿受益于营养计划，包括评估和干预。在此期间，接受培训的儿科营养师人数从 2 人增加到 8 人；SIOP PODC 级别从 2 级增加到 3-4 级，营养预算增加了 15 倍。在诊断时（n=5618）和 6 个月随访时（n=2674），59.6%和 51.2%的患儿存在营养不良，34.8%和 43%的患儿营养良好，4.7%和 5.7%的患儿营养过剩。自 2016 年以来，随访时营养不良的患儿人数减少，分别为 69.5%（2016 年）、60%（2018 年）、54%（2019 年）和 55%（2020 年，P<0.001）。该计划帮助培训了 500 多名营养方面的临床医生。
增加财务支持和能力建设有助于建立和维持有效的营养计划。优先领域包括实施最佳实践、早期营养干预、继续教育和本地相关研究。
