Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Department of Pediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Clin Nutr ESPEN. 2024 Oct;63:304-310. doi: 10.1016/j.clnesp.2024.06.047. Epub 2024 Jul 2.
BACKGROUND & AIMS: Different nutritional screening tools have been proposed in childhood cancer, but none has shown convincing predictive capacity so far. The "nutrition screening tool for childhood cancer (SCAN)" has been specifically designed for this population and provides an easy-to-use, promising approach to identify patients at risk of malnutrition. We aim to: 1. Validate the SCAN tool prospectively in identifying malnourished patients or those who required nutritional support 2. Validate the SCAN tool prospectively in predicting toxicities or outcome. 3. Compare performance of a pediatric screening tool (STRONG) with SCAN.
Children in our center with a new diagnosis of cancer from August 2018 to May 2019 were offered to participate in the study. Measurements (SCAN questionnaire, weight, height, body-mass index (BMI), and mid upper-arm circumference (MUAC)) were taken at diagnosis and at regular intervals throughout therapy. The last measurement was taken 6 months after finishing the intensive treatment phase. SCAN score at diagnosis was validated prospectively against variables of interest.
A total of 49 patients were recruited. When considering malnutrition during therapy the SCAN tool showed a sensitivity of 37.5% and negative predictive value (NPV) of 81%. Patients who required nutritional support were identified with a sensitivity of 50% and NPV of 62%. The SCAN tool was not able to predict increased toxicities, risk of relapse or decreased survival. The pediatric screening tool STRONG was unable to discriminate nutritional risk and labeled all 49 patients (100%) as medium or high-risk. Applying SCAN periodically during therapy increased sensitivity for identifying malnutrition to 87.5%.
In our study, applying the SCAN tool at diagnosis showed low sensitivity in identifying patients who go on to develop malnutrition during therapy. However, patients labeled as "not at risk" were unlikely to need nutritional support in the form of nasogastric tube or total parenteral nutrition. Using SCAN throughout therapy could be helpful in building awareness for malnutrition and successfully discriminates between patients who need further support and those who don't.
不同的营养筛查工具已在儿童癌症中提出，但迄今为止，没有一种工具显示出令人信服的预测能力。“儿童癌症营养筛查工具（SCAN）”专为该人群设计，提供了一种易于使用、有前途的方法来识别有营养不良风险的患者。我们的目标是：1. 前瞻性验证 SCAN 工具在识别营养不良患者或需要营养支持的患者方面的作用；2. 前瞻性验证 SCAN 工具在预测毒性或结局方面的作用；3. 比较儿科筛查工具（STRONG）与 SCAN 的性能。
2018 年 8 月至 2019 年 5 月期间，我们中心新诊断为癌症的儿童被邀请参加研究。在诊断时以及治疗过程中定期进行测量（SCAN 问卷、体重、身高、体重指数（BMI）和上臂中部周长（MUAC））。最后一次测量是在完成强化治疗阶段 6 个月后进行。前瞻性验证诊断时的 SCAN 评分与感兴趣的变量。
共招募了 49 名患者。当考虑治疗期间的营养不良时，SCAN 工具的敏感性为 37.5%，阴性预测值（NPV）为 81%。需要营养支持的患者的敏感性为 50%，NPV 为 62%。SCAN 工具不能预测毒性增加、复发风险或生存降低。儿科筛查工具 STRONG 无法区分营养风险，将所有 49 名患者（100%）标记为中危或高危。在治疗过程中定期应用 SCAN 可将识别营养不良的敏感性提高到 87.5%。
在我们的研究中，在诊断时应用 SCAN 工具识别在治疗期间发生营养不良的患者的敏感性较低。然而，被标记为“无风险”的患者不太可能需要通过鼻胃管或全胃肠外营养来提供营养支持。在整个治疗过程中使用 SCAN 可以帮助提高对营养不良的认识，并成功区分需要进一步支持和不需要支持的患者。
