Nyeko Richard, van Heerden Jaques, Kambugu Joyce Balagadde, Geriga Fadhil, Angom Racheal, de Rojas Teresa, Neven Anouk
Department of Pediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda.
Pediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda.
PLoS One. 2025 Aug 7;20(8):e0330107. doi: 10.1371/journal.pone.0330107. eCollection 2025.
Wasting contributes to poor treatment outcomes in children with cancer, especially in low-resource settings. In these settings, there is inadequate routine, systematic assessment of the wasting status of children with cancer. Wasting is diagnosed based on visual evidence, with a subjective bias for recognition. This study determined the prevalence of wasting at diagnosis among children with cancer at the Uganda Cancer Institute (UCI) and the diagnostic accuracy of "visible wasting" in identifying children with wasting as measured by anthropometric indices, and identified predictors of 6-months negative outcomes.
We assessed the wasting status at diagnosis, diagnostic accuracy of visible wasting, and 6-month outcomes of children newly diagnosed with cancer at the UCI (both ambulatory and hospitalized) between April 2022 and March 2023. Data were analyzed using SPSS version 26. Descriptive, bivariate, multivariate, and survival analyses were performed as appropriate. Statistical significance was determined at P-value<0.05.
One hundred forty-four children with cancer, with a median age of 10.0 years (interquartile range [IQR] 4.0-14.0 years), were included. The majority, 89 (61.8%), had solid tumor, whereas 55 (38.2%) had hemato-lymphoid malignancies. Thirty-two (22.2%) of the participants had visible wasting, and 57 (39.6%) were wasted based on anthropometric measurements, 32 (56.1%) of whom showed no visible wasting. Visible wasting had a low sensitivity of 43.9% (95% CI 30.7-57.6) - ROC 0.32 (95% CI 0.23-0.42), with a false negative rate of 56.1%. Overall, visible wasting missed up to 80.6% (25/31) of children with moderate wasting and 26.9% (7/26) with severe wasting. Twenty-one (14.6%) of the patients died, 8 (38.1%) of whom were deemed to be wasted, and 15 (71.4%) had anthropometrically-defined wasting. Neutropenia occurred in 20.8% (n = 30) of the participants and sepsis in 13.9% (n = 20). In univariate analyses, wasted patients were more likely to develop neutropenia (OR 3.63; 95% CI 1.56-8.42; p = 0.003), sepsis (OR 4.50; 95% CI 1.65-12.29; p = 0.003), and die (OR 3.08; 95% CI 1.15-8.28; p = 0.026).
Wasting at diagnosis is a common problem among children with cancer in this resource-limited setting and is associated with increased risks of neutropenia, sepsis, and mortality. Reliance on visible wasting as a marker for wasting misses other wasted children, some of who may be malnourished and at risk of poor outcome. For accurate categorization of wasting, all patients should undergo a standard anthropometric evaluation.
消瘦会导致癌症患儿的治疗效果不佳，在资源匮乏地区尤其如此。在这些地区，对癌症患儿的消瘦状况缺乏常规、系统的评估。消瘦是根据视觉证据诊断的，存在主观识别偏差。本研究确定了乌干达癌症研究所（UCI）癌症患儿诊断时消瘦的患病率，以及“明显消瘦”通过人体测量指标识别消瘦患儿的诊断准确性，并确定了6个月不良结局的预测因素。
我们评估了2022年4月至2023年3月期间在UCI新诊断为癌症的患儿（包括门诊和住院患儿）诊断时的消瘦状况、明显消瘦的诊断准确性以及6个月的结局。使用SPSS 26版进行数据分析。根据情况进行描述性、双变量、多变量和生存分析。P值<0.05时确定具有统计学意义。
纳入了144例癌症患儿，中位年龄为10.0岁（四分位间距[IQR]4.0 - 14.0岁）。大多数患儿，89例（61.8%）患有实体瘤，而55例（38.2%）患有血液淋巴系统恶性肿瘤。32例（22.2%）参与者有明显消瘦，57例（39.6%）根据人体测量结果消瘦，其中32例（56.1%）无明显消瘦。明显消瘦的敏感性较低，为43.9%（95%CI 30.7 - 57.6） - ROC为0.32（95%CI 0.23 - 0.42），假阴性率为56.1%。总体而言，明显消瘦漏诊了高达80.6%（25/31）的中度消瘦患儿和26.9%（7/26）的重度消瘦患儿。21例（14.6%）患者死亡，其中8例（38.1%）被认为消瘦，15例（71.4%）有人体测量定义的消瘦。20.8%（n = 30）的参与者发生中性粒细胞减少，13.9%（n = 20）发生败血症。在单变量分析中，消瘦患者更有可能发生中性粒细胞减少（OR 3.63；95%CI 1.56 - 8.42；p = 0.003）、败血症（OR 4.50；95%CI 1.65 - 12.29；p = 0.003）和死亡（OR 3.08；95%CI 1.15 - 8.28；p = 0.026）。
在这种资源有限的环境中，诊断时消瘦是癌症患儿中的常见问题，并且与中性粒细胞减少、败血症和死亡率增加相关。依赖明显消瘦作为消瘦的标志物会遗漏其他消瘦患儿，其中一些可能营养不良且预后不良风险高。为了准确分类消瘦，所有患者都应接受标准人体测量评估。
