Chapter 15: Pediatric Oncology

Question 1

Less than ___ of cancers happen in children.

Answer 1

1%

Question 2

Top 3 most common types of childhood cancers.

Answer 2

Leukemia, brain and nervous system, and neuroblastoma

Question 3

What are some of the adverse side effects of cancer and its treatments?

Answer 3

Anorexia, diminished immune response, disturbed drug metabolism, delayed/compromized wound healing, reduced quality of life, reduced treatment response, reduced survival

Question 4

Why are children more susceptible to malnutrition and protein depletion during cancer treatment?

Answer 4

Because of rapid growth, smaller reserves, higher relative needs per weight, and greater Resting Energy Expenditure

Question 5

For what reasons are children more susceptible to malnutrition and protein depletion?

Answer 5

Because of rapid growth, smaller reserves, higher relative needs per weight and greater resting energy expenditure (REE)

Question 6

Which assessment tool has been modified and validated for use in children?

Answer 6

Subjective Global Assessment (SGA) - renamed to Subjective Global Nutrition Assessment

Question 7

What is cachexia

Answer 7

The loss of both lean and fat mass seen in the context of an illness, including cancer.

Question 8

In children, what is the hallmark outcome of cachexia?

Answer 8

growth failure (as the result of anorexia, inflammation, and altered carbohydrate, fat and protein metabolism)

Question 9

In cachexia, ____ accelerates, contributing to muscle breakdown.

Answer 9

protein turnover

Question 10

What is the equation for catch-up growth?

Answer 10

kcal/kg x Ideal wt (kg) divided by kcal/day x Actual wt (kg)

Question 11

What are two micronutrients of concern for pediatric oncology patients?

Answer 11

Calcium and Vitamin D because a child’s bone health may be compromised during the course of cancer treatment.

Question 12

Breast milk is low in ____.

Answer 12

Vitamin D.

Question 13

All exclusively breast-fed infants should receive which supplement?

Answer 13

400 IU Vitamin D/day

Question 14

What are some chemotherapy-related consequences in pediatric patients?

Answer 14

GI side effects

Question 15

Radiation-related consequences in pediatric patients?

Answer 15

Diarrhea, mucositis, nausea/vomiting, fatigue, poor appetite. Long-term consequences include cognitive impairment, altered bone development, learning and hearing impairments, neuroendocrine problems and secondary malignancies.

Question 16

Side effects of radiation therapy may no manifest for up to ____ years after treatment?

Answer 16

10

Question 17

Surgical-related consequences in pediatric patients?

Answer 17

post-operative ileus, nausea/vomiting, maldigestion, malabsorption, and alterations in substrate metabolism, alterations in intake may result in energy, protein and micronutrient intake.

Question 18

Nutrition Assessment should include?

Answer 18

medical history, nutrition-focused physical findings, biochemical data, anthropometric measurements, dietary intake assessment, medical tests

Question 19

Nasogastric feedings are appropriate for children up need nutrition support for up to ___ months?

Answer 19

3

Question 20

Gastrostomy tube feeding is recommended for children who require enteral support for more than ___ months?

Answer 20

3

Question 21

PN can not be used for which groups?

Answer 21

preterm infants (first 3 days), term infants (first 5 days), children with GI dysfunction due to disease or injury more than 3 days (intractable vomiting, diarrhea, malabsorption, radiation-induced colitis, post-operative ileus.

Question 22

T/F: Short-term use of PN (< 7 days) is generally not recommended.

Answer 22

True

Question 23

What is PNLD

Answer 23

Pediatric Nutrition-associated Liver Disease (many cancer meds + PN can cause biliary dysfunction or steatosis.

Question 24

What is HSCT?

Answer 24

Hematopoietic Stem Cell Transplant (transplantation from a variety of sources of hematopoietic stem cells, including bone marrow, peripheral, blood stem cells and umbilical cord blood

Question 25

What are the two types of conditioning regimens for HSCT?

Answer 25

Myeloblastive and nonmyeloblastive

Question 26

What is the myeloblastive regimen?

Answer 26

It includes high dose chemotherapy with or without radiation to eliminate disease and ablate bone marrow

Question 27

What is the nonmyeloblastive regimen?

Answer 27

Provides low dose chemotherapy with or without radiation

Question 28

What is an autologous infusion?

Answer 28

the patient receives his or her own cells

Question 29

What is an allogenic infusion?

Answer 29

the patient receives cells from another person, related or unrelated.

Question 30

What is synergystic transplant?

Answer 30

the patient receives cells from a genetically identical twin

Question 31

____ % of children undergoing HSCT have suboptimal nutrition status.

Answer 31

50%

Question 32

What is the gold standard for assessing nutritional needs in children undergoing HSCT

Answer 32

Indirect calorimetry (IC)

Question 33

All HSCT patients undergoing an allogeneic transplant should be placed on a ______ diet.

Answer 33

Neutropenic

Question 34

Allogenic transplant patients should avoid all restaurants and fast food until day ____ after transplant.

Answer 34

+100

Question 35

What are some long-term nutrition issues of HSCT?

Answer 35

chronic GVHD (graft vs host disease), osteoporosis, endocrine complications, iron overload, oral aversion, compromised growth and development