Chapter 15: Pediatric Oncology Flashcards
Less than ___ of cancers happen in children.
1%
Top 3 most common types of childhood cancers.
Leukemia, brain and nervous system, and neuroblastoma
What are some of the adverse side effects of cancer and its treatments?
Anorexia, diminished immune response, disturbed drug metabolism, delayed/compromized wound healing, reduced quality of life, reduced treatment response, reduced survival
Why are children more susceptible to malnutrition and protein depletion during cancer treatment?
Because of rapid growth, smaller reserves, higher relative needs per weight, and greater Resting Energy Expenditure
For what reasons are children more susceptible to malnutrition and protein depletion?
Because of rapid growth, smaller reserves, higher relative needs per weight and greater resting energy expenditure (REE)
Which assessment tool has been modified and validated for use in children?
Subjective Global Assessment (SGA) - renamed to Subjective Global Nutrition Assessment
What is cachexia
The loss of both lean and fat mass seen in the context of an illness, including cancer.
In children, what is the hallmark outcome of cachexia?
growth failure (as the result of anorexia, inflammation, and altered carbohydrate, fat and protein metabolism)
In cachexia, ____ accelerates, contributing to muscle breakdown.
protein turnover
What is the equation for catch-up growth?
kcal/kg x Ideal wt (kg) divided by kcal/day x Actual wt (kg)
What are two micronutrients of concern for pediatric oncology patients?
Calcium and Vitamin D because a child’s bone health may be compromised during the course of cancer treatment.
Breast milk is low in ____.
Vitamin D.
All exclusively breast-fed infants should receive which supplement?
400 IU Vitamin D/day
What are some chemotherapy-related consequences in pediatric patients?
GI side effects
Radiation-related consequences in pediatric patients?
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.
Side effects of radiation therapy may no manifest for up to ____ years after treatment?
10
Surgical-related consequences in pediatric patients?
post-operative ileus, nausea/vomiting, maldigestion, malabsorption, and alterations in substrate metabolism, alterations in intake may result in energy, protein and micronutrient intake.
Nutrition Assessment should include?
medical history, nutrition-focused physical findings, biochemical data, anthropometric measurements, dietary intake assessment, medical tests
Nasogastric feedings are appropriate for children up need nutrition support for up to ___ months?
3
Gastrostomy tube feeding is recommended for children who require enteral support for more than ___ months?
3
PN can not be used for which groups?
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.
T/F: Short-term use of PN (< 7 days) is generally not recommended.
True
What is PNLD
Pediatric Nutrition-associated Liver Disease (many cancer meds + PN can cause biliary dysfunction or steatosis.
What is HSCT?
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
What are the two types of conditioning regimens for HSCT?
Myeloblastive and nonmyeloblastive
What is the myeloblastive regimen?
It includes high dose chemotherapy with or without radiation to eliminate disease and ablate bone marrow
What is the nonmyeloblastive regimen?
Provides low dose chemotherapy with or without radiation
What is an autologous infusion?
the patient receives his or her own cells
What is an allogenic infusion?
the patient receives cells from another person, related or unrelated.
What is synergystic transplant?
the patient receives cells from a genetically identical twin
____ % of children undergoing HSCT have suboptimal nutrition status.
50%
What is the gold standard for assessing nutritional needs in children undergoing HSCT
Indirect calorimetry (IC)
All HSCT patients undergoing an allogeneic transplant should be placed on a ______ diet.
Neutropenic
Allogenic transplant patients should avoid all restaurants and fast food until day ____ after transplant.
+100
What are some long-term nutrition issues of HSCT?
chronic GVHD (graft vs host disease), osteoporosis, endocrine complications, iron overload, oral aversion, compromised growth and development
