Nutritional Management of the Pediatric Oncology Patient Flashcards
What is the most common childhood malignancy?
Acute lymphoblastic leukemia (ALL)
True or False: Patients with ALL are at risk for developing obesity during the maintenance and continuation phases of treatment.
True
What nutrition-related issues are patients with acute myeloid leukemia (AML) most prone to d/t the intensive chemo regimen?
- Anorexia
- Weight loss
- N/V
- Mucositis
- Malnutrition
What are common nutrition-related side effects caused by medications used during the remission induction phase of ALL treatment?
- Vincristine: constipation, jaw pain
- Steroids: increased appetite, weight gain
- Asparaginase, Daunorubicin, Cytarabine: hyperglycemia, pancreatitis, anorexia, N/V, mucositis
What are common nutrition-related side effects caused by medications used during the consolidation phase of ALL treatment?
- Cyclophosphamide: anorexia
- Cytarabine: N/V
- Mercaptopurine: mouth sores
- Vincristine: constipation, jaw pain
- Pegasparaginase: pancreatitis
- Methotrexate
What are common nutrition-related side effects caused by medications used during the delayed intensification phase of ALL treatment?
- Vincristine: constipation, jaw pain
- Steroids: increased appetite, weight gain
- Doxorubicin: anorexia, mucositis
- Methotrexate (IT): hyperglycemia
- Pegasparaginase: pancreatitis
- Cyclophosphamide: N/V
- Cytarabine
- Thioguanine
What are common nutrition-related side effects caused by medications used during the interim maintenance phase of ALL treatment?
- Methotrexate (IV, high-dose): mucositis, mouth sores
- Methotrexate (IT): decreased appetite
- Vincristine: constipation, jaw pain
- Mercaptopurine
What are common nutrition-related side effects caused by medications used during the maintenance and continuation phase of ALL treatment?
- Steroids: increase appetite, weight gain
- Mercaptopurine (low-dose, oral)
- Methotrexate (low dose, oral or IT)
- Vincristine
What is one nutritional consideration during astrocytoma treatment?
- anorexia s/t chemo and radiation
What are nutritional considerations during brainstem glioma treatment?
- difficulty chewing or swallowing
- rapid weight gain with steroids
What are nutritional considerations during atypical teratoid/rhabdoid tumor (embryonal tumor) treatment?
- taste changes
- anorexia
What are nutritional considerations during atypical medulloblastoma (embryonal tumor) treatment?
- dysphagia
- anorexia
What are nutritional considerations during germ cell tumor treatment?
- diabetes insipidus
- anorexia
What are nutritional considerations during craniopharyngioma treatment?
- growth abnormalities
- hypothalamic obesity
What are nutritional considerations during ependymoma treatment?
- dysphasia
- anorexia
What are the four most common subtypes of non-Hodgkin lymphoma (NHL)?
- precursor lymphoblastic lymphoma
- Burkitt or Burkitt-like lymphoma
- diffuse large B-cell lymphoma (DLBCL)
- anaplastic large cell lymphoma
What nutrition impact symptoms are associate with neuroblastoma treatment?
- N/V
- taste changes
- anorexia
- abdominal discomfort
True or False: Wilms tumor is the most common kidney malignancy in children.
True
What nutrition impact symptoms are associated with chemotherapy for osteosarcoma?
- N/V
- anorexia
- hypomagnesemia
- metallic taste changes
- mucositis
What nutrition impact symptoms are associated with chemotherapy for Ewing sarcoma?
- N/V
- anorexia
- weight loss
What nutrition impact symptoms are associated with chemotherapy for hepatoblastoma?
- N/V/D
- anorexia
- mucositis
- renal toxicity
- electrolyte wasting
What are the primary indicators of pediatric malnutrition when a single data point is available?
Mild: Weight-for-height, BMI-for-age, or MUAC z score −1 to −1.9
Moderate: Weight-for-height, BMI-for-age, or MUAC z score −2 to −2.9
Severe: Weight-for-height, BMI-for-age, MUAC, or Length/height-for-age z score −3 or below
What are the primary indicators of pediatric malnutrition when 2+ data points are available?
Mild:
- weight gain velocity (<2 yr age) <75% of expected
- weight loss (2-20 yrs age) 5% of usual weight
- decline of 1 z score in weight for length or BMI
- 51-75% of estimated energy and protein needs
Moderate:
- weight gain velocity (<2 yr age) <50% of expected
- weight loss (2-20 yrs age) 7.5% of usual weight
- decline of 2 z score in weight for length or BMI
- 26-50% of estimated energy and protein needs
Severe:
- weight gain velocity (<2 yr age) <25% of expected
- weight loss (2-20 yrs age) 10% of usual weight
- decline of 3 z score in weight for length or BMI
- </=25% of estimated energy and protein needs
What are the 6 questions in SCAN (nutrition screening tool for childhood cancer)?
- Does the patient have a high-risk cancer? (1 pt)
- Is the patient currently undergoing intensive treatment? (1 pt)
- Does the patient have any symptoms r/t the GI tract? (2 pts)
- Has the patient had poor intake over the past week? (2 pts)
- Has the patient had any weight loss over the past month? (2 pts)
- Does the patient show signs of undernutrition? (2 pts)
> /= 3 pts: at risk for malnutrition
How much protein (g/kg) do pediatric patients need (based on RDA and stress (RDA x1.5-2))?
0-6 mo: 1.52; 2.3-3
7-12 mo: 1.2; 1.8-2.4
1-3 yr: 1.05; 1.6-2.1
4-13 yr: 0.95; 1.4-1.9
14-18 yr: 0.85; 1.3-1.7
What are the estimated fluid needs for pediatric patients (based on Holliday-Segar)?
< 10 kg BW: 100 mL/kg
10-20 kg BW: 1,000 mL + 50 mL/kg for each kg over 10 kg
> 20 kg BW: 1,500 mL + 20 mL/kg for each kg over 20 kg
What is the RDA for vitamin D for pediatrics?
0-12 mo: 400 IU
1-18 yr: 600 IU
What is the sufficient vitamin D level for pediatric patients with cancer?
30-100 ng/mL
What are 3 appetite stimulants commonly used in pediatric oncology?
- Cyproheptadine (Periactin)
- Dronabinol (Marinol)
- Megestrol acetate (Megace)
