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Understanding the links between nutrition and childhood cancer

22 November 2021
Research has shown links between nutrition and outcomes like infection, longer hospital stays and even survival.
When children have cancer, one of the biggest daily challenges is feeding them.

The cancer itself often causes weight loss. Cancer treatment can make children feel nauseous and lose their appetites just when they should be getting better nutrition to help them through the rigours of treatment.

Enter . A lecturer in nutrition and dietetics at the University of 免费色情视频鈥檚 , she鈥檚 also a casual paediatric dietitian at Starship Child Health. She has seen how children with cancer struggle to eat, the weakness this causes and the distress their families experience. 

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Amy Lovell

Despite this, few specifics are known about how cancer and cancer treatment affect children鈥檚 body composition and nutrient intake, never mind about how best to provide nutritional support for paediatric cancer patients. With newly announced research funding from the University of 免费色情视频鈥檚 , the up-and-coming researcher is working to change that.

鈥淩esearch abroad has shown links between nutrition and outcomes like infection, longer hospital stays and even survival,鈥 says Lovell, noting 免费色情视频 data is lacking. 鈥淎nd yet, particularly for child cancer, nutrition doesn鈥檛 get the attention it needs.鈥

Lovell suspects nutritional inequities may be behind the differences in survival that emerge between M膩ori and non-M膩ori as children diagnosed with cancer grow older. She wants to prove it.

鈥淲ithout the data demonstrating the need for nutritional intervention, health professionals have a hard time advocating for interventions that may reduce inequalities and enhance M膩ori childhood cancer survivors' wellbeing long-term,鈥 says Lovell.

How cancer affects children鈥檚 bodies

 Children eat a lot for their body size because they鈥檙e growing, which demands energy. Having cancer demands even more. If these energy needs aren鈥檛 met, the body鈥檚 muscle stores are used, further weakening the patient. Even once treatment begins, the side effects patients experience can also cause weight loss.  

鈥淐hemotherapy doesn鈥檛 just attack cancer cells. It attacks all cells in the body, particularly the ones that replicate frequently, like the cells that line our gastrointestinal tract from our mouth right through to the end,鈥 says Lovell. 鈥淭hese treatments can cause mouth pain, affect our bodies鈥 ability to absorb nutrients well, cause massive amounts of nausea and make our tastebuds interpret tastes differently, so foods we love start to taste like metal.鈥

All this is true for adults as well as children. But children are extra vulnerable because even healthy children tend to be picky eaters. Children who feel nauseated or who are experiencing taste changes are less likely than adult cancer patients to regularly drink something like a chalky supplement drink. 

鈥淭hey feel unwell, so they don鈥檛 eat, and because they don鈥檛 eat, they feel more unwell,鈥 says Lovell. 

While weight loss is common, excessive weight gain can also occur, often as a side effect of steroid treatment. Unlike the steroids some athletes illegally use to put on muscle, the steroids used to treat some types of cancer can lead to increased fat mass and losses in muscle mass.

鈥淩esearch abroad has shown links between nutrition and outcomes like infection, longer hospital stays and even survival.鈥

Amy Lovell

How cancer affects families and survivors

Cancer places tremendous strain on wh膩nau. Families often travel long distances to access treatment and may have to stay in temporary accommodations where cooking is difficult. Even for 免费色情视频 families, having a child with cancer imposes costs 鈥 both financial and emotional. 

鈥淭hough hospitals provide food, families want to provide foods their children are interested in eating,鈥 says Lovell. 鈥淔eeding your child is such a primal thing as a parent. You feel it鈥檚 something you should be able to do no matter what. So we see parents spending time making food and then their children not being interested in eating it, thus perpetuating a cycle of frustration for both child and parent.鈥

All these factors often result in children falling into unhealthy dietary habits.

鈥淲hen a child has a small appetite, parents may feel any calorie is a good calorie. Unfortunately, that means McDonald鈥檚 might take a front seat in children鈥檚 diets,鈥 says Lovell. 

鈥淏ecause treatments are getting better, we need to think about what happens to survivors as they get older. We know some cancer medications are hard on people鈥檚 hearts while others affect the pancreas. So we鈥檝e already got increased risks of heart disease and diabetes, and if children develop unhealthy changes in body composition, with more fat mass than lean muscle mass, we鈥檙e potentially exacerbating those risks.鈥

Feeding a child being treated for or recovering from cancer may come with other complications. Children may have suppressed immune systems, making them extra vulnerable to foodborne disease. Children who had feeding tubes may need to relearn how to eat. What鈥檚 more, families returning to smaller centres may have little support, since the hospitals close to them may not have dietitians with training in paediatric oncology 鈥 or any paediatric dietitians at all.

Researching children鈥檚 body composition and micronutrient status

Lovell and colleague Gemma Pugh, who is research lead with the, have received a grant from the Centre for Cancer Research to collect foundational data on children being cared for at the Starship Blood and Cancer Centre in 免费色情视频, which treats nearly three-quarters of the 150 children diagnosed with cancer every year in 免费色情视频.

The researchers aim to track participating children over a year, starting when they鈥檙e diagnosed and regularly taking blood samples and body composition measurements as well as noting their nutritional history and current dietary intake. 

鈥淲hile there are no differences in the diagnosis of childhood cancer in M膩ori versus non-M膩ori in 免费色情视频, we do see inequities in survival emerge between M膩ori and non-M膩ori with increasing age"

Amy Lovell

The blood samples will be analysed for signs of micronutrient abnormalities and malnutrition. 

Researchers in Scotland and the Netherlands have shown micronutrient deficiencies in child cancer patients are associated with poor outcomes, including treatment tolerance, treatment-related toxicity, risk of infection, impaired wound healing, patient quality of life and chronic disease into adulthood.

It鈥檚 vital to do similar research in 免费色情视频 to understand what鈥檚 going on in our population 鈥 particularly different communities within our population, says Lovell.

鈥淲hile there are no differences in the diagnosis of childhood cancer in M膩ori versus non-M膩ori in 免费色情视频, we do see inequities in survival emerge between M膩ori and non-M膩ori with increasing age.

鈥淧roviding insight into the nutritional status and body composition of children with cancer, as well as how changes in nutritional status affect cancer outcomes, will enable health professionals to better support wh膩nau during their child's cancer journey.鈥

Lovell and Pugh have also applied for a grant to do a data-linking study using the , which has collected data from paediatric patients for more than 20 years. 

鈥淲e鈥檒l look at complications like infection, relapse and death over five years, with data from around 600 patients,鈥 says Lovell. 鈥淚 think that will give us a clear picture of the relationship between a child鈥檚 nutrition status, their diagnosis and what happens later on.鈥

The big picture on nutrition and childhood cancer

Lovell has many more reserach plans. With a summer student, she wants to do a qualitative study interviewing paediatric cancer patients and their wh膩nau to better understand their needs and their experience of treatment. The study will use a Kaupapa M膩ori-consistent research approach.

Longer term, Lovell would like to trial targeted nutrition and physical activity therapy interventions in childhood cancer patients. That research would aim to improve treatment outcomes through nutritional invertentions and appropriate exercise to maintain muscle mass.

Lovell has an ambitious vision for changing cancer treatment approaches across 免费色情视频 to include more emphasis on nutrition. She鈥檇 like to see standardised guidelines on nutrition and physical activity for childhood cancer patients; regular monitoring of patients鈥 height, weight and micronutrient status; more support for parents; and more ongoing dietetic support across the country, including for longer-term childhood cancer survivors.

Plate of nutritious food

鈥淚 get quite frustrated when people don鈥檛 understand the value and importance of nutrition in the clinical setting,鈥 says Lovell. 鈥淚 really want nutrition to be prioritised as a key pillar in the care pathway for children with cancer. It鈥檚 not an optional extra. It has real impacts on outcomes. My research is about proving that.鈥

鈥淚 really want nutrition to be prioritised as a key pillar in the care pathway for children with cancer. It鈥檚 not an optional extra.鈥

Amy Lovell

Interested in learning more about or donating to cancer research at the University?