Pediatric Oncology Nutrition

Despite newer treatments for chemotherapy-related nausea and vomiting being around for over 20 years, the image of a person going through chemotherapy brings to mind a painfully thin and malnourished body. Today, that is often not the case. Yet, the diet recommendations for the pediatric population while going through treatment continue to be more focused on calorie intake and less on good nutrition. A healthy diet and proper nutrition during youth set people up for a lifetime of good nutrition and better health. There is also plenty of research showing that diets filled with veggies, fiber, lean meats, and plant-based proteins do help to control nausea, increase energy, and decrease the loss of muscle mass.

I recently cared for a patient who had moved from Japan to the US only a year earlier. She arrived in the hospital critically ill and required multiple procedures and interventions to get her stable enough to transfer to the Peds Hem/Onc/BMT unit. Once settled on the unit, it was clear that she was hungry and ready to make up for some of the meals she had missed during the early part of her stay. The high-dose steroids she was receiving as part of her treatment also significantly increased her appetite.

Unfortunately, the raw fish in the sushi that she loved was no longer safe for her to eat. The menu at the hospital offered a very limited number of items familiar to her. In addition, the high-dose steroids altered her food cravings. For the first time in her life, she was eating an American diet of hamburgers and fries, mac and cheese, and steak and mashed potatoes. It did not take long for her blood tests to begin to show the effects of her changed diet. Her triglyceride levels jumped to such high numbers the lab was unable to process some tests because of the amount of fat in her blood.

Due to the negative impact of her recent food choices, additional limits were placed on her diet. She was only able to eat foods low in salt and fat. The one thing she had looked forward to during her long hospital stay was her meals. Now, even mealtime was boring and repetitive.  Her mental health was also affected by the changes and restrictions in her diet. A month in a hospital, especially during a pandemic, could bring anyone down. But, the restricted diet she had to follow only helped to keep her mood down. Hindsight is 20/20.

I often scratch my head at the food choices made by my pediatric patients. But, even more, surprising are the choices parents and caregivers make for themselves and the children for whom they care. Including information and guidelines for a healthy diet at the beginning of treatment might help to guide families towards better choices from the start of treatment. The Mediterranean Diet is often touted as one of the best diets for the adult population and is being embraced by many people, both inside and outside of healthcare. Kids are not small adults and should not be treated as such. However, the healthy fats, fish, fruits, whole grains, and lots of vegetables that are part of the Mediterranean Diet can easily be incorporated into any healthy family meal plan.

There is plenty of research being done about nutrition and its effects on cancer treatment. Without exception, a Registered Dietician needs to weigh in on the diet decisions for every child being treated during cancer treatment. Perhaps food needs to be considered a medicine, part of supportive care treatment, and along with antiemetics. With the nearly inevitable changes in appetite, dietary likes, and dislikes during treatment, Registered Dietitians are an invaluable resource for families who do want to pursue healthier dietary choices. I will continue to help guide my patients and their families toward better food choices. My hope and goal are that knowledge gained about good nutrition and healthy food choices will continue into adulthood for some of my patients. The improved nutrition will provide a model for the entire family with some luck.

References

Is the Mediterranean Diet Healthy for Kids?

Metabolic Changes in Children that Received Chemotherapy

Cancer Diet: Foods to Add and Avoid During Cancer Treatment