Introduction
The nutrition management of childhood cancer patients is an important aspect of their multidisciplinary care plan and medical management. The focus of this management has been on the prevention of undernutrition1. Without nutrition therapy, up to 50% of paediatric cancer patients are likely to become malnourished 2. Nutrition therapy in childhood cancer patients tends to focus on weight and growth-based outcomes whereby the maintenance of normal growth and development is the primary goal of nutrition interventions3. Algorithms for initiating nutrition supplementation are predominantly based on weight changes and the suggested interventions themselves rely on commercial supplements, enteral tube feeding and parenteral nutrition 4.
Positively, recent research has shown that patients are meeting energy requirements during treatment 5, as a consequence of a focus on symptoms affecting dietary intake. In children treated for childhood leukaemia, 80% of patients experience disrupted eating behaviour with issues such as nausea, changes in appetite, vomiting, food refusal and fussy eating affecting intake 6-8. Consequently, parents often report changing their parenting strategies after diagnosis, including exerting higher levels of overprotectiveness, lower levels of discipline, offering nutrient-poor food rewards and non-food rewards for eating, and pressuring their child to eat9. There is a suggestion that the dietary intake of childhood cancer patients during treatment may be poor with research showing intake of poor quality foods and a reduction in food variety10,11. For those who are able to eat, food choices tend to be limited 8 or patients have a preference for “junk food” 12. It also appears that parents are not concerned about their child’s overall diet quality during their cancer therapy 13, as long as they are eating. Many childhood cancer patients are less than five years of age where long term feeding patterns and habits are being established 14. In childhood cancer the triad of disease, its treatment, and feeding difficulties, may therefore lead to poor eating habits that persist long into adulthood.
As medical treatments have advanced, outcomes for childhood cancer patients have also improved significantly. In contrast to these obvious positive outcomes, chronic disease such as obesity and cardiovascular disease are being recognised as long term sequelae in adult survivors of childhood cancer 15. Adult childhood cancer survivors have been shown to have poor dietary habits, with inadequate intake of fruit and vegetables, fibre and calcium and a high saturated fat intake16,17. It has also been shown that this poor dietary intake is manifesting within the early stages off treatment18,19. This is of particular concern as childhood cancer survivors have a predisposition to metabolic complications20 and there are high rates of obesity, especially in patients diagnosed with acute lymphoblastic leukaemia (ALL)21. Although the documented poor dietary habits reflect current unhealthy eating habits across the broader population22, there is a need to address the dietary habits of childhood cancer patients during treatment.
A number of recent reviews highlighted the need for dietary intervention studies that aim to optimise therapy and survival, and reduce treatment-related late effects 23,24. Decisions made regarding the nutrition management during cancer treatment the patient’s diet quality and nutrient intake, may have the potential to influence short- and long-term morbidity and mortality 25,26. There is a dearth of literature investigating the dietary intake of childhood cancer patients during treatment 27. The aim of this study was therefore to assess the dietary intake and diet quality of children receiving treatment for cancer.