English title dissertation Nutritional status in children with cancer; prevalence, related factors, and consequences of malnutrition
Name PhD (surname first) Brinksma, Aeltsje
Doctor is (has been) nurse
Date of promotion 01/10/2014
University Universitair Medisch Centrum Groningen
Promotores Petrie F. Roodbol, Robbert Sanderman, Eveline S.J.M. de Bont, Wim J.E. Tissing
Abstract (English)

Malnutrition has serious consequences for children with cancer
During treatment, children with cancer are not only confronted with undernutrition but also with overweight. Malnutrition (undernutrition or overweight) has substantial implications for both survival rates and quality of life. Children suffering weight loss have an higher risk of infections, and undernourished children have lower survival rates. Overweight during treatment can be the result of too long or too much tube feeding and low levels of physical activity.
Children with cancer nearly always have problems with eating – many of them eat too little because they have no appetite or they are feeling too ill. Other children have a voracious appetite due to the dexamethasone and want to eat all day long. Some children lose a lot of weight and become undernourished while others get fatter.
The problems are thus very diverse. The ‘Pediatric Cancer and Nutrition (Pecannut) Study’ investigated the nutritional status of children with cancer and examined the factors that influence weight loss or gain, as well as the consequences of malnutrition. With over 130 respondents, it is one of the largest studies in this field.
The Pecannut study revealed that more children than previously thought have a poor nutritional status at diagnosis because it is often not known that the children have been losing weight. After treatment starts, 35% of the children suffer serious weight loss and 17% have a muscle mass that is too low. However, weight and fat mass increase during treatment and the number of children with overweight doubles. The most important causes of this increase are tube feeding and low levels of physical activity.
The research also reveals that children with cancer do not need more energy but rather less as they are much less active than usual.
The Pecannut study shows that malnutrition in children with cancer has serious consequences for their chances of survival and their quality of life. Children suffering weight loss have an higher risk of infections, and undernourished children have lower survival rates. In addition, both undernourished and overweight children have a poorer quality of life than children with a healthy nutritional status.
The study indicates that the problems with nutritional status among children with cancer are very diverse and that the consequences of malnutrition can be serious. The advice for care providers is to ensure adequate nutritional support, to stop tube feeding in good time and to encourage physical activity from the start of treatment.
Based on the results of her research, the Paediatric Oncology department of the UMCG has initiated follow-up research where care providers develop programmes in collaboration with children and parents designed to improve dietary intake and to stimulate physical activity. The results will be evaluated in further research.

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