Despite recent advances in research and treatment, cancer is still the leading cause of death by disease for all children past infancy in the United States. As recent as 2014, researchers estimated 10,450 new cancer cases and 1,350 cancer deaths among children from birth to 14 years, and an additional 5,330 new cases and 610 deaths were expected in adolescents between 15-19 years old.
Progress in survival rates is nevertheless being made nationwide. An estimated 379,112 survivors of childhood cancer were in remission in the United States as of January 1, 2010. The five-year relative survival rate for all children diagnosed with cancer under age 20 years, increased from 58% in the late 1970’s (1975-1979), to over 83% between 2007-2013.2 This dramatic increase in childhood cancer survival is due to multiple factors, including improved treatment protocols; the opportunity for children and adolescents to participate in sophisticated clinical trials, such as those from Children’s Oncology Group (COG), and the increasing acceptance of interdisciplinary supportive care teams that specialize in treating and caring for children undergoing treatment.
More recently, since Nutrition Focus published “Nutrition Assessment and Management of the Child with Cancer” in 2009,4 researchers and treating providers have developed, and are now administering, new treatment options for certain relapsed pediatric cancers. These “novel” treatments, including biologic and immune-based therapies, harvest the patient’s own T-Cells, genetically modify them and reintroduce the cells into the body. This complex process is intended to boost the immune system to eradicate malignant tissues and lessen side effects caused by some cancer treatments. A recent published phase 1 trial of 45 children and young adults with relapsed or refractory CD 19* B-lineage acute lymphoblastic leukemia (ALL), with a dismal prognosis, were treated with CD19 CAR-T cells. The trial outcome showed patients can achieve remission of disease, without need for prolonged chemotherapy or allogeneic hematopoietic cell transplantation (HCT).
As further progress is made towards curing childhood malignancies, researchers will continue to focus on improving outcomes for all pediatric cancers by incorporating more precision treatment strategies based on specific tumor targets and approaches to new therapies. The challenge for oncology dietitians will be to continue to define and address the nutritional status of this patient population, to focus on reliable standards of care to prevent malnutrition and to support the child though their treatment process. This issue of Nutrition Focus addresses nutrition assessment and management of children with cancer. Nutritional effects of cancer therapy and nutrition support practices are also addressed.
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Nutrition Assessment and Management of the
Child with Cancer
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