Malnutrition in children with cancer: incidence and consequence.

Overt malnutrition in children with cancer is seen with surprising frequency: up to 37.5% in a group of patients with disease metastatic to or from bone, and 17.5% in a group of newly diagnosed patients with abdominal or pelvic tumors. It appears more frequent in some cancers. e.g., Ewing's sarcoma, than in others, e.g., osteosarcoma. Criteria for diagnosis of overt malnutrition are applicable to the child with cancer. Such overt malnutrition can be successfully and safely treated with intravenous hyperalimentation (IVH). Marginal malnutrition is a state that can be inferred from clinical behavior, although it cannot be objectively diagnosed as yet. Early data suggest that deterioration to overt malnutrition can be averted through IVH. Such nutritional intervention may increase chemotherapeutic tolerance and improve immune defenses. Since childhood cancer is beginning to frequently show excellent outcome, the association of malnutrition with progressive disease strongly suggests investigation of the role of nutritional support.