Kanserli Çocukta Malnütrisyon Gelişmesinde Rol Oynayan Faktörler

Yıl 2024, Cilt: 5 Sayı: 2, 113 - 122, 27.08.2024

Rumeysa Sultan Çevik

https://doi.org/10.58770/joinihp.1431825

Öz

Çocukluk çağı kanserleri, doğum ile 19 yaş arasında ortaya çıkan, anormal hücrelerin kontrolsüz bölünmesiyle karakterize, oluştuğu dokuyla sınırla kalmayıp vücudun farklı bölgelerine de yayılabilen ve çok ciddi zararlarla birlikte tedavi edilemediğinde ölüme sebebiyet veren bir hastalık grubudur. Kanserli çocuklar, erken tanı ve uygun tedavi yöntemleriyle iyileştirilebilmektedir. Ayrıca hastaya uygulanan kemoterapi, radyoterapi ve/veya cerrahi tedavi çeşitli vücut sistemlerini etkileyen fiziksel, psikososyal ve nörobilişsel sorunlara ve semptomlara sebebiyet verebilmektedir. Hastalığın seyri boyunca değişen metabolik etkiler, enerji gereksiniminin değişmesi, tümörün yerine ve boyutuna ve hastanın duygu durumuna bağlı değişen psikolojik süreçleri de başta hastanın beslenme durumu olmak üzere birçok fizyolojik ve psikolojik süreci olumsuz yönde etkileyebilmektedir. Tüm bu faktörler sebebiyle kanserli çocuklarda ishal, mukozit, bulantı, kusma, yutma güçlüğü, tat ve koku bozuklukları, reflü, bağırsak tıkanıklıkları, kanamalar, malabsorpsiyonlar, hipermetabolizma, katabolik sürecin artışı, anoreksi ve/veya kaşeksi gibi uzun vadede malnütrisyona sebebiyet verecek sağlık problemlerinin yaşanması kaçınılmaz olmaktadır. Kanserin tedavisinde beslenmenin önemi çok büyüktür. Geç teşhis veya düzeltilemeyen bu sağlık problemlerinden kaynaklı yeterli besin alınamaması, alınması gerekenden çok fazla veya dengesiz oranlarda besin alınması hastada ciddi oranda malnütrisyona sebebiyet verebilmektedir. Bunun için hastanın tanıdan itibaren hastalık ve beslenme takibi büyük önem arz etmektedir. Kılavuzlar ışığında, ekip çalışması ile uygun tedavi protokolünün uygulanması kanserli çocuklarda yaşam kalitesini artırıp, iyileşme sağlanması açısından çok önemlidir. Derleme olarak hazırlanan bu makale için literatür taraması; Google Akademik, Pubmed ve Science Direct veri tabanları kullanılarak yapılan çalışmalar taranmıştır. İnsan çalışmaları; meta-analizler, kohort çalışmaları, retrospektif çalışmalar da dahil olmak üzere birçok türde farklı kaynaktan kanserli çocuklarda malnütrisyona sebep olan etmenler ve bu etmenlerin genel etkilerinin araştırılması amaçlanmış olup konuya ilişkin yapılan çalışmalarda genel kabul görmüş makaleler derlemeye dahil edilmiştir.

Anahtar Kelimeler

Malnütrisyon, Kanserli çocuk, Beslenme, Tedavi

Factors Involved in the Development of Malnutrition in Children with Cancer

Öz

Childhood cancers are a group of diseases that occur between birth and 19 years of age, are characterised by uncontrolled division of abnormal cells, are not limited to the tissue in which they occur, but can spread to different parts of the body and cause death when left untreated with very serious damage. Children with cancer can be cured with early diagnosis and appropriate treatment methods. In addition, chemotherapy, radiotherapy and/or surgical treatment may cause physical, psychosocial and neurocognitive problems and symptoms affecting various body systems. Metabolic effects that change during the course of the disease, changes in energy requirements, psychological processes that change depending on the location and size of the tumour and the patient's emotional state can negatively affect many physiological and psychological processes, especially the nutritional status of the patient. Due to all these factors, it is inevitable that children with cancer will experience health problems such as diarrhoea, mucositis, nausea, vomiting, dysphagia, taste and smell disorders, reflux, intestinal obstructions, bleeding, malabsorption, hypermetabolism, increased catabolic process, anorexia and/or cachexia, which will cause malnutrition in the long term. Nutrition is of great importance in the treatment of cancer. Inadequate nutrient intake due to late diagnosis or uncorrectable health problems, taking too much or unbalanced amounts of nutrients can cause serious malnutrition in the patient. For this reason, disease and nutrition follow-up of the patient from the diagnosis is of great importance. In the light of the guidelines, implementation of the appropriate treatment protocol with teamwork is very important in terms of improving the quality of life and providing recovery in children with cancer. Literature search for this article prepared as a review; Google Scholar, Pubmed and Science Direct databases were used. Human studies; It was aimed to investigate the factors causing malnutrition in children with cancer and the general effects of these factors from many different sources, including meta-analyses, cohort studies, retrospective studies, and generally accepted articles were included in the review.

Anahtar Kelimeler

Malnutrition, Child with cancer, Nutrition, Treatment

Kaynakça

• Aarnivala, H., Pokka, T., Soininen, R., Möttönen, M., Harila-Saari, A., & Niinimäki, R. (2020). Trends in age- and sex-adjusted body mass index and the prevalence of malnutrition in children with cancer over 42 months after diagnosis: a single-center cohort study. European Journal of Pediatrics, 179(1), 91–98. https://doi.org/10.1007/S00431-019-03482-W/FIGURES/3
• Akdeniz Kudubes, A., Semerci, R., Bektas, M., & Akgün Kostak, M. (2022). The effects of administered interventions on quality of life of children with cancer in Turkey: A systematic review and meta-analysis. European Journal of Cancer Care, 31(2), e13544. https://doi.org/10.1111/ECC.13544
• Behling, E. B., Camelo, J. S., Ferriolli, E., Pfrimer, K., & Monteiro, J. P. (2020). Nutrıtıonal status ın chıldren wıth cancer: comparıson of deuterıum oxıde dılutıon wıth bıoelectrıc ımpedance analysıs and anthropometry. Revista Paulista de Pediatria, 39, e2019209. https://doi.org/10.1590/1984-0462/2021/39/2019209
• Bolasco, G., Capriati, T., Grimaldi, C., Monti, L., De Pasquale, M. D., Patera, I. P., Spada, M., Maggiore, G., & Diamanti, A. (2021). Long-term outcome of pancreatic function following oncological surgery in children: Institutional experience and review of the literature. World Journal of Clinical Cases, 9(25), 7340–7349. https://doi.org/10.12998/wjcc.v9.i25.7340
• Cano-Vázquez, E. N., Galmich-Gómez, Á. A., Soto-Flores, P. A., Gutiérrez-Chablé, L. E., Ochoa-Fuentes, D. A., Gónzalez-Merino, I. B., García-Flores, M. A., & Méndez-Martínez, S. (2022). Depresión, ansiedad y calidad de vida en pacientes pediátricos con leucemia. Revista Médica Del Instituto Mexicano Del Seguro Social, 60(5), 517. /pmc/articles/PMC10395942/
• De Lucena Ferretti, R., Maria, E., Caran, M., De, R., & Ferretti, L. (2023a). Malnutrition in Children and Adolescents with Cancer and the Challenge for Health Professionals: A Narrative Review. International Journal of Innovative Science and Research Technology, 8(4). www.ijisrt.com12
• De Lucena Ferretti, R., Maria, E., Caran, M., De, R., & Ferretti, L. (2023b). Malnutrition in Children and Adolescents with Cancer and the Challenge for Health Professionals: A Narrative Review. International Journal of Innovative Science and Research Technology, 8(4). www.ijisrt.com12
• Di Giuseppe, G., Thacker, N., Schechter, T., & Pole, J. D. (2020). Anxiety, depression, and mental health-related quality of life in survivors of pediatric allogeneic hematopoietic stem cell transplantation: a systematic review. Bone Marrow Transplantation 2020 55:7, 55(7), 1240–1254. https://doi.org/10.1038/s41409-020-0782-z
• Diakatou, V., & Vassilakou, T. (2020a). Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. Children 2020, Vol. 7, Page 218, 7(11), 218. https://doi.org/10.3390/CHILDREN7110218
• Diakatou, V., & Vassilakou, T. (2020b). Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. Children 2020, Vol. 7, Page 218, 7(11), 218. https://doi.org/10.3390/CHILDREN7110218
• Franke, J., Bishop, C., & Runco, D. V. (2022). Malnutrition screening and treatment in pediatric oncology: a scoping review. BMC Nutrition, 8(1), 1–9. https://doi.org/10.1186/S40795-022-00643-3/TABLES/3
• Gallo, N., Czuppon, K., Tomsits, E., Garami, M., Hauser, P., Jakab, Z., Nagy, K., & Kovacs, G. T. (2022). The Effect of Nutritional Support on the Disease Progression and Survival in Pediatric Patients with Solid Tumors. Nutrition and Cancer, 74(1), 184–192. https://doi.org/10.1080/01635581.2020.1869275
• Glatt, D., Hughes, C., McCarthy, O., O’Shea, F., Brougham, M. F. H., Wilson, D. C., & Revuelta Iniesta, R. (2020). Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results). Clinical Nutrition ESPEN, 38, 242–252. https://doi.org/10.1016/j.clnesp.2020.04.003
• Grain, A., Camuset, M., Gras-Leguen, C., Hardouin, J. B., Scherdel, P., & Caldari, D. (2023). Taste and smell alterations affect nutritional status in children under chemotherapy. Acta Paediatrica (Oslo, Norway : 1992), 112(10), 2231–2238. https://doi.org/10.1111/APA.16889
• Joffe, L., & Ladas, E. J. (2020). Nutrition during childhood cancer treatment: current understanding and a path for future research. The Lancet Child & Adolescent Health, 4(6), 465–475. https://doi.org/10.1016/S2352-4642(19)30407-9
• Johnston, W. T., Erdmann, F., Newton, R., Steliarova-Foucher, E., Schüz, J., & Roman, E. (2021). Childhood cancer: Estimating regional and global incidence. Cancer Epidemiology, 71, 101662. https://doi.org/10.1016/J.CANEP.2019.101662
• Kebudi, R., & Alkaya, D. U. (2021). Epidemiology and survival of childhood cancer in Turkey. Pediatric Blood and Cancer, 68(2). https://doi.org/10.1002/PBC.28754
• Murphy-Alford, A. J., Prasad, M., Slone, J., Stein, K., & Mosby, T. T. (2020). Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research. Advances in Nutrition, 11(2), 216–223. https://doi.org/10.1093/ADVANCES/NMZ095
• Muscaritoli, M., Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., Hütterer, E., Isenring, E., Kaasa, S., Krznaric, Z., Laird, B., Larsson, M., Laviano, A., Mühlebach, S., Oldervoll, L., Ravasco, P., Solheim, T. S., Strasser, F., … Bischoff, S. C. (2021). ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition, 40(5), 2898–2913. https://doi.org/10.1016/J.CLNU.2021.02.005
• Özalp Gerçeker, G., Yildirim, B. G., Arıcıoğlu Sülün, A., Bektaş, M., Hekimci Özdemir, H., & Malbora, B. (2022). The effect of chemotherapy on symptoms and nutritional status in children with cancer. European Journal of Oncology Nursing, 61. https://doi.org/10.1016/j.ejon.2022.102206
• Pedretti, L., Massa, S., Leardini, D., Muratore, E., Rahman, S., Pession, A., Esposito, S., & Masetti, R. (2023). Role of Nutrition in Pediatric Patients with Cancer. Nutrients 2023, Vol. 15, Page 710, 15(3), 710. https://doi.org/10.3390/NU15030710
• Roeland, E. J., Bohlke, K., Baracos, V. E., Bruera, E., Fabbro, E. Del, Dixon, S., Fallon, M., Herrstedt, J., Lau, H., Platek, M., Rugo, H. S., Schnipper, H. H., Smith, T. J., Tan, W., & Loprinzi, C. L. (2020). Management of cancer cachexia: ASCO guideline. Journal of Clinical Oncology, 38(21), 2438–2453. https://doi.org/10.1200/JCO.20.00611/ASSET/IMAGES/LARGE/JCO.20.00611TA1.JPEG
• Runco, D. V., Wasilewski-Masker, K., Mazewski, C. M., Patterson, B. C., & Mertens, A. C. (2021). Features Associated With Weight Loss and Growth Stunting for Young Children During Cancer Therapy. Journal of Pediatric Hematology/Oncology, 43(8), 301–307. https://doi.org/10.1097/MPH.0000000000002246
• Saleh, M. S., Mohammed, A. M., Bassiouni, D., Mostafa, H. H., & Monir, Z. M. (2023). Evaluation of health-related quality of life and its domains in pediatric patients with cancer. Journal of the Egyptian National Cancer Institute, 35(1), 1–10. https://doi.org/10.1186/S43046-023-00168-1/TABLES/3
• Shabani, M., Saeedi Moghaddam, S., Ataeinia, B., Rezaei, N., Mohebi, F., Mohajer, B., Gohari, K., Sheidaei, A., Pishgar, F., Yoosefi, M., Kompani, F., & Farzadfar, F. (2020). Trends of National and Subnational Incidence of Childhood Cancer Groups in Iran: 1990–2016. Frontiers in Oncology, 9, 472325. https://doi.org/10.3389/FONC.2019.01428/BIBTEX
• Sutisna, C. S. (2022). Effect of Enteral Nutrition in Child Surgical Cases. Science Midwifery, 10(2), 913–920. https://midwifery.iocspublisher.org/index.php/midwifery/article/view/379
• Teixeira, I. X., de Oliveira Lopes, M. V., & Diniz, C. M. (2021). Nutritional Deficits In Children With Cancer: A Situation-Specific Theory. International Journal of Nursing Knowledge, 32(1), 29–36. https://doi.org/10.1111/2047-3095.12287
• Triarico, S., Rinninella, E., Cintoni, M., Capozza, M. A., Mastrangelo, S., Mele, M. C., & Ruggiero, A. (2019). Impact of malnutrition on survival and infections among pediatric patients with cancer: a retrospective study. European Review for Medical and Pharmacological Sciences, 23(3), 1165–1175. https://doi.org/10.26355/EURREV_201901_17009
• van den Brink, M., IJpma, I., van Belkom, B., Fiocco, M., Havermans, R. C., & Tissing, W. J. E. (2021). Smell and taste function in childhood cancer patients: a feasibility study. Supportive Care in Cancer, 29(3), 1619–1628. https://doi.org/10.1007/S00520-020-05650-3/TABLES/4
• Viani, K., Trehan, A., Manzoli, B., & Schoeman, J. (2020). Assessment of nutritional status in children with cancer: A narrative review. Pediatric Blood & Cancer, 67(S3), e28211. https://doi.org/10.1002/PBC.28211
• Yin, W., Wang, J., Jiang, L., & James Kang, Y. (2021). Cancer and stem cells. Experimental Biology and Medicine, 246(16), 1791. https://doi.org/10.1177/15353702211005390
• Zahnreich, S., & Schmidberger, H. (2021). Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers 2021, Vol. 13, Page 2607, 13(11), 2607. https://doi.org/10.3390/CANCERS13112607