Nutritional support in children and young people with cancer undergoing chemotherapy.
BACKGROUND
Malnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment and promote weight gain and growth. The most effective and safe forms of nutritional support in children and young people with cancer are unclear.


OBJECTIVE
To determine the effects of any form of parenteral (PN) or enteral (EN) nutritional support in children and young people with cancer undergoing chemotherapy.


METHODS
We searched the following databases: CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CINAHL (1982 to 2006), the National Research Register (2007) and Dissertations & Theses (2007). We scrutinised reference lists of articles to identify additional trials. We also contacted experts in the field for information on relevant trials.


METHODS
Randomised or quasi-randomised controlled trials comparing any form of nutritional support with another, or control, in children or young people with cancer undergoing chemotherapy.


METHODS
Two authors independently selected trials. Three authors independently assessed quality and extracted data. We contacted trialists for missing information.


RESULTS
We included eight trials which randomised 159 participants (< 21 years) with leukaemias or solid tumours undergoing chemotherapy. The trials were all of low quality. One small trial found that compared to EN, PN significantly increased weight (mean difference (MD) 4.12; 95% CI 1.91 to 6.33), serum albumin levels (MD 0.70; 95% CI 0.14 to 1.26), calorie intake (MD 22.00; 95% CI 5.12 to 38.88) and protein intake (MD 0.80; 95% CI 0.45 to 1.15). One trial comparing peripheral PN and EN with central PN found that mean daily weight gain (MD -27.00; 95% CI -43.32 to -10.68) and energy intakes (MD -15.00; 95% CI -26.81 to -3.19) were significantly less for the peripheral PN and EN group, whereas mean change in serum albumin was significantly greater for that group(MD 0.47; 95% CI 0.13 to 0.81, P = 0.008).


CONCLUSIONS
There is limited evidence from individual trials to suggest that parenteral nutrition is more effective than enteral nutrition in well-nourished children and young people with cancer undergoing chemotherapy. The evidence for other methods of nutritional support remains unclear. No studies were identified comparing the nutritional content in the PN or EN groups of studies. Further research, incorporating larger sample sizes and rigorous methodology utilising valid and reliable outcome measures, is essential.
Jones
Leanne
L
Evidence Based Child Health Unit, Institute of Child Health, Alder Hey Children's NHS Foundation Trust, Alderhey, Eaton Road, Liverpool, UK, L12 2AP.
Watling
Ruth M
RM
Wilkins
Simone
S
Pizer
Barry
B
D000293:Adolescent; D002648:Child; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D009369:Neoplasms / Q000188:drug therapy*; D010288:Parenteral Nutrition / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult