Onkolojik Tedavi Sürecinde Kanserli Çocuklar ve Ebeveynlerinin Nutrisyon Konusundaki Bilgi, Farkındalık ve Beklentilerinin Değerlendirilmesi

Year 2020, , 34 - 38, 12.01.2020

Uğur Demirsoy

https://doi.org/10.30934/kusbed.615599

Abstract

Amaç: Kanserli
çocuklarda malnütrisyonun tedavi başarısı dahil birçok parametreyi olumsuz
etkilediği saptanmıştır. Bu çalışmada kanser tanısıyla kemoterapi almakta olan
çocuklar ve ebeveynlerinin tedavi sürecinde beslenme ve ‘Güvenli Gıda Diyeti’
konusundaki farkındalık, bilgi ve deneyimleri araştırıldı.

Yöntem: Kocaeli
Üniversitesi Tıp Fakültesi Çocuk Onkoloji Bölümü’nde kanser tanı ve tedavisi
alan 8 yaşın üzerindeki hastalar ve ebeveynlerine anket çalışması uygulandı.
Ebeveyn anketi 19 soru, çocuk anketi 13 soru içermekteydi. Soruların bir kısmı
‘evet/hayır/fikrim yok’ yanıtlarını, diğerleri ise çoktan seçmeli yanıtlar
içeriyordu.

Bulgular: Çalışmaya
101 gönüllü (42 hasta çocuk/59 ebeveyn) katıldı. En sık tanılar Hodgkin lenfoma
(n=14, %33,3), non-Hodgkin lenfoma (n=8, %19) ve kemik-yumuşak doku
sarkomlarıydı (n=8, %19). Hastaların 23’ü (%54,8) kanser tedavisi sürecinde
beslenme sorunu yaşadığını düşünüyor ve bu hastaların 4’üne (%17,4) parenteral
beslenme (PB) uygulanıyordu. Hastaların 2’si (%4,8) enteral yolla (gastrostomi
ve nazogastrik tüp), 4’ü (%9,6) parenteral yolla beslenmişti. Yirmi üç ebeveyn
(%43) çocuklarına oral beslenme ürünleri (OBÜ) kullandığını belirtti. Hastalara
göre oral beslenme ürünlerinin en beğenilmeyen 2 özelliği tadının kötü olması
(n=10, %23,8) ve bulantı etkisiydi (n=5, %11,9). Hastalar ve ebeveynleri
ağızdan beslenmenin mümkün olmadığı durumlarda ilk olarak PB’yi seçmişlerdi
(n=16, %38,1 ve n=29, %49,2).

Sonuç: Kanser
tedavisi alan çocuklarda oral beslenme desteklenmelidir. Oral beslenmenin
mümkün olmadığı hastalarda diğer enteral beslenme yollarının parenteral yola
tercih ve tavsiye edilmesi önerilir. 

Keywords

çocuk kanseri, beslenme, enteral, parenteral

Evaluation of Knowledge, Awareness and Expectations of Children with Cancer and Their Parents about Nutrition During Oncological Treatment Process

Abstract

Objective: Malnutrition
negatively affects several parameters including treatment success in children
with cancer. The awareness, knowledge and experiences of children (receiving
chemotherapy with cancer diagnosis) and their parents about nutrition and ‘Safe
Food Handling’ during cancer treatment were investigated.

Methods: A
questionnaire was applied to parents and their children (age 8 years) who were
diagnosed and treated for cancer in the Department of Pediatric Oncology,
Faculty of Medicine, Kocaeli University. The parent questionnaire included 19
questions and the child questionnaire included 13 questions. Some questions
included ‘yes /no / no idea’ and others included multiple-choice answers.

Results: A
total of 101 volunteers (42 sick children / 59 parents) participated in the
study. The most common diseases were Hodgkin's lymphoma (n=14, 33.3%),
non-Hodgkin's lymphoma (n=8, 19%) and bone-soft tissue sarcomas (n=8, 19%).
Twenty-three (54.8%) patients had nutritional problems during chemotherapy and
4 of them (17.4%) were fed parenterally (PN). Two (4.8%) of the patients were
fed enterally (gastrostomy and nasogastric tube), 4 (9.6%) were parenterally.
Twenty-three parents (43%) stated that they used oral nutrition supplement
(ONS) for their children. According to the patients, the two most undesirable
effects of oral nutrition products were poor taste (n=10, 23.8%) and nausea
(n=5, 11.9%). Patients and their parents chose primarily PN when oral feeding
was not possible (n=16, 38.1% and n=29, 49.2%).

Conclusion: Oral
feeding should be supported in children receiving cancer treatment. Enteral
feeding routes should be preferred and recommended rather than parenteral route
in patients in whom oral feeding is not possible.

Keywords

pediatric cancer, nutrition, enteral, parenteral

References

• Ladas EJ, Sacks N, Brophy P, Rogers PC. Standards of nutritional care in pediatric oncology: results from a nationwide survey on the standards of practice in pediatric oncology. A Children's Oncology Group study. Pediatr Blood Cancer. 2006;46(3):339-344. doi:10.1002/pbc.20435
• Oguz A, Karadeniz C, Pelit M, Hasanoglu A. Arm anthropometry in evaluation of malnutrition in children with cancer. Pediatr Hematol Oncol. 1999;16:35–41. doi:10.1080/088800199277579
• Montgomery K, Belongia M, Haddigan Mulberry M, ve ark. Perceptions of nutrition support in pediatric oncology patients and parents. J Pediatr Oncol Nurs. 2013;30(2):90-98. doi: 10.1177/1043454212471726.
• Moody KM, Baker RA, Santizo RO, ve ark. A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients. Pediatr Blood Cancer. 2018;65(1). doi:10.1002/pbc.26711.
• Fox N, Freifeld AG. The neutropenic diet reviewed: moving toward a safe food handling approach. Oncology (Williston Park). 2012;26(6):572-582.
• Esra Devecioğlu, Gülbin Gökçay, Serap Karaman. Follow-up of Cancer Survivors in Child Health Clinical. J Child. 2014;14(4):143-147.
• Braegger C, Decsi T, Dias JA, ve ark. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51(1):110-122. doi: 10.1097/MPG.0b013e3181d336d2.
• Duggan C. Manual pediatric nutrition. 4. Baskı. Hamilton: BC Decker; 2005.
• Nisim AA, Allins AD. Enteral nutrition support. Nutrition. 2005;21(1):109-112.
• Bruno Raynard. Integrating nutrition into cancer treatment. Clinical Nutrition Highlights. 2010;6(1):2-7.
• Scolapio JS, Picco MF, Tarrosa VB. Enteral versus parenteral nutrition: the patient's preference. JPEN J Parenter Enteral Nutr. 2002;26(4):248-250. doi: 0.1177/0148607102026004248
• Stattin P, Björ O, Ferrari P, et al. Prospective study of hyperglycemia and cancer risk. Diabetes Care. 2007;30(3):561-567. doi: 10.2337/dc06-0922.
• Ho VW, Leung K, Hsu A, ve ark. A low carbohydrate, high protein diet slows tumor growth and prevents cancer initiation. Cancer Res. 2011;71(13):4484–4493. doi: 10.1158/0008-5472.CAN-10-3973.
• Sparreboom A, Cox MC, Acharya MR, Figg WD. Herbal remedies in the United States: potential adverse interactions with anticancer agents. J Clin Oncol. 2004;22(12):2489-2503. doi:10.1200/jco.2004.08.182
• Jermini M, Dubois J, Rodondi PY, ve ark. Complementary medicine use during cancer treatment and potential herb-drug interactions from a cross-sectional study in an academic centre. Sci Rep. 2019;9(1):5078. doi: 10.1038/s41598-019-41532-3.
• Ireton-Jones CS, Garritson B, Kitchens L. Nutrition intervention in cancer patients: Does a registered dietitian make a difference? Top Clin Nutr. 1995;10:42–48. doi:10.1097/00008486-199509000-00006