Nutrition

The nutritional status of CYP is an important factor to consider both at diagnosis and throughout treatment. Studies have shown that well-nourished CYP are more likely to cope better with treatment, have reduced complications and is more able to fight infection (Revuelta‑Iniesta et al., 2021). Malnutrition may be present at diagnosis or develop during therapy secondary to side-effects of treatment (Lovell et al., 2024). It is for this reason that the nutritional status of all CYP should be assessed at diagnosis and their weight and height closely monitored and plotted on an age-appropriate centile chart throughout their treatment. CYP may lose or gain weight throughout their treatment which may lead to a reduction in drug doses. It may also have an adverse effect on their emotional and physical wellbeing.

Malnutrition is a term used to define an imbalance of nutrients. It is often associated with weight loss; however, it should be noted that CYP may be of normal weight or be overweight and still be malnourished. Malnutrition may be masked in patients with an abdominal mass as they may have a falsely elevated body weight (Viani et al., 2025). Malnutrition can occur due to an inadequate diet or the inability to utilise the nutrients effectively (Viani et al., 2025).

If you are concerned about a patient’s nutritional status or weight during their cancer treatment, please contact the team managing their cancer care at the Principal Treatment Centre or Paediatric Oncology Shared Care Unit.

At diagnosis there will be a multi-disciplinary team (MDT) approach to maximise the nutritional status of the CYP with the cancer service dietician playing a key part. Assessment of nutritional status and subsequent monitoring is essential in highlighting when and if any nutritional intervention is required. Validated screening tools are used as part of the assessment.

When considering the nutritional status of an individual it is not only the weight, height and nutritional content of the diet that need to be taken into account but also the diagnosis, subsequent therapy and anticipated toxicity. By considering the treatment protocol and drug toxicity, patients likely to require nutritional support can be identified early. Regularly carrying out a nutritional screening tool will highlight when additional dietitian input is required.

In some cases, it may be beneficial to introduce nutritional support at the beginning of treatment and consider, for example, early placement of a gastrostomy.

High risk 

• Neuro-oncology patients, especially medulloblastoma
• Osteosarcoma
• Stage III and IV Wilms’ tumour
• Ewing’s sarcoma / PNET (Primitive Neuro Ectodermal Tumour)
• Nasopharyngeal tumours
• High risk rhabdomyosarcoma
• High risk neuroblastoma
• Patients with abdominal disease which may respond poorly or slowly to treatment
• B cell non Hodgkin’s lymphoma
• Acute myeloid leukaemia
• Some acute lymphoblastic leukaemia (ALL) – Infant ALL, those on protocol A receiving a short dose of dexamethasone, regimen A protocol randomised to Methotrexate, B and C protocols, relapsed ALL
• Bone marrow transplant
• Peripheral blood stem cell transplant (PBSCT).

There are many reasons why children with cancer lose weight. Understanding the predisposing factors leading to inadequate nutrition enables healthcare professionals to support the patient and family (Viani et al., 2025). Some individuals can present with a long history of poor intake that is easily reduced further with treatment.

There may be many reasons for weight loss and malnutrition. It may be due to catabolic (chemical energy) effects of the tumour; presence of the tumour resulting in, early satiety (feeling full), dysphagia (difficulty swallowing) or bowel obstruction. Reduced food intake can also occur secondary to the side-effects of treatment, such as nausea, vomiting, anorexia, altered taste or smell, mucositis, diarrhoea, constipation and pain. Psychological factors may also affect intake, such as the realisation of the diagnosis itself, fatigue, depression and anxiety (Lovell et al., 2024).  The younger child can also refuse food as a way of taking control and for attention.

Prolonged hospital admission can also have an adverse effect on a CYP’s food intake and overall nutritional status. Mealtimes are generally very structured with few options out with these times. Meals not looking appetising or familiar can all reduce the CYP’s willingness to eat.

It should be noted that children and young people presenting with a large tumour burden may have a falsely elevated body weight. Consideration of this will be taken into account especially when calculating drug dosages and when tumour (or limb in some cases) is removed/reduced in size.  

Rapid weight gain in CYP undergoing treatment for cancer is frequently linked to steroids. A balanced diet following healthy eating principles, including five fruit and vegetables a day and limiting intakes of foods high in salt, sugar or carbohydrates, can help limit excessive weight gain. Protein and healthy fats are fine and are a good source of calories. Once intensive treatment is finished, these principles should also be encouraged with the whole family becoming involved.

It is important that the child and family are made aware of the impact that the treatment may have on the patient’s weight and nutritional status. It is important that they are involved in the decision-making process.
 
Helping your child to eat well during cancer treatment | CCLG - The Children & Young People's Cancer Association

Generally it is important not to restrict the food intake of any individual with a reduced intake. There are some foods, however, that should be avoided as they may cause harm. These are listed below. 

• Raw or lightly cooked eggs 
• Probiotic or bio foods, drinks or supplements  
• High energy drinks and those loaded with high dose caffeine are not suitable for children and adolescents  
• All unpasteurised dairy products, e.g milk sold on local farms 
• Soft,  ripened cheese, e.g. brie, camembert, blue veined cheese such as stilton, goat’s cheese 
• Soft cheese made with unpasteurised milk, e.g. feta, parmesan 
• Pate 
• Shellfish 
• Raw / undercooked meat, poultry or fish, e.g meat that is still pink, sushi.  

Patients undergoing a stem cell or bone marrow transplant will be advised to avoid additional foods as well as those mentioned above.

The aim of nutritional support is to correct malnutrition at diagnosis, prevent malnutrition due to treatment and to promote normal growth and development throughout treatment (Viani et al., 2025). 
 
How we are making sure all young patients receive the best nutrition care and support | CCLG - The Children & Young People's Cancer Association 

Nutrition support options in childhood cancer | CCLG - The Children & Young People's Cancer Association

Parents and carers may ask about complimentary therapies in order to help children cope with the side effects of treatment or generally improve their well-being. If a parent or carer discusses this with you, it is important to stress they discuss it with their consultant and possibly the cancer pharmacists too, to explore any interactions and contraindications.