ALL maintenance therapy explored the feasibility of a 12-month home-based nutrition and exercise
intervention program, and although the study led to improvement in the frequency of physical
activity p = 0.05, no difference in dietary behav- iors was observed Moyer-Mileur et al.
2009 .
Due to lack of resources, effective dietary and lifestyle interventions remain a poorly studied
area and emphasize the importance of ongoing education; the involvement of family, peers,
schools and healthcare providers; and the need for continued care of childhood cancer survivors.
The American Institute for Cancer Research
www.aicr.org has published nutrition guide-
lines focused on cancer prevention and are avail- able for medical providers to review with patients.
Ideally, dietary counseling should be performed by a registered dietician so that strategies for
behavior modifi cation may be discussed with the individual and their families. Additionally, the
infl uence on dietary choices by gender, ethnicity, age and socioeconomic status should be included
when discussing behavior modifi cation pro- grams. The use of lifestyle education programs
has been found to be successful in promoting long-term behavior change among adult survi-
vors of cancer Mosher et al.
2013 . The effec-
tiveness of such programs in childhood cancer survivors is unknown. Until additional research is
available, current clinical practice should incor- porate all aspects of lifestyle intervention and
provide the opportunity for survivors to receive continual access to nutrition information specifi -
cally designed for cancer survivors Table
12.6 .
12.5 Summary
Nutrition assessment and intervention are critical components of a pediatric oncology supportive
care program, both during cancer therapy and after the completion of therapy. The inclusion of
nutrition therapy promotes normal growth and development over the course of cancer therapy,
may improve quality of life, and prevents therapy- related toxicities and decreased survival as has
been shown in patients that are under- and over- nourished. Nutritional assessment and interven-
tion should be proactive and start at diagnosis and must continue well beyond the completion of
antineoplastic therapy. Although a clear evidence basis is lacking for many recommendations, there
are general indications for nutritional support during cancer therapy including the use of nutri-
tional supplements, appetite stimulants, enteral tube feeding and parenteral nutrition.
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