Childhood cancer survivors with poor diet at risk of chronic illness

 

A new study suggests that survivors of childhood cancer tend to have a poor diet in their adult life; a diet lacking essential nutrients might increase the risk of chronic disease for survivors of childhood cancer, as they are already more prone to developing serious illnesses.

Researchers say choosing a healthy diet helps decrease the risk of chronic disease.

The study was carried out by researchers from the Friedman School of Nutrition Science and Policy at Tufts University in Massachusetts, in collaboration with St. Jude Children's Research Hospital in Tennessee.
The team examined whether there was a connection between childhood cancer treatment and the survivors' nutritional intake.
Using a self-administered Block Food Frequency questionnaire, the study looked at the diets of 2,570 adult survivors of childhood cancer to see if they met the requirements of the 2010 Dietary Guidelines for Americans. The results were recently published in The Journal of Nutrition.
Researchers found that study participants had particularly low intakes of whole grains but excessive intakes of sodium and so-called empty calories, which are those from solid fats and added sugars.
The study found "excessive levels of sodium and saturated fat, both of which are risk factors for chronic diseases such as cardiovascular disease, diabetes and obesity," explains lead researcher Dr. Fang Fang Zhang, from Tufts University.
"When compared to existing dietary recommendations, we found that childhood cancer survivors consumed below the recommended intake of fiber, potassium, magnesium, vitamin D, calcium and vitamin E," Dr. Zhang added.

Risk of second cancer and chronic illness decreased by healthy diet

According to the Centers for Disease Control and Prevention, low fruit and vegetable consumption and high saturated fat intake may lead to coronary heart disease, some cancers, and diabetes.
By contrast, a diet consisting of fruit, vegetables, and whole grains - with limited amounts of fat, red and processed meat, as well as low added sugar - may reduce the risk of developing second cancers and the risk of chronic diseases, according to the latest Cancer Treatment and Survivorship report by the American Cancer Society.
Researchers led by Zhang used the Healthy Eating Index (HEI-2010) to calculate how well study participants adhered to the Dietary Guidelines.
The index works on a scale from zero to 100, where zero indicates no adherence and 100 represents perfect adherence. The group of participants averaged only 57.9 on the scale.

Cancer care should include nutrition

Both Zhang and Melissa Hudson, M.D., St. Jude Children's Research Hospital, point out the importance of incorporating nutrition into cancer care. "Healthy eating can improve the physical and mental functioning of childhood cancer survivors," says Dr. Zhang.

"The findings of this study emphasize the importance of integrating nutritional services and interventions to promote healthy dietary habits in childhood cancer patients during treatment and throughout survivorship care."

Dr. Melissa Hudson

She goes on to say that "survivors of childhood cancer have a high prevalence of chronic health problems that may be exacerbated by poor nutrition." A study following up on pediatric cancer survivors found that 50% of them had developed a severe or life-threatening chronic health condition by 50 years of age.
According to another study quoted by the American Cancer Society, more than half of the childhood cancer survivors that underwent potentially toxic treatments - for example, chest radiation or anthracyclines - go on to experience heart or lung problems later in life.
The study led by Dr. Zhang did not compare survivors' diets with the dietary intake of those who have not had cancer. However, Dr. Zhang reports that adult cancer survivors have "worse overall diet quality compared to age- and sex-matched controls in the National Health and Nutrition Examination Survey."
The researchers mention that the current study did not account for dietary supplements, such as vitamins or minerals.
Learn how the Mediterranean diet is linked to reduced risk of CVD.

Written by Ana Sandoiu

 Suicide is a major cause of death for persons of all ages in the United States and around the world, and its association with both physical and emotional distress is well-documented. In a recent issue of Journal of Clinical Oncology, Dr Recklitis et al¹ suggest that when viewed in the context of population-based studies of suicide, adult survivors of childhood cancer have an elevated risk for suicidality.
Suicidal ideation is a serious health problem and a key indicator of possible major depression.² However, few cancer patients and off-treatment survivors are routinely screened for depression, let alone suicide risk. For those screened, the majority do not receive guideline-based assessment, and even fewer receive guideline-based depression care management.^3-5 This condition is troubling in that effective treatments exist and that patients can choose from these if properly and rightfully informed.³ The recent report on suicidality in childhood cancer survivors offers a critical focus on yet another population that is not receiving care on evidence-based guidelines.
As social scientists, we appreciate the methodological rigor and excellent reporting by Recklitis et al. As a cancer survivor and former oncology social worker, however, I (B.J.Z.) struggled to understand my initial distressing reaction to their report. First, I was struck by the literally calculating and disembodying statistical presentation of suicidal risk in this report. It reminded me of the anonymous motto I once kept above my computer: “Statistics are people with their tears wiped away.” I also wondered about the 29 young adult survivors in the study whose responses led the investigators to conclude that they were at risk for suicide. Have any of those survivors in fact committed suicide since the completion of data collection? What actions, if any, were initiated on their behalf? I can only assume that the routine psychological screening at the multidisciplinary cancer survivor clinic where the survey data collection occurred detected respondents who were at risk for suicide and resulted in evidence-based care. A nice test of inter-rater reliability would have been a comparison to see if the same 29 respondents who indicated suicidality in their survey also were assessed and identified by clinicians as demonstrating indicators of suicide risk: ideation, a plan, and access to means for carrying out their plan.
Epidemiological survey research and a clinical encounter represent two different ways of knowing and accumulating information about a person, a situation, and a phenomenon. Each way has the potential to contribute to suicide assessment and an understanding of “truth,” but neither represents the whole truth. While the story told by Recklitis et al offers important knowledge regarding risk factors and suicide in childhood cancer survivors, it does not capture the emotional, cognitive, and what Shea⁶ refers to as the “nightmarish” aspects of suicide as a social phenomenon and individual experience. Suicide is a complex and deeply personal phenomenon with behaviors and aspects that vary from person to person. Even Recklitis et al,¹ who used just two items to assess suicidal ideation and past attempts, acknowledged the viewpoint that “adequate assessment of suicidal ideation requires multiple questions reflecting a range of intensity and symptoms.”
In The Practical Art of Suicide Assessment, Shea⁶ suggests that suicide assessment comprises three tasks: gathering information related to risk factors, assessing ideation and plans for carrying out suicide, and decision making with regard to action. He also tells us that individuals' responses to questions about suicide ideation are context specific, depending on setting, who is asking the questions, and even the time when they are asked. Thus, what an individual reveals about his/her thoughts of suicide and even past attempts is specific to the situation. For example, some investigators have used approaches to assess ideation or past attempts in a way that distinguishes lethal attempts from cries for help.⁷ In this way, investigators acknowledge that all suicide attempts are not alike and are somehow related to the emotions, cognitions, and meanings that individuals attribute to their condition or situation. As for assessing suicidal ideation, information-collecting methods must extend beyond simple endorsements of one or two items about thoughts of killing oneself and more to a deeper appreciation of ideation as it may indicate depression or reflect an expression of some inner emotional or outer physical pain and suffering.