International Initiative for Pediatrics and Nutrition (IIPAN) Regional Training
The World Health Organisation (WHO) describes cancer as a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably and go beyond their usual cell boundaries to invade adjoining parts of the body and spread to other organs.
On January 13th2020, The Columbia Global Centes| Nairobi in collaboration with Columbia University’s International Initiative for Pediatrics and nutrition (IIPAN) from the Center for Comprehensive Wellness held a one week workshop training from 13th to 17th January 2020 that dwelt generally on Nutritional Care of Children with Cancer. Facilitated by Dr. Elena Ladas, Associate Professor of Nutrition (in Pediatrics, Epidemology, and in the institute of Human Nutrition) at the Columbia University Medical Center, assisted by Judy Schoeman, Chief Dietician, Pediatric Oncology Unit, Steve Biko Academic Hospital Pretoria, South Africa, Dr. Gulsen Saleh, Head of Clinical Nutrition Department at the Children’s Cancer Hospital in Egypt Dr. Mariana Kruger, Executive head of Department of Paediatrics and child health at University of Stellenbosch (via Webcast) and also assisted by Dr. Karina Viani, Nutritionist at the Onco- Hematology service of the Children’s Institute of Hospital, University of Sao Paulo (via Webcast). They all spearheaded a team of forty nutritionists from different hospitals in Kenya, Tanzania, Cameroon, Uganda and Malawi through the guidelines for nutritional care of children with cancer in the region.
Dr. Murugi Ndirangu, Director of Columbia Global Centers| Nairobi in her opening remarks gave an introduction of Columbia Global Centers Network and Columbia University’s collective action on collaborative research to address current challenges such as nutrition.
In September 2018, the World Health Organisation (WHO) announced a new effort- The WHO global initiative for childhood cancer- this was with the aim of reaching at least a 60% survival rate for children with cancer by 2030, thereby saving an additional one million lives. This new target represents a doubling of the global cure rate for children with cancer. Guided by this, the training aimed at equipping the participants with an awareness of childhood cancer and expanding the capacity to deliver the best practices in childhood cancer care.
Dr. Mariana Kruger in her introductory remarks (via Webcast), noted that according to research conducted by Curesearch, every day, 43 children are diagnosed with cancer globally and out of these 43 diagnosed, a large number goes to the boys thus creating children cancer a challenge globally. This was further compounded by statistics that depict that more than 40, 000 children are in cancer treatment each year, the common of these cancers being: Acute lymphoblastic Leukaemia, Brain tumors, Lymphomas, Neuroblastoma, Nephroblastoma, and Acute Myeloid Leukaemia. In her presentation, Dr. Marina Kruger also pointed out the common warning signs of childhood cancer which include:
- Continued unexplained weight loss.
- Headaches, especially in the early mornings accompanied by vomiting.
- Increased pain in bones, joints, back or legs.
- Lumps or unexplained masses.
- Development of bruising, bleeding or rash.
- Constant infections.
- A white spot in the eye.
- Nausea with or without vomiting.
- Constant tiredness and/or notably pale
- Eye or vision changes.
- Recurrent fevers.
Dr. Marina Kruger also pointed out that 60% of the children who survive cancer suffer long- term side effects of cancer, and for the past 20 years globally, only four cancer treatments have been specifically developed and approved for children. This thus points out the need for more in-depth research and collaboration into childhood cancer treatment.
In the management of nutrition-related side- effects of cancer therapy with nutrition, Dr. Elena Ladas pointed out on the common side- effects which include:
- Bowel obstruction
- Gastrointestinal hemorrhage
- Mucositis/ Stomatitis
- Nausea/ Vomiting
- Steroid-induced weight gain
- Loss of appetite
Thereafter, Dr. Elena highlighted on the general dietary strategies in the management of children cancer that include: Drinking warm liquids preferably throughout the day, Adding insoluble fiber to diet, avoiding foods that may cause bloating, Increase Cereal intake, especially during breakfast, avoiding acidic foods eating frequent but small meals, and avoiding foods that have a strong flavor.
According to Judy Schoeman’s presentation on Collaboration with other disciplines, she created emphasis on the fact that to deal with child cancer, we require a team and pediatric oncologists can’t do all this by themselves. This team comprises of Pediatric Oncologist, Pediatric registrar, Pediatric Surgeon, Radiation oncologist, orthopedic neuro; urologist, gynecologist, nurses, occupational therapist, physiotherapist, speech therapist, counselor, radio graphist and the family as a whole.
The other presentations in the five-day Nutritional Care of Children with Cancer workshop training included:
- Guidelines for Nutritional Care of Children with Cancer. Presented by ( Dr. Elena Ladas)
- Nutrition Screening. Presented by ( Dr. Gulsen Saleh)
- Anthropometrics nutritional assessment. Presented by (Judy Schoeman)
- Nutrition assessment: Biochemical/ Clinical evaluation. Presented by (Dr. Gulsen Saleh)
- Components of a healthy diet, dietary benchmarks and performing a 24hr recall. (Presented by Dr. Elena Ladas)
- Case study presentations. Presented by (Judy Schoeman)
- Dietary evaluation of food groups/food diversity. Presented by (Dr. Elena Ladas)
- Nutritional Intervention. Presented by (Dr. Karina Viani)
- Homemade Feeds. Presented by (Judy Schoeman)
- Criteria for nutrition intervention /monitoring. Presented by (Dr. Karina Viani)
- Types and indications of enteral formulas. Presented by (Judy Schoeman)
- Setting up a nutrition program. Presented by (Dr. Elena Ladas)
- Nutrition Review and Evaluations. Presented by (Dr. Elena Ladas)
As part of the interactive one week workshop, the participants visited the Kenyatta Hospital in Kenya for a practical clinical evaluation. They gathered data from children living with cancer and later came back to analyze the data at the center. This visit allowed the nutritionists to identify the ongoing interventions on children cancer in Kenya as well as highlighted the success and lessons learned from the fails.