Date of Award

Summer 8-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Cathy L. Rozmus, PhD, RN - Chair

Second Advisor

Penelope Z. Strauss, PhD, CRNA, RRT-NPS

Third Advisor

Joya Chandra, PhD

Fourth Advisor

Pascal Owusu-Agyemang, MD

Abstract

Background: Pediatric oncology patients often experience nutritional status changes, particularly malnutrition, which may adversely affect their outcomes. Although the consequences of malnutrition are elucidated, its causes remain unclear. A possible cause of malnutrition in pediatric oncology patients is repetitive, pre-anesthetic fasting prior to non-invasive procedures and treatments, such as anesthesia-assisted radiation therapy (AART). This exploratory study investigated the association between repetitive, pre-anesthetic fasting and non-fasting days and malnutrition in pediatric oncology patients receiving AART.

Procedure: A retrospective cohort of 138 pediatric oncology patients (£ 10 years of age) who received any type of radiation therapy (RT) with or without anesthesia between 2006 and 2015 in a tertiary care hospital was evaluated for nutritional status changes from the start to the end of RT using three primary indicators for malnutrition (weight gain velocity < 75% of expected weight gain, deceleration in weight for length/height z-score ³ 1, and percent weight loss ³ 5%). Univariate and multivariate regression analyses were conducted to evaluate the association between fasting and non-fasting days and malnutrition.

Results: The number of fasting and non-fasting days was not significantly associated with malnutrition by the end of AART. However, after adjusting for age, patients who received concurrent chemotherapy had higher odds of becoming malnourished (odds ratio [OR] = 3.48; p = 0.024). Furthermore, after adjusting for concurrent chemotherapy, patients 2 years of age and older had lower odds of becoming malnourished (OR = 0.23, p = 0.018 for patients ³ 2 to < 5 years; OR = 0.26, p = 0.047 for patients ³ 5 years).

Conclusions: In pediatric oncology patients receiving AART, malnutrition status is not associated with repetitive, pre-anesthetic fasting, but with young age and concurrent chemotherapy. Further research is needed to corroborate these findings.

Keywords

pre-anesthetic fasting, patient malnutrition, pediatric oncology, radiation therapy

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