It is vital that Children with Cancer, including Children with Brain Cancer, eat well-balanced, nutritional meals and snacks in order to maintain their weight, rebuild any tissue lost in treatment, and strengthen their immune system and power it to fight against the brain cancer.
The occurrence of malnutrition in children with childhood tumours is multifactorial and develops during therapy for cancer in 40-80% of children. Malnutrition is more commonly seen in patients with advanced neuroblastoma, Wilms tumour, Ewing sarcoma and advanced lymphomas.
Malnutrition is usually more severe with aggressive tumours in the later stages of malignancy. Children who have a poor nutritional status have lower survival rates compared to those with a good nutritional status.
The majority of childhood cancers are treated by combined modality therapy, including surgery, radiotherapy, and antineoplastic schedules commonly providing a variety of side effects, which may lead a child into a state of nutritional deprivation.
Each of these treatment modalities may produce injuries to major organ systems (liver and pancreas), and a combination of therapies could result in a synergism of adverse effects.
Multimodality therapies combined with the effects of the tumour itself affect nutritional status and damage rapidly growing cells, e.g., in the gastrointestinal tract, causing serious and undesirable symptoms.
As a result of intense diarrhoea, vomiting, mucositis, and systemic effects of therapy, affected children often experience a lengthy period of minimal oral intake. This contributes to fluid loss, electrolyte and trace elements imbalance, and alterations of their carrier proteins, as well as iron and vitamin deficiency that may result in acute and chronic malabsorption of micro- and macronutrients.
In childhood cancer, undernourishment can negatively impact the survival rate, especially in children with solid tumours and metastatic diseases. Low survival rates in children with newly diagnosed stage IV Neuroblastoma, Acute Lymphoblastic Leukaemia, and Acute Myeloid Leukaemia, are associated with the degree of an unfavourable weight loss.
Research studies that compared the BMI of Paediatric Cancer Survivors to the general population of a similar age demonstrated that survivors of specific cancer types, including soft tissue sarcoma, neuroblastoma, non-Hodgkin’s lymphoma, brain tumours, male survivors of leukaemia, and non-amputated females with bone cancer, Wilms tumours, and survivors of Hodgkin’s disease are more likely to be underweight.
Survivors of common paediatric malignancies are at risk for adult-onset diseases such as obesity, which is associated with a high risk for cardiovascular and endocrine diseases. Increased BMI was found in paediatric survivors of Acute Lymphoblastic Leukaemia with an age of less than 4 years at diagnosis receiving cranial radiation therapy and in children with brain tumours, especially in craniopharyngeoma survivors.
Managing Side Effects with Nutrition Therapy
Brain cancer patients often experience nausea, diarrhoea, constipation, and fatigue, which can make it difficult to eat. It is therefore important to combat various side effects using nutrition therapy:
Nausea: A low-fat, bland diet of cold foods, ginger products, peppermint can combat nausea.
Diarrhoea: A BRAT diet of bananas, white rice, applesauce and toast can help minimise irritation to the digestive tract, and water-soluble fibre supplements will help form firmer stool.
Constipation: Increasing fibre intake and staying hydrated, including drinking warm liquids (e.g., prune juice) will help relieve constipation
Fatigue: Try small, frequent meals of protein-rich foods, and decreasing sugar intake, will give your child more energy. It may also be necessary to give your child certain iron and folic acid supplements to boost red blood cell count (speak to your oncologist before giving your child any supplements).
It is vital that your child eat well during treatment for brain cancer, in order to help them fight the cancer, combat fatigue, cope more easily with the side effects of treatment, and build up their immune system.
Some children may experience nausea or vomiting during treatment while others may never have either. If nausea or vomiting is a problem, try feeding your child six to eight small meals during the day rather than three large meals and avoid sweet, greasy, fried or pungent (strong-smelling) foods.
A diet rich in healthy oils, such as olive oil and fish, can boost the immune system while reducing inflammation and swelling, and is therefore an essential component in treating brain cancer. Omega-3 fats, found in fish and flax-seed oil, are beneficial in reducing tumour resistance to therapy.
Trans fatty acids, which can be found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, doughnuts, processed foods, and margarine, should be either reduced or, preferably, avoided.
Sugar feeds cancerous cells, which consume 10 to 15 times more sugar than normal cells, increasing the chances of inflammation. Sugar also suppresses the immune system during cancer treatment. It is vital therefore to reduce refined sugar and carbohydrate intake and to replace them with whole grain products and naturally sweet vegetables, such as sweet potatoes.
A high- fibre diet can decrease chances of constipation and diarrhoea, lower cholesterol and triglyceride levels, and regulate blood sugar level. Include whole grain breads and cereals, fresh fruits, vegetables, and legumes in the diet and if your child is still not getting sufficient fibre, combine one to two tablespoons of grounded flaxseed into yogurt, oatmeal, salads, and smoothies.
“Phyto” means plant. Phytochemicals are nutrients derived from plants, and they appear to stimulate the immune system; they also demonstrate antibacterial and antiviral activity, and, in general, help the body fight cancer.
Phytochemicals can be found in onions, garlic, leeks, chives, carrots, sweet potatoes, apricots, tea, coffee, citrus fruits, cruciferous vegetables (broccoli, cabbage, kale, and cauliflower), berries, beans and whole grains.
The best way to ensure good health is to eat the “Rainbow Way”
Red: Improves Heart & Blood Health and supports Joints
Orange: Prevents Cancer and promotes Collagen growth
Yellow: Helps Heart, Vision, Digestion & Immune System
Green: Detoxifies, Fights Free Radicals, Improves Immune System
Blue/Purple: Improves Mineral absorption; powerful Anti-oxidants
White: Activates Natural Killer Cells & Reduces Cancer Risk
Hydration is vital during treatment as additional fluids are required to replace fluid lost through side effects of chemotherapy treatment.
Vitamin D: Vitamin D is vital to a healthy brain, as it activates chemical pathways, in particular the sphingomyelin pathway, which kills glioblastoma cells (Magrassi L et al 1998). Vitamin D3, the chemical form of vitamin D has been shown to inhibit growth and trigger apoptosis in neuroblastoma and glioma cells (Naveilhan P et al 1994, Baudet C et al 1996, Elias J et al 2003, van Ginkel PR et al 2007).
Melatonin: There is growing evidence suggesting melatonin may be useful in treating primary brain tumours. An in vitro experiment showed that melatonin, at physiologic concentrations, inhibits growth of neuroblastoma cells (Cos S et al 1996). 2 – 6 mg of melatonin given at bedtime may help immune support and promote sleep. Melatonin may interact with a variety of medications, including, but not limited to, antidepressants, psychiatric medications, blood-thinning medications, sedatives, and blood pressure medications, so be sure to speak to your child’s oncologist before giving them Melatonin.
Vitamin E: Vitamin E is another antioxidant of particular interest in connection with brain cancer. According to a 2005 study, alpha-tocopherol-succinate enhances chemotherapy treatment of drug resistant glioblastoma cells, increasing effectiveness (Kang YH et al 2005). A researcher from Tufts University described the use of vitamin E in treating glioblastoma multiforme in a 2004 article in the Journal of Nutrition. “Glioblastoma multiforme is the most common and aggressive brain cancer in humans and resists all forms of therapy. Pre-treatment with vitamin E may have a potential role in sensitizing glioblastoma to radiotherapy” (Borek C 2004).
Probiotic Supplements: A Probiotic supplement (containing Lactobacillus acidophilus) can help with the maintenance of gastrointestinal and immune health. Probiotics may not be appropriate in cases of severe immunosuppression.
Herbs: Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should speak to your health care provider before starting treatment.
Essential Oils: Combining essential oils of bergamot (Citrus bergamia), chamomile (Matricaria recutita), and lavender (Lavendula angustifolia) in aromatherapy applications – place several drops in a warm bath, or 4 – 6 drops in 1 tbsp. of vegetable oil for massage.
Selenium: Selenium is another antioxidant that patients with brain tumours should consider. Many oncologists fear that any nutritional supplement classified as an antioxidant will interfere with the ability of radiation or chemotherapy to kill cancer cells. Though this theory sounds logical, there is little published evidence to support it. In the case of selenium, a 2004 paper in the journal Anticancer Research, reports a “radiosensitising effect” on glioma cells (Schueller P et al 2004). Exposing brain cancer cells to selenium makes them more sensitive to, and more likely to die after, radiation therapy.
The optimal diet for cancer patients and survivors emphasises fruits and vegetables, whole grains, legumes, foods rich in healthy fats like omega-3 and monounsaturated fats and lean protein sources.
At every meal, you should strike a healthy balance of foods by planning your plate into these sections:
- 1/2 vegetables and/or fruits
- 1/4 protein
- 1/4 whole grains
- A small amount of healthy fats
- Plenty of water
Below are some tips on how to plan for each part of your child’s plate for optimal nutrition. Be sure to ask your health care team about any foods which should be avoided while on medications or undergoing cancer treatment.
Fruits and Vegetables
Fruits and vegetables contain phytonutrients, which are essentially the plant’s immune system and offer protection to your child in a variety of ways; they act as antioxidants, boost immunity, form anti-inflammatory pathways, discourage tumours from being able to create their own blood supply, promote apoptosis (cancer cell death), and help your body to detoxify naturally.
Try to eat 5-10 servings of fruits and vegetables per day. One serving is equal to:
- 1 cup of leafy greens, berries, or melon chunks;
- 1/2 cup for all other cut, cooked, or sliced fruit or vegetable;
- 1 medium-sized fruit or vegetable (e.g., apple or orange);
- 1/4 cup dried fruit;
- 3/4 cup or 6 ounces of 100% juice or fresh juice.
Where possible, choose local and in-season produce.
Whole grains contain the entire grain kernel, including the bran, germ and endosperm. Unlike refined grains, they contain fiber, phytonutrients as well as other vitamins and minerals that are important for supporting your immune system during and after cancer treatment.
Aim to eat 25-35 grams of fiber per day by following these tips:
- Switch to whole-wheat pastas, bread, and crackers.
- Choose brown rice instead of white.
- Experiment with different grains such as quinoa, bulgur, and barley.
- Choose whole grains and limit your intake of white flour and sugar.
- Eat the skin of potatoes and fruit.
- Choose whole-grain breakfast cereals.
- Add wheat germ to cereal or yogurt.
- Look for the terms “100% whole” or “100% whole grain” in the ingredient list.
- Look for at least 5 grams of fibre per serving on the food label.
Protein is necessary for the growth and repair of all the cells in your body, including red blood cells, white blood cells, muscles, and hormones. Protein is made up of amino acids, some of which cannot be made by your body. When selecting a protein, choose lean, high-quality sources.
Protein-rich foods include:
- Lean red meat
- Low-fat or non-fat dairy (milk, yogurt, cheese)
- Soy foods like tofu, edamame, and tempeh
- Nuts and nut butters
- Beans and legumes
- When possible, choose organic, free-range, grass-fed, and wild options
A diet that is low in saturated and trans fats and high in omega-3, monounsaturated fats from plant oils, nuts, seeds, and fish is recommended for everyone, and may be particularly important for cancer survivors. Aim to decrease your consumption of foods that are high in saturated and trans fats, which are unhealthy and can be taxing to your heart and circulation. Instead, choose foods that are high in healthy unsaturated and omega-3 fats.
Healthy fats include:
- Fish (salmon, flounder, herring, sardines)
- Olive oil, canola oil, flax oil, and coconut oil
- Nuts and natural nut butters
- Ground flax-seed
- Chia seeds
- Wheat germ
Unhealthy fats include:
- Whole milk products
- Butter and margarine
- High fat red meat (except grass-fed)
- Processed meats (like bacon, hot dogs)
- French fries and other deep-fried foods
- Partially hydrogenated oils in pastries, crackers, processed foods
Fluids are important for your child’s overall health because their body is 70-80% fluid. Drinking insufficient fluids can make your child become dehydrated, which can slow their metabolism and harm their body’s ability to eliminate toxins.
Fluids are considered anything that is liquid when kept at room temperature, excluding caffeinated and alcoholic beverages.
Examples of healthy fluids include:
- Water, soda water, flavoured water (try adding lemon or lime)
- Coconut water
- 100 percent fruit juice
- Low fat or non-fat milk (dairy, soy, almond, coconut, or rice)
- Bottled liquid nutrition supplements
- Soups and broths
- Ice cream, sorbet, sherbet (dairy, soy, almond, coconut, or rice)
- 100% juice popsicles
- Crushed ice, ice cubes (one cube contains one ounce of water)
- Herbal teas (lemon, apple, berry, mint)
- Decaffeinated coffee and tea
The amount of fluid your child needs may change from day-to-day.
Please note that the Little Fighters Cancer Trust shares information regarding various types of cancer treatments on this blog merely for informational use. LFCT does not endorse or promote any specific cancer treatments – we believe that the public should be informed but that the option is theirs to take as to what treatments are to be used.
Always consult your medical practitioner prior to taking any other medication, natural or otherwise.