How can we most effectively support the nutrition of children with osteosarcoma?

Many children lose weight during treatment for osteosarcoma, a type of bone cancer. This is because of the intensive chemotherapy that affects taste, appetite and children’s ability to digest nutrients. This can be linked to problems like a higher risk of catching infections, lower quality of life, and can also affect patients’ ability to tolerate chemotherapy. Losing weight may also mean doctors need to lower the amount of chemotherapy given, which could affect how effective treatment is.

This means that children often need support with their nutrition. This is managed differently across the UK. Some hospitals recommend placing a surgical feeding tube (gastrostomy) into the stomach at diagnosis, whilst others adopt a ‘wait and see’ approach. If their patient has problems with nutrition, a doctor or nurse can put in a nasogastric feeding tube that goes through the nose into the stomach.

There are advantages and disadvantages to both. A gastrostomy is a reliable route for nutrition but might be an infection risk. Nasogastric tubes are easily inserted at the bedside, but they are visible and can be vomited out. The insertion and feeling of the tube in the throat can also be upsetting for some children. There is little evidence to show which is more effective in supporting nutrition or to show which option children prefer.

Laura Sealy, Specialist Paediatric Dietitian for children with cancer at Bristol Royal Hospital for Children, will be comparing differences in nutrition support between her hospital and Alder Hey Children’s Hospital. She hopes to see whether the type of feeding tube makes any difference to a child’s growth or time spent in hospital during treatment.

Laura hopes that her initial results will lead to a larger research project that can decide the best option for nutrition support. She will also be involving children and families with experience of osteosarcoma in her research, who will act as a focus group to ensure the project is relevant and useful for children with osteosarcoma.