Introduction
Childhood cancer is a significant global health concern, and while advances in oncology have greatly improved survival rates, treatment outcomes remain influenced by various factors beyond chemotherapy and radiation. Nutrition plays a critical role in the care of paediatric cancer patients, impacting their ability to tolerate treatment, recover, and maintain long-term health.1 Among the nutritional challenges faced by this population, vitamin deficiencies are a common yet underappreciated issue that can hinder recovery and compromise treatment efficacy. Cancer treatments, including chemotherapy and radiation, place substantial physical stress on young patients, leading to increased nutritional demands. At the same time, side effects such as nausea, vomiting, anorexia, and malabsorption can further exacerbate the risk of malnutrition, particularly in the form of vitamin deficiencies. Deficiencies in key vitamins such as A, D, C, E, and B-complex not only weaken immune function but also impair wound healing, reduce resistance to infections, and may negatively impact the body’s ability to tolerate and respond to cancer therapies.2 Despite the recognized importance of nutrition in paediatric oncology, vitamin deficiencies are often overlooked in clinical practice. This review aims to explore the scope of vitamin deficiencies in paediatric cancer patients, their impact on treatment and recovery, and the importance of addressing these deficiencies through early nutritional intervention and supplementation. By examining current evidence and clinical guidelines, this article underscores the need for a more integrated approach to nutrition in pediatric oncology, with an emphasis on individualized vitamin supplementation as a means to optimize recovery and improve overall outcomes.3
Discussion
Prevalence of vitamin deficiencies in pediatric oncology patients
Nutritional deficiencies, particularly in essential vitamins, are common in pediatric oncology patients and can adversely affect treatment outcomes and recovery. Cancer treatments such as chemotherapy and radiation increase nutritional demands, often leading to deficiencies in vitamins D, A, C, B-complex, and E due to factors like malabsorption, reduced appetite, and altered metabolism.4 Vitamin D deficiency, reported in up to 70% of pediatric cancer patients, can compromise bone health and immune function. Similarly, vitamin A, C, and B-vitamin deficiencies impair immune response, tissue repair, and energy metabolism, increasing infection risks and treatment side effects. Vitamin E deficiency exacerbates oxidative stress, further impacting recovery.5 The prevalence of these deficiencies varies by cancer type and treatment regimen, with children undergoing intensive therapies or those with gastrointestinal cancers being particularly vulnerable. Routine nutritional assessments and early supplementation are crucial for optimizing immune function, improving treatment tolerance, and enhancing overall recovery in paediatric oncology patients.6
Impact of cancer treatment on nutritional status in pediatric patients
Cancer treatment in paediatric patients, including chemotherapy, radiation, and surgery, can significantly impact their nutritional status in several ways:7
Decreased appetite: Many treatments cause side effects such as nausea, vomiting, and mouth sores, leading to reduced food intake and poor appetite.
Malabsorption: Treatments can damage the gastrointestinal tract, impairing nutrient absorption. This is especially common in patients receiving abdominal radiation or those with gastrointestinal cancers.
Increased metabolic demands: Cancer and its treatments elevate metabolic rates, requiring more calories and nutrients for healing and recovery, which can exacerbate deficiencies.
Altered taste and smell: Chemotherapy and radiation can change how foods taste and smell, making it difficult for children to consume adequate nutrition.
Weight loss and malnutrition: The combination of decreased intake, malabsorption, and increased needs can lead to significant weight loss and malnutrition, impacting treatment tolerance and recovery.
Long-term consequences: Nutritional deficits during treatment can lead to long-term complications, affecting growth, development, immune function, and overall health in survivors.
Vitamin deficiencies and immune function in pediatric cancer patients
Vitamin deficiencies can significantly impair immune function in paediatric cancer patients, making them more susceptible to infections and complications during treatment. Essential for immune system modulation, vitamin D deficiency can lead to weakened immune responses, increasing the risk of infections.8 Critical for maintaining mucosal barriers and immune cell function, a deficiency can result in compromised immunity and increased infection rates. An antioxidant that supports immune cell function, vitamin C deficiency can hinder the body's ability to fight off infections and delay recovery. Important for energy metabolism and immune cell production, deficiencies in B6, B12, and folate can lead to reduced immune function and increased fatigue. As an antioxidant, vitamin E protects immune cells from oxidative damage. Its deficiency may contribute to a diminished immune response.9
The role of vitamin-D in paediatric oncology: immune support and bone health
Immune support: Vitamin D is essential for the proper functioning of the immune system. It enhances the pathogen-fighting effects of monocytes and macrophages, which are crucial for defending against infections. Adequate vitamin D levels may help reduce the risk of infections, particularly important for children undergoing immunosuppressive cancer treatments.10
Bone health: Cancer treatments, such as chemotherapy and corticosteroids, can negatively impact bone health. Vitamin D helps maintain calcium and phosphate levels, essential for healthy bone development and density. Deficiency can lead to bone demineralization, increasing the risk of fractures and complications like osteopenia or osteoporosis.
Overall recovery: Ensuring sufficient vitamin D levels can enhance recovery from treatment by supporting immune function and promoting bone health, ultimately improving quality of life for pediatric cancer patients.11
Nutritional interventions for addressing vitamin deficiencies in pediatric oncology
Conduct regular nutritional assessments that include dietary history, clinical evaluation, and laboratory tests to identify potential vitamin deficiencies. Blood tests can help assess levels of key vitamins such as D, A, C, B6, B12, and folate. Encourage a nutrient-dense diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. After implementing dietary changes and supplementation, regularly monitor vitamin levels and overall nutritional status to assess effectiveness and make adjustments as needed. Collaborate with dietitians, oncologists, and other healthcare professionals to ensure comprehensive care that addresses both cancer treatment and nutritional needs.12 Develop personalized supplementation plans based on specific deficiencies identified through assessments. Use evidence-based guidelines to determine appropriate dosages. Vitamin D supplementation may range from 400 to 2000 IU/day, depending on the deficiency level and individual needs. Vitamin A, C, and B Vitamins: Dosages should be based on dietary intake and clinical needs, guided by healthcare providers.13
Vitamin deficiencies and their impact on treatment tolerance and side effects
Deficiencies in vitamins like D and C can impair immune responses, increasing the risk of infections. Infections can lead to treatment delays and dose reductions, compromising overall treatment effectiveness. Vitamins A and C are crucial for healing and tissue regeneration.14 Deficiencies can exacerbate side effects such as mucositis (inflammation of the mucous membranes) and slow wound healing, resulting in prolonged discomfort and increased risk of complications. B vitamins (especially B6, B12, and folate) are essential for energy production and red blood cell formation. Deficiencies can lead to anemia and fatigue, reducing a child's ability to tolerate chemotherapy and radiation sessions. Poor nutritional status from vitamin deficiencies can prolong recovery times between treatment cycles, making it challenging for patients to maintain the intended treatment schedule.15
Long-term consequences of vitamin deficiencies in pediatric cancer survivors
Unresolved vitamin deficiencies in childhood cancer survivors can lead to significant long-term health complications affecting various systems in the body:
Cognitive impairments: Vitamin deficiencies, particularly in B vitamins (B6, B12, and folate), can negatively impact neurodevelopment and cognitive function. Children with these deficiencies may experience issues such as memory deficits, attention problems, and decreased academic performance. Long-term deficiencies in vitamins like D and B12 have been linked to mood disorders and behavioral issues, affecting the psychological well-being of survivors.
Bone health: Deficiencies in vitamin D and calcium can lead to reduced bone mineral density, increasing the risk of osteopenia and osteoporosis. This is especially concerning for survivors who may already be at risk due to treatments like chemotherapy or steroids that can weaken bones. Poor bone health resulting from vitamin deficiencies can increase the likelihood of fractures and long-term skeletal issues, impacting mobility and quality of life.16
Immune system impairments: Vitamin deficiencies, particularly in vitamins D, A, and C, can compromise immune function, leading to increased susceptibility to infections. Survivors may face recurrent infections, which can impact their overall health and ability to participate in daily activities. Chronic vitamin deficiencies may affect the long-term development of the immune system, potentially increasing the risk of autoimmune disorders or other immune-related conditions later in life.17
Multivitamin supplementation in pediatric oncology: Risks and benefits
Benefits of multivitamin supplementation
Cancer treatments can lead to decreased appetite and malabsorption, increasing the risk of vitamin and mineral deficiencies. Multivitamin supplementation can help fill these nutritional gaps, ensuring that children receive essential nutrients necessary for recovery and overall health. Vitamins such as A, C, D, and E play critical roles in immune health. Supplementing with a multivitamin may help bolster the immune response, potentially reducing the risk of infections, which are common during cancer treatment. Adequate vitamin levels may help mitigate some of the side effects associated with chemotherapy and radiation, such as fatigue, mucositis, and anemia. This could lead to better treatment adherence and overall outcomes. Vitamins D and calcium are vital for maintaining bone density, particularly important for pediatric patients whose bone development may be affected by cancer treatments. Multivitamins can help ensure sufficient intake of these nutrients. Adequate levels of B vitamins and antioxidants can support cognitive health and mood stability, which may be beneficial for children experiencing the psychological stress of cancer treatment.18
Risks of multivitamin supplementation
High doses of certain vitamins (e.g., vitamin A, vitamin D) can lead to toxicity, especially in children who may already be receiving concentrated doses through fortified foods or medications. Careful monitoring is necessary to avoid exceeding safe levels. Some vitamins and minerals can interact with chemotherapy drugs, potentially reducing their effectiveness or increasing side effects. For example, antioxidants may counteract the oxidative stress that some treatments rely on to kill cancer cells. There is a risk that parents and caregivers may rely too heavily on multivitamins, neglecting the importance of a balanced diet rich in whole foods that provide a range of nutrients.19 The quality and composition of multivitamin supplements can vary widely. Some may not provide the labelled amounts of nutrients or contain inappropriate fillers, potentially leading to inadequate supplementation.
Personalized Nutrition in Pediatric Oncology: Tailoring Vitamin Interventions for Optimal Recovery:
Personalized nutrition plans offer a tailored approach to addressing specific vitamin and nutrient deficiencies in pediatric cancer patients, with the potential to significantly improve treatment outcomes.
Benefits of personalized nutrition
Targeted Deficiency Management: By identifying specific vitamin deficiencies (e.g., vitamin D, B vitamins, or antioxidants) through assessments, personalized plans can provide the right supplements or dietary changes, optimizing recovery and treatment tolerance.
Improved Treatment Response: Correcting nutrient imbalances through individualized care can help reduce the severity of side effects from chemotherapy or radiation, such as fatigue, immune suppression, or bone loss, leading to better overall treatment adherence and effectiveness.20
Enhanced Immune Support: Tailored nutrition ensures that patients receive nutrients critical for immune function (e.g., vitamins A, C, and D), reducing infection risks and boosting resilience during treatment.
Prevention of Long-Term Complications: Personalized plans help prevent long-term issues, such as cognitive impairments or bone health problems, by addressing specific needs early and consistently throughout treatment.21
Role of individualized care
Holistic Approach: Working with dietitians, oncologists, and caregivers ensures that each patient’s nutritional needs are met alongside cancer treatment, improving overall quality of life.
Continuous Monitoring: Regular adjustments based on evolving needs (e.g., changes in metabolism or side effects) allow for more effective and responsive care.
By integrating personalized nutrition into cancer care, healthcare teams can better support pediatric oncology patients, improving their ability to cope with treatment and enhancing long-term recovery outcomes.22
Challenges in nutritional care for pediatric oncology patients
Role of Healthcare Providers
Lack of Nutritional Focus: Oncologists and healthcare teams may prioritize cancer treatment over nutritional care, with limited emphasis on addressing vitamin deficiencies and malnutrition during treatment.
Limited Nutrition Expertise: Not all paediatric oncology centres have access to specialized dietitians or nutritionists, leading to inadequate dietary planning or supplementation.
Communication Gaps: Lack of coordination between oncologists, dietitians, and caregivers can result in inconsistent nutritional support and delayed interventions.23
Socio-economic factors
Financial constraints: Many families face financial difficulties, which may limit their ability to afford high-quality, nutrient-rich foods or supplements essential for recovery. The costs of specialized diets or medical nutrition products can add to the burden.
Food insecurity: Low-income families may struggle with food access, leading to poor dietary intake and increased risk of vitamin deficiencies. This is particularly challenging during long hospital stays or intensive treatment phases.
Insurance coverage: Limited insurance coverage for nutritional assessments and supplementation can further restrict access to essential care.24
Limited access to specialized care
1. Geographic barriers: Families living in rural or underserved areas may have limited access to pediatric oncology centers that offer specialized nutritional support. This can delay diagnosis and treatment of vitamin deficiencies.
2. Nutrition resources: Specialized nutritional interventions, like tailored supplementation plans, may not be widely available outside of larger, well-funded cancer treatment centers.
3.Inadequate education: Families may lack knowledge about the importance of nutrition during cancer treatment or have limited access to educational resources, making it difficult to implement effective dietary strategies at home.25
Addressing vitamin deficiencies in pediatric oncology is crucial for enhancing treatment outcomes and recovery. Deficiencies in vitamins like D, A, and B12 can weaken immune function, delay tissue repair, and increase treatment toxicity. Personalized nutritional assessments and targeted supplementation are essential for minimizing side effects and promoting optimal recovery in young cancer patients.26
Conclusion
To conclude, vitamin deficiencies treatment in pediatric oncology is vital for improving treatment tolerance and recovery. Personalized nutrition plans, regular assessments, and targeted supplementation can reduce complications, enhance immune function, and optimize long-term health outcomes for children undergoing cancer treatment.
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