Improving Pediatric Cancer Patients' Nutritional Outcomes: A Multi-Institutional Approach Using Electronic Health Records
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Abstract
Study to describe cluster patterns of weight loss and growth in pediatric oncology patients as indicators of nutritional status while also examining the effects of changes in weight on mortality and non-fatal, serious adverse events (delays in chemotherapy, sterile site infections, duration of cytopenias, acute organ toxicities, and healthcare utilization [days admitted to an intensive care unit, days admitted to a hospital]), controlling on cancer type and risk stratification.
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Approximately half of pediatric oncology patients experience malnutrition as a direct result of cancer and its treatment. Malnutrition is associated with a twofold increase in mortality and a threefold increase in morbidity (e.g., infections and neutropenia). Previous studies of nutritional risk factors and outcomes have been limited by small sample sizes, an inability to stratify by malnutrition severity, and an inability to evaluate the impact of nutritional interventions such as enteral and parenteral calorie supplementation that are known to improve weight with better cancer outcomes. To improve nutritional outcomes for pediatric cancer patients, there is a critical need to determine which patients are at greatest risk for malnutrition and examine if current, standard-of-care interventions that increase weight also reduce morbidity and mortality.
Supportive care research in pediatric oncology lends itself to new data sources outside of the classic clinical trial model and fits with recent calls for evidence from pragmatic and alternative data sources. With the rapid adoption of electronic health records (EHR) over the past decade, unprecedented amounts of digitized health and healthcare data are now available for large-scale studies. Moreover, the aggregation of multi-institutional health data in large networks, such as PEDSnet (pedsnet.org) which has a repository of 25,000 cases of childhood cancer and over 1 billion data elements, enables rapid cycle, real-world evidence generation on pediatric cancer care, which complements evaluative clinical trials on innovative therapeutics and treatment strategies.
Project Aims
The study goal is to determine the patients at greatest risk for malnutrition and examine the effects of weight changes on important outcomes including morbidity and mortality. These are crucial first steps to the long-term goal of comparing the effectiveness of current supportive care interventions on reducing the impact of malnutrition on health outcomes for pediatric patients with cancer and testing these interventions as part of a clinical trial. For this initial research, innovative methodological approaches with a combination of classical statistical and machine learning methods that leverage multi-institutional EHR data in a national network of children�s hospitals were proposed. The following specific aims were pursued:
- Describe cluster patterns of weight loss and growth in pediatric oncology patients as indicators of nutritional status.
- Examine the effects of changes in weight on mortality and non-fatal, serious adverse events (delays in chemotherapy, sterile site infections, duration of cytopenias, acute organ toxicities, and healthcare utilization [days admitted to an intensive care unit, days admitted to a hospital]), controlling on cancer type and risk stratification.
Cohort Description
Pediatric oncology patients with leukemia, lymphoma, or a solid organ tumor, and having received treatment (specifically chemotherapy) at a PEDSnet hospital between 2011 and 2017.
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