Impact of Nutritional Status on Survival among Children with World Health Organization Tracer Cancers Patients at Jimma University Medical Center, Jimma, Ethiopia: A Retrospective Cohort Study

Abstract

Introduction: According to the WHO, more than 1,000 children with cancer are diagnosed every day worldwide. The WHO tracer cancers are a diverse and heterogeneous group of cancers that collectively represent 50–60% of childhood cancers. These tracer cancers have potential for cure if diagnosed early and treated with available standard care, indicating the quality of cancer care. Malnutrition is a common complication and a highly prevalent comorbidity in children with these cancers and affects survival. There are limited studies regarding the impact of nutritional status on these cancers in Ethiopia. Objectives: To evaluate the impacts of nutritional status on survival among children with WHO tracer cancers at Jimma University Medical Center from January 1st, 2019, to December 31st, 2023. Methods: A hospital-based 5-year retrospective cohort study was used. Children diagnosed with WHO tracer cancers between 2019 and 2023 were included. A sample size of 244 (122 for each cohort) was determined by using Epi Info 7 based on malnutrition as the exposure. The stratified-proportional sampling technique was used by year and type of cancer. Data were extracted from medical records using a structured questionnaire. SPSS version 27.0 and Stata/SE 14 were used for analysis. Descriptive statistics were used to summarize patient characteristics. The Kaplan-Meier survival curves, along with the log-rank test, were used to determine and compare the survival probabilities over time. The results from the Cox proportional hazard model were presented as hazard ratios along with 95% confidence intervals. The P < 0.05 was set as statistical significance. Results: In this study, a total of 244 children with WHO tracer cancers were included. Males accounted for 127(56.70%). Median (interquartile range) age was 5[4, 9] years. Out of 122 malnourished children, 82.79% had severe acute malnutrition. During the total 3466.08 person-months follow-up, 82 (33.61%) deaths occurred, and the overall incidence of death rate was 23.66 cases per 1000 person-months. The overall median survival time was 27.07 months (95% CI: 11.07 - 43.07). Malnutrition (AHR=4.687, 95% CI: 2.670 - 8.228, P<0.001), Metastatic stage of cancer (AHR=2.030, 95% CI: 1.253 - 3.290, P = 0.004), and presence of comorbid condition (AHR=1.749, 95% CI: 1.057 - 2.893, P = 0.029) were independent predictors of mortality. Furthermore, inverse-probability-weighted analysis findings indicated that malnutrition shortened survival by 14.94 months (95% CI: [-27.8, -2.1], p = 0.023). Conclusion and recommendations: The presence of malnutrition, metastasized cancer, and comorbid conditions increases the risk of mortality among children with WHO tracer cancers. A comprehensive care strategy that includes routine nutritional screening at diagnosis and interventions throughout the care process to improve survival in children with WHO tracer cancer is an essential step of care.