Background: Progresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child’s optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children’s nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment.
Objective: The objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects.
Methods: The workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution’s clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants’ perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants’ anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health.
Results: The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019.
Conclusions: This research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer.
Long-Term Health Complications in Childhood Cancer Survivors
Progresses accomplished in childhood cancer treatment, diagnosis, and management in the past decades have led to survival rates exceeding 80% [, ]. Despite these encouraging statistics, it is estimated that about two-thirds of childhood cancer survivors (CCS) will be affected by treatment-related long-term complications [ ], including cardiovascular and metabolic diseases [ , ]. Lifestyle practices such as healthy eating and physical activity are well-recognized modifiable factors that contribute to lower the risk of cardiometabolic complications [ ]. Particularly, adherence to a Mediterranean dietary pattern has been associated with reduced risk factors related to the metabolic syndrome in survivors of childhood acute lymphoblastic leukemia [ ]. In addition to the prevention of long-term sequelae, good nutrition is essential to ensure children’s requirements for growth and development during cancer treatments. Adequate nutritional status is also associated with increased tolerance to cancer treatments, better prognosis, and enhanced quality of life [ ]. Side effects of cancer treatments such as nausea, mucositis, taste disorders, poor appetite, or increased appetite secondary to steroids intake can impact children’s eating behaviors and nutritional status [ ]. Furthermore, it is known that eating habits acquired in childhood are likely to persist in adulthood [ , ] and after completion of cancer treatments [ ].
Children’s Dietary Habits During Cancer Treatment
Studies on CCS have described similar dietary habits to those of the general population, reflecting a suboptimal diet for the prevention of metabolic syndrome components such as obesity, insulin resistance, arterial hypertension, or dyslipidemia . So, involving families of children with cancer to adopt or maintain healthy habits during and after cancer treatment is essential. Moreover, given that parents often experience time constraints [ ] and economic burden related to transportation, accommodation, or loss of work income [ ], practical advice for meal preparation should be provided to meet families’ needs. Design and evaluation of family-based nutrition and cooking education programs are increasingly reported in the literature, mainly related to the prevention or management of childhood obesity [ - ]. Nutritional interventions for young CCS and their families have been described in the literature [ - ], but, to our knowledge, only few were developed for children undergoing cancer treatment and those that were targeted patients in the maintenance phase of therapy [ - ]. As there is a need to develop and evaluate the feasibility of an early intervention during the course of pediatric cancer treatments, we have developed 6 nutrition and cooking education workshops that aim to increase knowledge relative to the following: (1) children’s nutrition during and after cancer treatments; (2) healthy, quick, and economical food preparation, cooking techniques, and food safety specific for children with cancer; and (3) development of food preferences during childhood and parental feeding practices. Here, we describe the following: (1) the development and validation of the workshops; (2) the elaboration of an evaluation tool; and (3) the study protocol to implement the workshops and to measure their impact.
We have developed a protocol for a nonrandomized controlled study. This study has been developed within the VIE (Valorization, Implication, Education) Program at the Sainte-Justine University Health Center (SJUHC) in Montreal, Canada. This research program consists of a 4-year family-oriented multidisciplinary interventional program integrating physical activity, nutrition, and psychosocial clinical and research teams. The nutritional intervention includes personalized assessment, goal setting, and counseling for behavioral changes with a registered dietitian (RD) as well as group nutrition education and cooking workshops providing complementary information. The SJUHC Institutional Review Board approved the study, and investigations will be carried out in accordance with the principles of the Declaration of Helsinki.
Curriculum Development and Validation Process
The research- and practice-based curriculum consists of 6 lessons developed by a team of researchers and RD and validated by the hematology-oncology clinical nutrition team at SJUHC. The workshops are designed to provide reliable, up-to-date nutritional information geared to address specific themes and associated to cooking demonstrations facilitated by a RD and a chef.
To develop the curriculum, evidence for common nutritional and behavioral eating problems related to side effects of childhood cancer treatment and their management has been reviewed in the scientific literature published between 2000 and 2017 contained in Medline, PubMed, and Scopus databases. A few core papers published before 2000 have also been considered. Gray literature was searched for Canadian governmental guidelines and family-oriented documentation related to children’s diet while on cancer treatment published by recognized organizations, such as the Children Oncology Group and the Canadian Cancer Society. Insight from the SJUHC Centre de cancérologie Charles-Bruneau (CCCB) clinical nutrition team has also been sought. Recipes for demonstration were developed and standardized to match each of the 6 lesson themes. Nutritional value of recipes was analyzed based on general (for protein, lipid, and sodium content) and theme-specific criteria and was inspired by those of the SJUHC institutional food service, of early childhood nutrition reference , and of the Heart and Stroke Foundation program [ ].
The curriculum was validated concurrently with its development within an 8-step process (). The first 6 steps have already been completed. Subsequent to the literature review, primary themes and specific lesson objectives were elaborated and submitted to a steering committee, composed of SJUHC CCCB clinical RD (n=2) and the Department head of the Clinical Nutrition Services, representing, respectively, 19, 15, and 10 years of experience in pediatric oncology. A consensus on improvements to be made was obtained, and a detailed content of the lessons was then elaborated based on current scientific evidence and common practices by the clinical nutrition team. The modified and detailed content was submitted to the clinicians for a second validation, followed by a final revision of the curriculum. Workshops were pretested with nonparticipants, including CCCB health care professionals, leading to further refinements.
Subsequent steps will be performed before official implementation and intervention evaluation. A validation meeting will be conducted with a committee composed of family members and CCS to better tailor the curriculum regarding the length of the workshop, the timing, and the amount of information delivered. After implementation, we will continually monitor the curriculum and evaluation tools to fine-tune and optimize content delivery.
Curriculum Description and Content
The developed curriculum consists of 6 themed workshops with specific objectives and key messages (). The 6 lessons are independent from one another, and there is no specific sequence to attend the workshops. This will increase convenience and allow flexibility according to participants’ schedule and needs for information. The nutritional criteria of the recipes are presented in .
The curriculum will promote a liberalized diet that reinforces food safety guidelines for immunocompromised patients based on Health Canada food safety guidelines for people with a weakened immune system  and in line with the SJUHC CCCB standard clinical practices. Patients receiving hematopoietic cell transplantation will be referred to the hematology-oncology RD for personalized diet and food safety guidelines.
|Lesson theme||Specific objectives||Learning objectives (specific key messages)|
|Meal fortification during cancer treatment|
|Changes in taste during cancer therapy and their impact on children|
|Adapting diet to eating-related side effects of treatments|
|Nutritional support during cancer treatment|
|Mediterranean diet and health|
|Planning quick and economic meals|
|Lesson theme||Nutritional criteriaa|
|Meal fortification during cancer treatment||Recipes rich in proteins that include at least one calcium-rich and one vitamin D-rich ingredient |
|Changes in taste during cancer therapy and their impact on children||Recipes include ingredients to enhance the taste of dishes (eg, herbs or spices) while limiting sodium and dietary fat and include ingredients to mask metallic taste (eg, acidic ingredients like lemon juice or vinegar)|
|Adapting diet to eating-related side effects of treatments||Recipes for nausea include: |
|Nutritional support during cancer treatment|
|Mediterranean diet and health|
|Planning quick and economic meals||Recipe includes 2 pantry essentials and costs less than Can $4 per portion|
aNutritional criteria are based on adult portions. Parents will be advised to adapt the portion served according to the child’s usual appetite. According to the Satter Eating Competence Model, the parent decides the type of food served while letting the child decide the amount based on his or her internal cues [, ].
Recruitment of Participants and Controls
From January 2018 to December 2020, parents and children newly diagnosed with cancer, treated at the SJUHC, and meeting the inclusion criteria will be offered to participate in the VIE Program. Participant recruitment will be sequential. Inclusion criteria are as follows: (1) being less than 21 years old at diagnosis, (2) being treated with radiotherapy or chemotherapy (including patients receiving hematopoietic cell transplantation), and (3) able to give an informed consent (by parents or legal tutors). Participants who are not receiving radiotherapy or chemotherapy will be excluded from the study. Patients will be followed for 4 years. On average, 140 children per year are admitted at the SJUHC’s CCCB, of which about 110 would be eligible. On the basis of earlier studies, we expect an average of 75 patients recruited per year (70.0% recruitment rate), for a total of 150 participants over 2 years. Enrolled participants and their family (parents, grandparents, etc) will be encouraged to attend the nutrition education and cooking workshops. It is to the parents’ discretion to attend workshops with or without the child, according to the child’s age, interest, and health condition. The control group will be recruited sequentially from patients diagnosed at the CCCB 3 to 4 years ago, who were not exposed to the VIE Program and who fulfill the same inclusion criteria as for the intervention group. No intervention will be offered to control participants. The measures and questions used will be the same as for the end-of-protocol intervention in the patients from the intervention group.
Delivery of Educational Workshops
At first, the workshops will be offered in French considering that a majority of patients treated at the SJUHC CCCB are French speaking, but they will eventually be translated and offered in English. The lessons will be dispensed on a weekly basis. Weekly rotation of the 6 themed lessons and variable scheduled day and time will contribute to maximize participants’ exposure and participation. A total of 40 workshops will be offered each year for 4 years. The workshops will take place at the SJUHC CCCB in a room designed for this purpose. Participants will be invited to taste the demonstrated recipes at the end of the workshop, and printed material will be distributed, including recipes and key messages. Because the mean age of patients treated at the CCCB is 7 years old, additional food-related activities are planned for young children. A signature sheet will be used to record attendance at each session. Videotaped workshops will also be made available to participants on a secure Web platform. Posters will advertise the schedule and topics of the workshops, and the clinical team will receive reminders of the upcoming workshops so they can promote attendance.
Workshop Evaluation Tools and Outcome Measurement
A total of 6 self-administered post-intervention questionnaires were developed to measure short-term outcomes of the workshops, namely, perception of knowledge acquisition, behavioral intention, and satisfaction. At the end of each workshop, adults and children of 12 years and older will be asked to fill out a printed version of the lesson-specific questionnaire available in both French and English. To reduce the burden of participants, the questionnaires contain limited number of items and can be answered in a few minutes. The questionnaires have been reviewed by an expert in the field of program evaluation and were pretested with the target population to validate their comprehension and literacy .
These questionnaires will measure participants’ perception of knowledge acquisition based on the corresponding workshop’s key messages . This measure based on the perception was preferred to a scholastic questionnaire that measures knowledge to reduce participants’ burden. Overall, 3 to 4 items are presented in the form of a statement derived from the learning objectives (key messages) and begin with “I have learned.” Participants will answer according to their degree of agreement: “I agree,” “I agree more or less,” “I don’t agree,” or “I already knew this information.” Additional questions about the intention to try the recipes at home or to use the information to adapt the child’s diet [ ] are also included. Participants’ relationship with the patient (patient, parent, grandparent, etc) consists in the only sociodemographic item captured by the questionnaire. General satisfaction will be measured by asking about the intention to recommend the workshop to others and, if not, to specify why. Finally, a comment section will enquire for qualitative feedback and for suggestions to improve the curriculum.
An activity report to be filled out by the facilitators after each session has also been developed to assess fidelity to the developed curriculum, to record attendance at each session, and to document any adverse event that could have disturbed the group or compromise content transmission. Qualitative feedback from facilitators related to challenges experienced during the workshops will also be sought in the activity report. These short-term outcome data will be used for evaluating the educational workshops.
Medium-term outcomes of the workshops as a component of the nutrition program will be measured as part of the evaluation of the broader controlled study of the VIE Program. Data will be collected by research staff at the beginning, during, and at the end of the intervention for each participant in the program. They will include socio-demographic data (ethnicity and socio-economic status), clinical data (age, diagnosis, age at diagnosis, and treatment protocol), anthropometric profile (body mass index, tricipital and subscapular skinfolds, head circumference [for children <3 years old]), and biomarkers of metabolic health (fasting lipid profile, glucose, insulin, and glycated hemoglobin). Diet will be assessed by an RD using 24-hour diet recalls and food journals. Diet data will be analyzed using the software Nutrific (Department of Food Science and Nutrition, Université Laval, Montreal, Canada). Nutrient values from this application are derived from the 2010 Canadian Nutrient File. Participation in workshops will be assessed using an attendance sheet at each workshop and by questioning participants and their family, at RD follow-up visits, the workshops attended or viewed on the Web platform, and their topics. Quality of diet and anthropometric and biochemical profiles will be analyzed in relation to workshop attendance and will be compared with those of the control group who did not participate in the workshops. Qualitative data regarding usefulness of each workshop will also be collected through focus groups of workshops’ participants. They will be leaded by the research RD and will take place at the end of selected sessions for all 6 thematic workshops. Collected data will be subject to thematic analysis to better understand if attendance to specific sessions is related to participants’ success.
A logic model [, ] has been developed describing the resources needed (inputs), the activities achieved or to be implemented, the public reached (outputs), and the expected short- and medium-term outcomes of the VIE Program educational workshops ( ).
The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019.
Development of the Intervention
With this study, we have developed a family-oriented nutrition education and cooking workshop curriculum specific to pediatric oncology. The elaboration based on scientific evidence and on years of clinical experience, combined with an 8-step validation process, are strengths and features of interest of this study [, ]. There is a consensus on the value of including field actors and representatives of the target population in the development of lifestyle interventions. Including clinicians in the development process offers precious insight to enhance the curriculum content and ensures coherence with the medical team. In CCS overweight children, a group lifestyle intervention used interviews and focus groups with health care providers and CCS parents to adapt a curriculum previously shown to be effective in non-CCS overweight children [ ].
Some authors suggested that adding a cooking component to nutrition education is a good way to enhance participants’ skills and increase application of knowledge [, ]. In our curriculum, cooking demonstrations will allow observational learning [ ] and may enhance participants’ familiarity with specific foods [ ], cooking techniques, and food safety practices. Moreover, the nutrition education content will focus on practical application as several ideas to apply recommendations and tips to overcome barriers to healthy eating and home cooking will be presented. Furthermore, the developed content aims at reinforcing the messages conveyed by the clinical and research RD during individual follow-up. Therefore, the workshops may serve as a complementary intervention tool to facilitate behavioral change.
Familial Influence on the Development of Eating Habits
The curriculum was developed based on the social-ecological model, considering that individuals’ eating behaviors are influenced by determinants of their environment . Family, as part of their social environment, is one of the most influent determinants of healthy eating in children. Indeed, parents play a crucial role as they usually are responsible for food selection, serve as role models, and use parental feeding practices that impact children’s eating behaviors [ ]. According to studies designed for obesity prevention or management in children, family-oriented lifestyle interventions are the most effective in noncancer and in CCS populations [ , ]. Therefore, our curriculum targets patients and their families. It will address the use of positive parental feeding practices [ , ] to promote healthy eating behaviors in children during and after cancer treatments, for example, healthy eating role modeling and avoidance of restrictions or control over eating [ , ].
The curriculum will put forward a positive and total diet approach to healthy eating that considers the whole eating pattern, suggests adding healthy foods instead of forbidding specific foods (apart from those restricted for food safety), and avoids categorization of food as “good” or “bad” . The Mediterranean diet pattern is associated with the prevention of cardiovascular diseases [ ] that are frequent long-term complications of CCS [ , ]. Therefore, coupled with Canadian Dietary Guidelines [ ], this pattern has guided the development of nutrition education content and recipe criteria.
Food safety is a major concern during pediatric cancer treatment due to weakened immune system. It will be addressed throughout all cooking demonstrations when facilitators will model safe food handling practices. Only little evidence support a neutropenic diet to prevent infection for patients undergoing chemotherapy or radiotherapy, as the only few randomized control trials performed used variable methodologies and presented several limitations [, ]. Indeed, a neutropenic diet may impose unnecessary food restrictions on patients who often consume insufficient dietary intakes [ , ].
Considerations Related to Childhood Cancer
Further studies need to evaluate the feasibility of implementing workshops for pediatric oncology patients undergoing cancer treatments. The moment surrounding the diagnosis and treatment of cancer has been described as a teachable moment for a healthier lifestyle in adult cancer . However, this opportunity window is not well documented in children. Families overwhelmed with the diagnosis might be less interested or find it too challenging to adopt healthy habits while experiencing a distressing life event [ ]. However, focus groups with parents of overweight CCS testing a 6-lesson curriculum after completion of their child’s treatment revealed that some would have preferred to receive the intervention earlier in the process [ ], supporting that the timing of our intervention might be optimal.
The heterogeneity of the target population, which comprises children of various ages, diagnoses, and treatments, was a challenge in the development of the curriculum. Evaluating the implementation of the workshops will inform us on participation rate and will allow to calculate sample size of future nutrition education and cooking program in pediatric oncology. The nonrandomized design is also a limitation of this study. Our study was designed to ensure that every newly diagnosed patient could participate and benefit from this novel lifestyle study. Therefore, control participants will only be recruited among patients who completed the standard treatment before the VIE Program was implemented.
We are confident that this intervention will contribute to increase knowledge about nutrition and cooking in the context of childhood cancer. Hopefully, it will improve children’s diet quality while promoting long-term healthy eating habits to prevent cardiometabolic complications. This research- and practice-based nutrition education and cooking demonstration curriculum will be a valuable complement to the VIE Program lifestyle intervention for the prevention of cardiometabolic long-term complications.
This research project is funded by The Fondation Charles-Bruneau and The Joy of Eating Better Foundation. The authors would like to acknowledge Christina Blais, MSc, RD, senior lecturer at Université de Montréal, for her advices relating to taste disorders and recipe criteria.
Conflicts of Interest
- Hudson MM. A model for care across the cancer continuum. Cancer 2005 Dec 01;104(11 Suppl):2638-2642 [FREE Full text] [CrossRef] [Medline]
- Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Society. Toronto, Ontario; 2015. Canadian cancer statistics 2015 URL: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2015-EN.pdf?la=en [accessed 2017-12-16] [WebCite Cache]
- Phillips SM, Padgett LS, Leisenring WM, Stratton KK, Bishop K, Krull KR, et al. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiol Biomarkers Prev 2015 Apr;24(4):653-663 [FREE Full text] [CrossRef] [Medline]
- Mertens AC, Yasui Y, Neglia JP, Potter JD, Nesbit ME, Ruccione K, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the childhood cancer survivor study. J Clin Oncol 2001 Jul 01;19(13):3163-3172. [CrossRef] [Medline]
- Nottage KA, Ness KK, Li C, Srivastava D, Robison LL, Hudson MM. Metabolic syndrome and cardiovascular risk among long-term survivors of acute lymphoblastic leukaemia - From the St. Jude Lifetime Cohort. Br J Haematol 2014 May;165(3):364-374 [FREE Full text] [CrossRef] [Medline]
- Cardiometabolic Risk Working Group: Executive Committee, Leiter LA, Fitchett DH, Gilbert RE, Gupta M, Mancini GBJ, et al. Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group. Can J Cardiol 2011;27(2):e1-e33. [CrossRef] [Medline]
- Tonorezos ES, Robien K, Eshelman-Kent D, Moskowitz CS, Church TS, Ross R, et al. Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia. Cancer Causes Control 2013 Feb;24(2):313-321 [FREE Full text] [CrossRef] [Medline]
- Bauer J, Jürgens H, Frühwald MC. Important aspects of nutrition in children with cancer. Adv Nutr 2011 Mar;2(2):67-77 [FREE Full text] [CrossRef] [Medline]
- Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics 1998 Mar;101(3 Pt 2):539-549. [Medline]
- Mikkilä V, Räsänen L, Raitakari OT, Pietinen P, Viikari J. Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study. Br J Nutr 2005 Jun;93(6):923-931. [Medline]
- Cohen J, Wakefield CE, Tapsell LC, Walton K, Fleming CAK, Cohn RJ. Exploring the views of parents regarding dietary habits of their young cancer-surviving children. Support Care Cancer 2015 Feb;23(2):463-471. [CrossRef] [Medline]
- Stolley MR, Restrepo J, Sharp LK. Diet and physical activity in childhood cancer survivors: a review of the literature. Ann Behav Med 2010 Jun;39(3):232-249 [FREE Full text] [CrossRef] [Medline]
- James K, Keegan-Wells D, Hinds PS, Kelly KP, Bond D, Hall B, et al. The care of my child with cancer: parents' perceptions of caregiving demands. J Pediatr Oncol Nurs 2002;19(6):218-228. [CrossRef] [Medline]
- Barr RD, Sala A. Hidden financial costs in the treatment for childhood cancer. J Pediatr Hematol Oncol 2003 Nov;25(11):842-844. [Medline]
- Ling J, Robbins LB, Wen F. Interventions to prevent and manage overweight or obesity in preschool children: a systematic review. Int J Nurs Stud 2016 Jan;53:270-289. [CrossRef] [Medline]
- Dickin KL, Hill TF, Dollahite JS. Practice-based evidence of effectiveness in an integrated nutrition and parenting education intervention for low-income parents. J Acad Nutr Diet 2014 Jun;114(6):945-950. [CrossRef] [Medline]
- Fulkerson JA, Friend S, Flattum C, Horning M, Draxten M, Neumark-Sztainer D, et al. Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial. Int J Behav Nutr Phys Act 2015 Dec 15;12:154 [FREE Full text] [CrossRef] [Medline]
- Mazzeo SE, Kelly NR, Stern M, Gow RW, Cotter EW, Thornton LM, et al. Parent skills training to enhance weight loss in overweight children: evaluation of NOURISH. Eat Behav 2014 Apr;15(2):225-229 [FREE Full text] [CrossRef] [Medline]
- Hand RK, Birnbaum AS, Carter BJ, Medrow L, Stern E, Brown K. The RD parent empowerment program creates measurable change in the behaviors of low-income families and children: an intervention description and evaluation. J Acad Nutr Diet 2014 Dec;114(12):1923-1931. [CrossRef] [Medline]
- Zhang FF, Kelly MJ, Must A. Early nutrition and physical activity interventions in childhood cancer survivors. Curr Obes Rep 2017 Jun;6(2):168-177. [CrossRef] [Medline]
- Stern M, Ewing L, Davila E, Thompson AL, Hale G, Mazzeo S. Design and rationale for NOURISH-T: a randomized control trial targeting parents of overweight children off cancer treatment. Contemp Clin Trials 2015 Mar;41:227-237. [CrossRef] [Medline]
- Huang JS, Dillon L, Terrones L, Schubert L, Roberts W, Finklestein J, et al. Fit4Life: a weight loss intervention for children who have survived childhood leukemia. Pediatr Blood Cancer 2014 May;61(5):894-900 [FREE Full text] [CrossRef] [Medline]
- Zhang FF, Meagher S, Scheurer M, Folta S, Finnan E, Criss K, et al. Developing a web-based weight management program for childhood cancer survivors: rationale and methods. JMIR Res Protoc 2016 Nov 18;5(4):e214 [FREE Full text] [CrossRef] [Medline]
- Raber M, Crawford K, Chandra J. Healthy cooking classes at a children's cancer hospital and patient/survivor summer camps: initial reactions and feasibility. Public Health Nutr 2017 Jun;20(9):1650-1656. [CrossRef] [Medline]
- Moyer-Mileur LJ, Ransdell L, Bruggers CS. Fitness of children with standard-risk acute lymphoblastic leukemia during maintenance therapy: response to a home-based exercise and nutrition program. J Pediatr Hematol Oncol 2009 Apr;31(4):259-266. [CrossRef] [Medline]
- Nos petits mangeurs. URL: http://www.nospetitsmangeurs.org [accessed 2017-06-26] [WebCite Cache]
- Heart and Stroke Foundation. URL: http://www.heartandstroke.ca/ [accessed 2017-06-26] [WebCite Cache]
- Matthews DE. Proteins and amino acids. In: Ross AC, editor. Modern Nutrition in Health and Disease. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014:4-36.
- Helms R, Tillman E, Patel A, Kerner J. Protein digestion, absorption, and metabolism. In: Corkins MR, editor. The A.S.P.E.N. Pediatric Nutrition Support Core Curriculum. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2010:31-44.
- Mamerow MM, Mettler JA, English KL, Casperson SL, Arentson-Lantz E, Sheffield-Moore M, et al. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr 2014 Jun;144(6):876-880 [FREE Full text] [CrossRef] [Medline]
- Viljakainen HT. Factors influencing bone mass accrual: focus on nutritional aspects. Proc Nutr Soc 2016 Dec;75(3):415-419. [CrossRef] [Medline]
- Ma NS, Gordon CM. Pediatric osteoporosis: where are we now? J Pediatr 2012 Dec;161(6):983-990. [CrossRef] [Medline]
- Satter E. The feeding relationship: problems and interventions. J Pediatr 1990 Aug;117(2 Pt 2):S181-S189. [Medline]
- Bernstein IL. Learned taste aversions in children receiving chemotherapy. Science 1978 Jun 16;200(4347):1302-1303. [Medline]
- Skolin I, Hursti UK, Wahlin YB. Parents' perception of their child's food intake after the start of chemotherapy. J Pediatr Oncol Nurs 2001;18(3):124-136. [CrossRef] [Medline]
- Ladas EJ, Sacks N, Meacham L, Henry D, Enriquez L, Lowry G, et al. A multidisciplinary review of nutrition considerations in the pediatric oncology population: a perspective from children's oncology group. Nutr Clin Pract 2005 Aug;20(4):377-393. [CrossRef] [Medline]
- Skolin I, Wahlin YB, Broman DA, Koivisto HU, Vikström LM, Hernell O. Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses. Support Care Cancer 2006 Apr;14(4):369-378. [CrossRef] [Medline]
- Peregrin T. Improving taste sensation in patients who have undergone chemotherapy or radiation therapy. J Am Diet Assoc 2006 Oct;106(10):1536-1540. [CrossRef] [Medline]
- Larsson M, Hedelin B, Athlin E. Lived experiences of eating problems for patients with head and neck cancer during radiotherapy. J Clin Nurs 2003 Jul;12(4):562-570. [Medline]
- Bernhardson B, Tishelman C, Rutqvist LE. Chemosensory changes experienced by patients undergoing cancer chemotherapy: a qualitative interview study. J Pain Symptom Manage 2007 Oct;34(4):403-412. [CrossRef] [Medline]
- Grant B, Bloch A, Hamilton K, Thomson C. American Cancer Society Complete Guide to Nutrition for Cancer Survivorsating Well, Staying Well During and After Cancer. Atlanta, GA: American Cancer Society; 2010.
- Stern J, Ippoliti C. Management of acute cancer treatment-induced diarrhea. Semin Oncol Nurs 2003 Nov;19(4 Suppl 3):11-16. [Medline]
- McRorie JW. Evidence-based approach to fiber supplements and clinically meaningful health benefits, part 2: what to look for and how to recommend an effective fiber therapy. Nutr Today 2015 Mar;50(2):90-97 [FREE Full text] [CrossRef] [Medline]
- Ward EJ, Henry LM, Friend AJ, Wilkins S, Phillips RS. Nutritional support in children and young people with cancer undergoing chemotherapy. Cochrane Database Syst Rev 2015 Aug 24(8):CD003298. [CrossRef] [Medline]
- Van EJ. Benefits of nutritional intervention on nutritional status, quality of life and survival. Int J Cancer Suppl 1998;11:66-68. [Medline]
- Szeszycki E, Cruse W, Strup M. Evaluation and monitoring of pediatric patients receiving specialized nutrition support. In: Corkins MR, editor. The A.S.P.E.N. pediatric nutrition support. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2010:460-476.
- Sacks N, Wallace E, Desai S, Prasad V, Henry D, Guzikowski V, et al. Oncology, hematopoietic transplant, and survivorship. In: Corkins MR, editor. The A.S.P.E.N. pediatric nutrition support. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2010:349-377.
- Sajeev M, Cohen J, Wakefield CE, Fardell JE, Cohn RJ. Decision aid for nutrition support in pediatric oncology: a pilot study. JPEN J Parenter Enteral Nutr 2016 Aug 08;41(8):1336-1347. [CrossRef] [Medline]
- Kastorini C, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011 Mar 15;57(11):1299-1313 [FREE Full text] [CrossRef] [Medline]
- Castro-Quezada I, Román-Viñas B, Serra-Majem L. The Mediterranean diet and nutritional adequacy: a review. Nutrients 2014 Jan 03;6(1):231-248 [FREE Full text] [CrossRef] [Medline]
- Hoffman JR, Falvo MJ. Protein - which is best? J Sports Sci Med 2004 Sep;3(3):118-130 [FREE Full text] [Medline]
- Reeds PJ. Dispensable and indispensable amino acids for humans. J Nutr 2000 Jul;130(7):1835S-1840S [FREE Full text] [Medline]
- Nettleton JA, Lovegrove JA, Mensink RP, Schwab U. Dietary fatty acids: is it time to change the recommendations? Ann Nutr Metab 2016;68(4):249-257 [FREE Full text] [CrossRef] [Medline]
- Vannice G, Rasmussen H. Position of the academy of nutrition and dietetics: dietary fatty acids for healthy adults. J Acad Nutr Diet 2014 Jan;114(1):136-153. [CrossRef] [Medline]
- Abbot JM, Byrd-Bredbenner C. A tool for facilitating meal planning. J Nutr Educ Behav 2010;42(1):66-68. [CrossRef] [Medline]
- Jabs J, Devine CM, Bisogni CA, Farrell TJ, Jastran M, Wethington E. Trying to find the quickest way: employed mothers' constructions of time for food. J Nutr Educ Behav 2007;39(1):18-25. [CrossRef] [Medline]
- Storfer-Isser A, Musher-Eizenman D. Measuring parent time scarcity and fatigue as barriers to meal planning and preparation: quantitative scale development. J Nutr Educ Behav 2013 Mar;45(2):176-182. [CrossRef] [Medline]
- Carlson A, Frazao E. USDA. 2012. Are healthy foods really more expensive? it depends on how you measure the price URL: https://www.ers.usda.gov/webdocs/publications/44678/19980_eib96.pdf?v=42321 [accessed 2017-12-17] [WebCite Cache]
- Brown AC. Meal management. In: Understanding Food: Principles and Preparation. Belmont, CA: Wadsworth Publishing; 2011:120-139.
- Satter E. Eating competence: definition and evidence for the satter eating competence model. J Nutr Educ Behav 2007;39(5 Suppl):S142-S153. [CrossRef] [Medline]
- Health Canada. Government of Canada. 2015. Food safety for people with a weakened immune system URL: https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/food-safety-people-with-weakened-immune-system.html [accessed 2017-12-17] [WebCite Cache]
- Contento IR, Randell JS, Basch CE. Review and analysis of evaluation measures used in nutrition education intervention research. J Nutr Educ Behav 2002;34(1):2-25. [Medline]
- La Tablée des Chefs. 2013. The brigades culinaires URL: http://www.tableedeschefs.org/en/culinary-training/brigades-culinaires [accessed 2017-06-26] [WebCite Cache]
- Contento IR. Nutrition education: linking research, theory, and practice. Asia Pac J Clin Nutr 2008;17 Suppl 1:176-179 [FREE Full text] [Medline]
- Medeiros LC, Butkus SN, Chipman H, Cox RH, Jones L, Little D. A logic model framework for community nutrition education. J Nutr Educ Behav 2005;37(4):197-202. [Medline]
- Abram JK, Hand RK, Parrott JS, Brown K, Ziegler PJ, Steiber AL. What is your nutrition program missing? finding answers with the guide for effective nutrition interventions and education (GENIE). J Acad Nutr Diet 2015 Jan;115(1):122-130. [CrossRef] [Medline]
- Stern M, Lamanna J, Russell C, Ewing L, Thompson A, Trapp S, et al. Adaptation of an obesity intervention program for pediatric cancer survivors (NOURISH-T). Clin Pract Pediatr Psychol 2013;1(3):264-275. [CrossRef]
- Michaud P, Condrasky M, Griffin SF. Review and application of current literature related to culinary programs for nutrition educators. Top Clin Nutr 2007;22(4):336-348. [CrossRef]
- Nelson SA, Corbin MA, Nickols-Richardson SM. A call for culinary skills education in childhood obesity-prevention interventions: current status and peer influences. J Acad Nutr Diet 2013 Aug;113(8):1031-1036. [CrossRef] [Medline]
- Chen Q, Goto K, Wolff C, Bianco-Simeral S, Gruneisen K, Gray K. Cooking up diversity. Impact of a multicomponent, multicultural, experiential intervention on food and cooking behaviors among elementary-school students from low-income ethnically diverse families. Appetite 2014 Sep;80:114-122. [CrossRef] [Medline]
- Bronfenbrenner U. Ecological models of human development. In: International Encyclopedia of Education. Oxford, England: Elsevier Science; 1994:1643-1647.
- Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 2007;35(1):22-34 [FREE Full text] [CrossRef] [Medline]
- Raber M, Swartz MC, Santa MD, O'Connor T, Baranowski T, Li R, et al. Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review. Pediatr Res 2016 Sep;80(3):338-346. [CrossRef] [Medline]
- Williams LK, Lamb KE, McCarthy MC. Behavioral side effects of pediatric acute lymphoblastic leukemia treatment: the role of parenting strategies. Pediatr Blood Cancer 2014 Nov;61(11):2065-2070. [CrossRef] [Medline]
- Fleming CAK, Cohen J, Murphy A, Wakefield CE, Cohn RJ, Naumann FL. Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation. Appetite 2015 Jun;89:219-225. [CrossRef] [Medline]
- Galloway AT, Fiorito LM, Francis LA, Birch LL. 'Finish your soup': counterproductive effects of pressuring children to eat on intake and affect. Appetite 2006 May;46(3):318-323 [FREE Full text] [CrossRef] [Medline]
- Freeland-Graves JH, Nitzke S, Academy of Nutrition and Dietetics. Position of the academy of nutrition and dietetics: total diet approach to healthy eating. J Acad Nutr Diet 2013 Feb;113(2):307-317. [CrossRef] [Medline]
- Health Canada. Government of Canada. 2007. Eating well with Canada's food guide URL: https://www.canada.ca/en/health-canada/services/food-nutrition/canada-food-guide/get-your-copy/eating-well-2007.html [accessed 2017-06-26] [WebCite Cache]
- van Dalen EC, Mank A, Leclercq E, Mulder RL, Davies M, Kersten MJ, et al. Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. Cochrane Database Syst Rev 2016 Apr 24(4):CD006247. [CrossRef] [Medline]
- Sonbol MB, Firwana B, Diab M, Zarzour A, Witzig TE. The effect of a neutropenic diet on infection and mortality rates in cancer patients: a meta-analysis. Nutr Cancer 2015;67(8):1230-1238. [CrossRef] [Medline]
- Foster M. Reevaluating the neutropenic diet: time to change. Clin J Oncol Nurs 2014 Apr;18(2):239-241. [CrossRef] [Medline]
- Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005 Aug 20;23(24):5814-5830 [FREE Full text] [CrossRef] [Medline]
- Fuemmeler BF, Pendzich MK, Clark K, Lovelady C, Rosoff P, Blatt J, et al. Diet, physical activity, and body composition changes during the first year of treatment for childhood acute leukemia and lymphoma. J Pediatr Hematol Oncol 2013 Aug;35(6):437-443 [FREE Full text] [CrossRef] [Medline]
|CCCB: Centre de cancérologie Charles-Bruneau|
|CCS: childhood cancer survivors|
|RD: registered dietitian|
|SJUHC: Sainte-Justine University Health Center|
|VIE: Valorization, Implication, Education|
Edited by G Eysenbach; submitted 26.06.17; peer-reviewed by BT Joyce, R Hand; comments to author 03.08.17; revised version received 04.10.17; accepted 29.10.17; published 09.01.18Copyright
©Cynthia Chaput, Sabrina Beaulieu-Gagnon, Véronique Bélanger, Simon Drouin, Laurence Bertout, Lucie Lafrance, Cinthia Olivier, Marthe Robitaille, Caroline Laverdière, Daniel Sinnett, Marie Marquis, Valérie Marcil. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 09.01.2018.
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