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The link between childhood cancer survival and access to food

19 June 2023 | Story André Damons | Photo André Damons

Many children in South Africa diagnosed with childhood cancer have a poorer overall survival rate and are more likely to abandon their treatment because they experience high poverty and food insecurity at home.

This is according to findings from a new study which Prof Jan du Plessis, Head of the Paediatric Oncology Unit at the University of the Free State (UFS), was part of. The study, titled ‘Prevalence of Poverty and Hunger at Cancer Diagnosis and Its Association with Malnutrition and Overall Survival in South Africa’, was recently published in the journal Nutrition and Cancer.

It found a high prevalence of poverty and hunger among South African children diagnosed with cancer. Food insecurity was associated with treatment abandonment and poorer overall survival.

The research was conceptualised by Judy Schoeman, dietitian at the Steve Biko Academic Hospital, as part of her PhD study. Prof Du Plessis and departmental dietitian Mariechen Herholdt, who recognised the importance and value of this study, enrolled patients, collected data, and critically reviewed the manuscript. Five different paediatric oncology units throughout the country participated.

Stunting as indicator of chronic malnutrition

Prof Du Plessis says stunting is an indicator of chronic malnutrition, and causes tissue damage, reduced function of neurotransmitters, and decreased overall development of all factors. Stunting is also associated with reduced lung growth and -function, which can influence the prevalence of pulmonary infections, have an impact on morbidity, and increase the risk of mortality. It also affects cognitive development, with poorer academic achievement and reduced economic productivity for children and adults affected by stunting.

“Our study found that South African children with malnutrition at cancer diagnosis often experienced food insecurity at home, underscoring the need to address primary rather than secondary malnutrition. This observation was especially apparent among children from rural provinces,” Prof Du Plessis says. “Many children in our study experienced high poverty and food insecurity risk at diagnosis; thus, nutritional counselling targeting dietary intake in the home setting should be a priority for these patients.”

High-quality diet may have protective effect

Recent literature has found that a high-quality diet may have a protective effect against some treatment-related toxicities of cancer treatment. Hunger at home was significantly associated with increased risk for treatment abandonment and risk of death.

Prof Du Plessis states, “According to the South African census (2015), 30 million people live on less than R84.11 (US$5) per day, and 55% of South African children live below the ultra-poverty line (R800/month or US$45.81/month)…

“In a previous South African study of children with germ cell tumours from families with higher socioeconomic status (household income of US$191/year or US$6/day), they have experienced significantly improved overall survival (OS) at five years. Indonesian children from low-income families diagnosed with acute lymphoblastic leukaemia have also experienced significantly lower event-free survival two years or longer after diagnosis than those from higher-income families.”

Prof Du Plessis says nutritional intervention should be implemented from diagnosis to improve patients’ nutritional status and survival.

Enhance collaborations to enhance outcomes

The study further illustrated that children with stunting and malnutrition at cancer diagnosis were more likely to live in poverty, thereby highlighting a group of children needing social services and support networks over and above the existing structures available to South African children with cancer.

The study underscores the need for medical centres to enhance collaboration with organisations that provide financial and/or other support to families throughout treatment to enhance outcomes.

The study came about as poor nutritional status in children with cancer has been associated with poorer cancer outcomes. Identifying modifiable risk factors that lead to poor nutrition in children with cancer is an understudied area, especially in a country such as South Africa, explains Prof Du Plessis.

“Understanding the scope of poverty and hunger and its association with nutritional status among children undergoing cancer treatment is needed. As half of South Africans experience chronic poverty over time, food insecurity will be affected; we investigated the prevalence of poverty and food insecurity at cancer diagnosis, their association with malnutrition at the time of diagnosis, and overall survival at one year post-diagnosis.

“Malnutrition is a modifiable prognostic risk factor. The findings underscore the importance of incorporating an assessment of the risk of living in poverty and/or with food insecurity at diagnosis – and potentially throughout therapy – to ensure that families are referred to appropriate support networks. Evaluating sociodemographic factors at diagnosis is essential among South African children to identify at-risk children and implement adequate nutritional support during cancer treatment,” Prof Du Plessis concludes.

This research aligns with the UFS’s Vision 130 – to not only be a university that cares and is sustainable, but also to be a research-led, student-centred, and regionally engaged university that contributes to development and social justice. This knowledge will assist in efficiently allocating hospital resources and establishing support networks to ensure that the most vulnerable children are supported with proactive nutrition interventions while undergoing cancer treatment.

News Archive

“To forgive is not an obligation. It’s a choice.” – Prof Minow during Reconciliation Lecture

2014-03-05

“To forgive is not an obligation. It’s a choice.” – Prof Minow during the Third Annual Reconciliation Lecture entitled Forgiveness, Law and Justice.
Photo: Johan Roux

No one could have anticipated the atmosphere in which Prof Martha Minow would visit the Bloemfontein Campus. And no one could have predicted how apt the timing of her message would be. As this formidable Dean of Harvard University’s Law School stepped behind the podium, a latent tension edged through the crowded audience.

“The issue of getting along after conflict is urgent.”

With these few words, Prof Minow exposed the essence of not only her lecture, but also the central concern of the entire university community.

As an expert on issues surrounding racial justice, Prof Minow has worked across the globe in post-conflict societies. How can we prevent atrocities from happening? she asked. Her answer was an honest, “I don’t know.” What she is certain of, on the other hand, is that the usual practice of either silence or retribution does not work. “I think that silence produces rage – understandably – and retribution produces the cycle of violence. Rather than ignoring what happens, rather than retribution, it would be good to reach for something more.” This is where reconciliation comes in.

Prof Minow put forward the idea that forgiveness should accompany reconciliation efforts. She defined forgiveness as a conscious, deliberate decision to forego rightful grounds of resentment towards those who have committed a wrong. “To forgive then, in this definition, is not an obligation. It’s a choice. And it’s held by the one who was harmed,” she explained.

Letting go of resentment cannot be forced – not even by the law. What the law can do, though, is either to encourage or discourage forgiveness. Prof Minow showed how the law can construct adversarial processes that render forgiveness less likely, when indeed its intention was the opposite. “Or, law can give people chances to meet together in spaces where they may apologise and they may forgive,” she continued. This point introduced some surprising revelations about our Truth and Reconciliation Commission (TRC).

Indeed, studies do report ambivalence, disappointment and mixed views about the TRC. Whatever our views are on its success, Prof Minow reported that people across the world wonder how South African did it. “It may not work entirely inside the country; outside the country it’s had a huge effect. It’s a touchstone for transitional justice.”

The TRC “seems to have coincided with, and maybe contributed to, the relatively peaceful political transition to democracy that is, frankly, an absolute miracle.” What came as a surprise to many is this: the fact that the TRC has affected transitional justice efforts in forty jurisdictions, including Rwanda, Sierra Leone, Cambodia and Liberia. It has even inspired the creation of a TRC in Greensborough, North Carolina, in the United States.

There are no blueprints for solving conflict, though. “But the possibility of something other than criminal trials, something other than war, something other than silence – that’s why the TRC, I think, has been such an exemplar to the world,” she commended.

Court decision cannot rebuild a society, though. Only individuals can forgive. Only individuals can start with purposeful, daily decisions to forgive and forge a common future. Forgiveness is rather like kindness, she suggested. It’s a resource without limits. It’s not scarce like water or money. It’s within our reach. But if it’s forced, it’s not forgiveness.

“It is good,” Prof Minow warned, “to be cautious about the use of law to deliberately shape or manipulate the feelings of any individual. But it is no less important to admit that law does affect human beings, not just in its results, but in its process.” And then we must take responsibility for how we use that law.

“A government can judge, but only people can forgive.” As Prof Minow’s words lingered, the air suddenly seemed a bit more buoyant.

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