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19 June 2023 | Story André Damons | Photo André Damons
Prof Jan Du Plessis
Prof Jan du Plessis is Head of the Paediatric Oncology Unit at the University of the Free State.

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

Shimlas shock Tuks by staying calm
2016-02-19

Description: KL News 2016 02 19  Varsitycup Tags: KL News 2016 02 19  Varsitycup
Prop Ox Nche was one of the substitutes who had a huge impact against Tuks in Pretoria on 15 February 2016. Nche and other Shimlas substitutes helped their team wipe out a massive deficit. Photo: Johan Roux.

He has never been involved in a match like this in his rugby career.
This is what Neil Claassen had to say about his team’s performance on 15 February 2016, when the Shimlas came up with one of the biggest fight-backs in the history of the Varsity Cup in Pretoria. According to the Shimlas Captain, his bench had a great impact, and this helped in shocking Tuks with 47-46 towards the end. This came after Tuks had been leading 43-15 in the 44th minute.

Great fighting spirit
The Shimlas' fighting spirit, and a new Varsity Cup points system in which converted tries may count up to 11 points, enabled them to wipe out this deficit.
“It was a tough match, especially after being so far behind,” Neil said.
“Coach (Hendro Scholtz) told us during half-time (when we were 15-36 behind) that we should stay calm."
“We weren't completely out of the game. We knew that if we eliminated unnecessary mistakes, we could make it.”

Impact from bench
This is the second consecutive match - the other was against Ikeys in Cape Town - where the Shimlas’ substitutes swayed the match. “The bench made a big difference,” Neil said. “We also scored an 11-point try, which helped a lot.”
The Shimlas’ fullback, Marco Mason, was named Player of the Match. He succeeded with a tricky conversion to gain victory for his team.

Injuries
The eighth man, Nardus Erasmus (knee) and flanker, Fiffy Rampeta (eye socket), sustained injuries, but should be able to play in the first home game against the Madibaz on 22 February 2016. The injured scrumhalf, Zee Mkhabela (concussion), could return for this match.
Shimlas are second on the log, with nine league points after two away matches. Maties has ten league points.

Young Guns get stuck
The University of the Free State (UFS') Young Guns got stuck 8-14 against Tuks in Pretoria on 15 February 2016.
Vishuis, the UFS's residence team, will start their onslaught in the residence league against Dagbreek in Stellenbosch on 22 February 2016.

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