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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

Power interruptions: Information for internal communication

2008-01-31

As part of the UFS’s commitment to address load shedding, the management would like to communicate the following:

The UFS mainly deals with the power interruptions by way of (a) the possible installation of equipment (e.g. generators) and (b) operational arrangements to ensure the functioning of the UFS in spite of power interruptions.

During the past week progress was made on both fronts. The information that follows resulted from a meeting of a task team of Physical Resources led by Mr Nico Janse van Rensburg, which took place on Monday 28 January (this task team naturally focuses on physical solutions) and a discussion by Exco on Wednesday 30 January 2008. Exco discussed the recommendations of the mentioned task team in respect of physical aspects, as well as the operational arrangements proposed by faculties.

Physical solutions

A Main Campus

1. New emergency power installations already approved:

Last week Exco gave its approval for the design and installation of emergency power equipment in all the large lecture-hall complexes to proceed immediately.

In all these cases

load surveys have been completed and a start has been made with the ordering of equipment and the process of appointing contractors. (Exco approved the adjustment of normal tender procedures in an attempt to expedite completion.)
generators with 20-30% more capacity than required for the current load are being ordered.
provision is being made for the connection of lights and at least one wall plug to the emergency power.
the expected construction time is 16 weeks (except in the case of the Flippie Groenewoud Building where it is 6 weeks).

The above-mentioned concerns lecture halls/ venues in the following buildings: Examination Centre, Flippie Groenewoud Building, Stabilis, Genmin and the Agriculture Building.

As far as the Agriculture Building is concerned, a larger generator (larger than required for lecture venues only) is being ordered in view of simultaneously providing essential research equipment (refrigerators, ovens, glasshouses) with emergency power within 16 weeks.

2. Investigation into the optimal utilisation of present emergency power installations

All the emergency power systems are being investigated on the basis of a list compiled in 2006 to determine whether excess capacity is available and whether it is possible to connect additional essential equipment or lights to it.

The electrical engineer warns as follows:
“Staff members must under no circumstances overload present emergency power points.

A typical example of this is a laboratory with 10 power points of which 2 points are emergency power outlets. Normally a fridge and freezer would, for example, be plugged into the two emergency power points, but now, with long load-shedding interruptions, a considerably larger number of appliances are being plugged into the power point by means of multi-sockets and extension cords. In the end the effect of such connections will accumulate at the emergency generator, which will then create a greater danger of it being overloaded and tripping, in other words, no emergency power will then be available.”

3. Requests and needs addressed directly to Physical Resources or reported to Exco via the line managers.

All the physical needs and requests addressed directly to Physical Resources or submitted to Exco via the line managers are being listed, classified and considered technically in view of their being discussed by the task team on Monday 11 February.
The information will (a) lead to recommendations to Exco regarding possible additional urgent emergency power installations, and (b) be used in the comprehensive investigation into the UFS’s preparedness for and management of long power interruptions.

Requests that can easily be complied with immediately and that fit into the general strategy will indeed be dealt with as soon as possible.

4. Purchase of loose-standing equipment: light, small, loose-standing generators, UPSs as solutions to/ aids during power interruptions

Exco approved that

a) faculties and support services accept responsibility themselves for the funding and purchase of loose equipment such as, for example battery lights, should they regard these as essential.
b) UPSs (uninterruptible power supplies) that faculties and support services wish to purchase to combat the detrimental effect of unexpected power interruptions on computer equipment) can (as at present) be purchased from own funds via Computer Services.
c) UPSs (uninterruptible power supplies) that faculties and support services wish to purchase to combat the detrimental effect of unexpected power interruptions on other types of equipment can normally be purchased from own funds with the consent of the line manager concerned.
Note: Please just make sure of the appropriateness of the equipment for a specific situation: it is not a power supply that can bridge a two-hour power interruption.)
d) small, loose-standing generators can be purchased from own funds via Physical Resources and installed under their supervision.
e) laptop computers can , where necessary, be purchased from own budgets. The availability of second-hand laptop computers must be taken into account.

B Vista

No major problems have been reported to date. The situation is being monitored and will be managed according to need. The same guidelines that apply to the Main Campus will naturally also apply to the Vista Campus.

C Qwaqwa

The situation is receiving attentions and solutions have already been found for most problems.

D General

1. All-inclusive project
A comprehensive investigation into the UFS’s preparedness for and management of long power interruptions will be launched as soon as possible. Available capacity will be utilised first to alleviate the immediate need. The needs assessment to which all faculties and support services have already contributed is already an important building block of the larger project.

2. Building and construction projects currently in the planning and implementation phase
The need for emergency power for projects such as the new Computer Laboratory is being investigated proactively and will be addressed in a suitable manner.

3. Liaison with Centlec
Attempts at direct and continuous liaison are continuing in an attempt to accommodate the unique needs of the UFS.

4. HESA meeting and liaison with other universities
A representative of the UFS will attend a meeting of all higher education institutions on 11 February. The meeting is being arranged by HESA (Higher Education South Africa) to discuss the implications for the sector, the management of risks and the sector’s response to government.

5. Internal communication
It is the intention to communicate internally after every meeting of the task team, which will take place on Mondays. Strategic Communication will assist in this regard.

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