Effect of malnutrition at the time of diagnosis on the survival of children treated for cancer in El Salvador and Northern Brazil

Purpose: To investigate the relationship between survival and malnutrition at the time of diagnosis among children treated for cancer in two developin g countries. Patients and Methods: We studied 443 children treated for cancer between 19 95 and 1998 at two centers in San Salvador, El Salvador, and Recife, Brazil . Median age at diagnosis was 4.9 years; 283 children had leukemia and 160 had solid tumors. Z-scores were calculated for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) at diagnosis. Z scores <-2 indi cated malnutrition. Patients were also stratified by low-risk disease (soli d tumors: stage I, stage II, or localized; acute lymphocytic leukemia: whit e blood cell count <25,000/muL, no central nervous system involvement, no m ediastinal mass and age >1 and <10 yrs) and high-risk disease tall other pa tients, including those with acute or chronic myelocytic leukemia). Results: Z-scores indicated malnutrition in 23.5% (WAZ), 22.8% (HAZ), and 1 5.7% (WHZ) of patients. Z-score was not significantly related to overall su rvival rates, to survival rates analyzed by type of malignancy or risk stat us, or to survival rates at the end of the first month of treatment. Conclusions: We found no relationship between nutritional status and surviv al in these patients. This implies that future protocols for use in develop ing countries can be designed to provide optimal treatment intensity despit e the high incidence of malnutrition.