More than 60% of children with cancer receive treatment in a low-and middle-income countries (LMIC) where nutritional morbidities are often present at diagnosis and must be managed concomitantly with the initiation of life-saving cancer therapy. Recently more attention has been paid to nutritional therapies and their role in optimizing treatment for children and adolescents with cancer. CCW has played an instrumental role in disseminating nutritional research and optimal clinical practice to clinicians in LMIC, worldwide.

In collaboration with International Society of Pediatric Oncology (SIOP), Association de Hemato-Oncologia Pediatrica de Centro America (AHOPCA), and participants in the Cure4Kids, Dr. Ladas completed the first international survey of nutrition practice in LMIC. This survey found that there is a strong need to improve resources, collaborations, and clinician education to improve the delivery of nutritional therapy to children undergoing treatment for cancer in LMIC. Priorities for improving the nutritional management in LMIC include: 1) Improving nutrition education and assessment tools for doctors and nurses; 2) Increasing the availability of nutrition education resources for families and patients; and 3) Identifying the role of complementary and alternative therapies in closing gaps in symptom management.

To achieve these aims, Dr. Ladas is collaborating with clinicians in the countries listed below.

Guatemala

In 2014, Dr. Ladas and colleagues received a grant to examine the role of nutritional status on treatment-outcomes in children with acute lymphoblastic leukemia undergoing treatment in Guatemala City, Guatemala. In collaboration with the Medical Director of Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala, Dr. Federico Antillion and Dr. Ronald Barr, the investigators will examine the role of body composition used to define nutritional status and its relationship with treatment-related toxicities and outcome. The outcome of this research will provide information so that clinicians can correctly identify those children at nutritional risk. The long-term goals are to identify the point at which a clinical intervention is necessary and then to prevent the adverse changes in body composition, gain in fat mass with loss of lean body mass – notably muscle (sarcopenic obesity), without compromising the efficacy of treatment.

India

In September 2014, Dr. Ladas collaborated with local clinicians and investigators to host the first nutrition workshop for clinicians at Tata Memorial Hospital (TMH) in Mumbai, one of the leading cancer hospitals in Asia. TMH diagnoses 800 new cases of childhood cancer each year. Fifty percent of its young patients are malnourished at the time of diagnosis, greatly reducing their chances of recovery. Dr. Brijesh Arora, a pediatric oncologist at TMH, has been an advocate in advancing this initiative on a local level as well as through the International Society of Pediatric Oncology (SIOP). Drs. Ladas and Arora have launched an international initiative to improving training and education to clinicians providing care to children with cancer in LMIC. The first international workshop was held in Mumbai, India in September of 2014 and was attended by 255 pediatric oncologists, hematologists, nutritionists, nurses, and social workers.

With Dr. Brijesh Arora of TMH, Dr. Ladas has also launched an initiative to provide fellowships, identify research opportunities, and create an educational manual for nutritionists focusing on pediatric oncology. Their combined efforts have reduced abandonment of cancer care by more than 20 percent among children in India, demonstrating the importance of providing good nutrition and healthy food to patients and families. Moreover, Drs. Arora and Ladas have been successful in establishing training workshops around the globe including Amman, Jordon (April, 2015) and Sao Paolo, Brazil (November, 2015). These workshops have trained several hundred clinicians in pediatric oncology and have built local capacity in advancing local nutrition research agendas.