Child cancer nutrition study wins $1.5m grant

The Health Research Council has granted $1.35 million to the University of Auckland's Dr Amy Lovell in its latest funding round, allowing her to find out more about the impact of nutrition on children with cancer in Aotearoa.

In 2018, Lovell, now a senior lecturer in nutrition, worked in the children’s cancer ward at Starship Hospital and what she saw shaped her life’s direction.

“I realised how important dietitians were up there.

“I finished my PhD in 2019 and that became my focus,” she says.

Lovell's part-time role as a paediatric oncology dietitian at the Starship Blood and Cancer Centre has driven her research direction.

Currently there are no national guidelines for nutrition for children with cancer and that has added to the challenges of her work as a paediatric dietitian, she says.

“I was getting frustrated at how much I had to argue with health professionals about the importance of nutrition.

“There is so much allowance for nutrition to hit rock bottom, before we intervene – and I want to see that change,” says Lovell, who is also chair of the National Child Cancer Network’s Nutrition Working Group.

Her new research project will begin with using a national database of about 2500 cancer patients aged under 14 to see whether malnutrition influences cancer survival rates or increases the risk of complications.

The second aspect of her project will involve interviewing 20 to 30 families to understand their nutrition experiences and challenges during a child’s cancer treatment and after recovery.

Cancer treatment, such as chemotherapy, can make children nauseous and cause sores in their mouths, affecting their appetite and food choices.

“It becomes very challenging to feed and nourish a child who is undergoing cancer treatment.

“Upward of 90 percent of children will be impacted by malnutrition of some kind during treatment,” Lovell says.

Some children become underweight and need nasogastric feeding to help them survive cancer treatment.

“Being underweight can increase the risks of treatment-related toxicities in the body – there’s less strength to fight with.”

That can lead to delays to chemotherapy schedules.

Up to 20 percent of children are overweight or obese at the time of diagnosis, similar to national averages – but that rate can double by the time treatment ends. Some children lose muscle and gain fat, as they reduce their movement while sick. Changes to the types of foods that children are offered and will accept can compound the issue.

International studies show malnutrition - being overweight or underweight - is a risk factor hindering children’s survival and increasing the risks of relapse.

It’s vital children with cancer get lots of nutrient-rich foods, like fruit, vegetables and wholegrains, and less takeaways and sweets, she says.

“I want to empower families to make food choices that will give their child the best chance to beat cancer and have a healthy life.”

In the third phase of the project, Lovell and her team will develop national nutrition guidelines for children with cancer, using her research findings and information from international studies. The guidelines will be co-designed with Māori health researchers from the Waikato, who have developed He Pikinga Waiora, a framework for healthcare that makes patients central to research questions, actualises self-determination and honours Te Tiriti o Waitangi.

The guidelines will provide parents and health professionals with information about the types of foods children need while going through treatment and criteria to gauge when they require intense nutrition support, such as nasogastric feeding.

“There are no guidelines in the world, so we will be leading the way in developing these.”

To implement the guidelines, Lovell plans to visit New Zealand’s two primary treatment centres for childhood cancer in Auckland and Christchurch, as well as 14 smaller centres around the country.

She hopes her work might help make access to knowledge about nutrition more equitable and standardised around Aotearoa.

“Nutrition care shouldn’t change based on where a child lives, if we do these guidelines right.”

About 150 children aged under 14 are diagnosed with cancer in Aotearoa every year. More than 85 percent of children survive their cancer, but it remains a leading cause of death for children in Aotearoa.

The first three months of treatment are the critical window to address eating behaviours, because this is the period where changes in food choices, body weight and composition often occur, she says.

Eating habits established during treatment for cancer can linger for years after a child has recovered, Lovell says.

Poor eating patterns might then contribute to health problems, such as heart disease and diabetes, later in life.

“Many of these children survive with lots of nutrient-related consequences, like high weight, poor food choices and micronutrient abnormalities.

“These kids are surviving at a cost - and I don’t want nutrition to play a role in that cost.”

Her ultimate aim is that “no child is impacted by malnutrition in all its forms during treatment for childhood cancer and after surviving cancer”.

The 37-year-old says the Health Research Council grant will fund her research for the next three years – but her interest in the field isn’t likely to wane anytime soon.

“It’s my life’s work. I realise it’s going to be my entire career focus - and that makes me excited,” she says.

Lovell is grateful for ongoing support from Te Aka Mātauranga Matepukupuku - Centre for Cancer Research, University of Auckland, including $100,000 in research funding over the past few years. Te Whatu Ora, the Maurice and Phyllis Paykel Foundation, and the University Research Development Fund have also provided support for her work on nutrition for children with cancer.