Nutritional Status and Chemotherapy-Induced Toxicities in Children with Cancer: Implications for Care in Low-Resource Settings

Background: Childhood cancer is an increasing public health issue, particularly in low- and middle-income countries, where over 80% of new cases arise. Malnutrition is common in these settings and may worsen chemotherapy-induced toxicities. This scoping review explored existing evidence on the impact of nutritional status on chemotherapy-induced toxicities in children with cancer in sub-Saharan Africa. Methods: Using the Levac et al. framework, we conducted a scoping review of studies published up to February 2025. Searches were carried out in Medline, Embase, Scopus, African Index Medicus, African Journals Online, and Google Scholar. Studies were eligible if they assessed the relationship between nutritional status and chemotherapy-induced toxicities in pediatric cancer patients in sub-Saharan Africa. Two reviewers independently conducted study selection, data extraction, and critical appraisal. Results: Out of 460 initial records, nine studies involving 1229 children from five countries were included. Most assessed nutrition using anthropometric indicators like BMI, MUAC, TSFT, UAMA, and Z-scores; others included serum albumin. Reported undernutrition prevalence ranged from 14.6 to 76%. Eight studies found an association between poor nutritional status and increased risks of chemotherapy-induced toxicities such as neutropenia, infections, mucositis, and altered pharmacokinetics. However, small sample sizes, methodological differences, and non-uniform malnutrition definitions limited comparability. Resource constraints and a lack of standard assessments were common challenges. Most studies offered moderate-to-low-level evidence but emphasised the clinical importance of nutritional assessment. Conclusion: Undernutrition is common among children with cancer in sub-Saharan Africa and may contribute to increased chemotherapy-induced toxicities. Nutrition is a potentially modifiable factor influencing treatment outcomes.

Duke Scholars

Author Kristin M. Schroeder Pediatrics, Hematology-Oncology