Delayed diagnosis of anorexia nervosa following childhood cancer treatment: a case report and literature review

Paediatric oncology treatment frequently affects appetite and eating behaviours, yet there is limited evidence regarding the incidence and recognition of eating disorders among childhood cancer survivors. Misinterpretation of eating-related symptoms may delay appropriate psychiatric care. We describe a 15-year-old male survivor of stage IV Wilms tumour, previously treated with chemotherapy and nephrectomy, who presented during oncology follow-up with weight loss, food restriction, and excessive exercise. Despite fulfilling diagnostic criteria for anorexia nervosa, his symptoms were initially attributed to post-traumatic stress and disease recurrence, resulting in a four-month delay in referral and treatment. On eventual admission, he met multiple Medical Emergencies in Eating Disorders (MEED) red criteria. Following inpatient treatment with nutritional rehabilitation and psychological support, the patient made a full recovery and remains in remission from both his malignancy and eating disorder. This case illustrates diagnostic overshadowing of anorexia nervosa in paediatric oncology survivors, a population potentially at increased risk for disordered eating due to treatment side effects, body image changes, and psychological trauma. Routine screening for restrictive eating, avoidant restrictive food intake disorder (ARFID), and food-related anxieties during oncology follow-up may facilitate early recognition and intervention. Increased awareness of eating disorders as possible late effects of cancer treatment is warranted among oncology and mental health professionals.