Consistent Physical Activity and Future Neurocognitive Problems in Adult Survivors of Childhood Cancers: A Report From the Childhood Cancer Survivor Study

Abstract

PURPOSE To investigate longitudinal associations between physical activity (PA) and neurocognitive problems in adult survivors of childhood cancer. METHODS A total of 12,123 5-year survivors diagnosed between 1970 and 1999 (median [range] age at diagnosis, 7 [0-21] years, time since diagnosis at baseline, 16 [6-30] years) and 720 siblings self-reported PA and neurocognitive problems. PA was collected at baseline, and PA and neurocognitive data were obtained 7 (1-12) years and 12 (9-14) years later. PA consistency was defined as any combination of ≥ 75 minutes of vigorous or 150 minutes of moderate activity per week on all surveys. Multiple linear regressions, conducted separately for CNS and non-CNS survivors, identified associations between PA consistency and neurocognitive outcomes (expected mean, 50; standard deviation [SD], 10). Mediating effects of body mass index (BMI) and chronic health conditions (CHCs) were evaluated. RESULTS Survivors were less likely than siblings to report consistent PA (28.1% v 33.6%) and more likely to report problems in Task Efficiency (T-scores mean ± SD: siblings, 50.0 ± 0.4; CNS, 61.4 ± 0.4; non-CNS, 53.3 ± 0.3), Emotion Regulation (siblings, 51.4 ± 0.4; CNS, 54.5 ± 0.3; non-CNS 53.4 ± 0.2), and Memory (siblings, 50.8 ± 0.4; CNS, 58.9 ± 0.4; non-CNS, 53.5 ± 0.2; all P < .001). Survivors of CNS cancers (52.8 ± 0.3) also reported poorer Organization than siblings (49.9 ± 0.4; P < .001). After adjusting for age at diagnosis, age at questionnaire, emotional distress, and cancer treatment exposures, consistent PA was associated with fewer neurocognitive problems compared with consistent inactivity for both CNS and non-CNS groups (T-score differences ranging from −7.9 to −2.2) and larger neurocognitive improvements over time (−6.0 to −2.5), all P ≤ .01. BMI and severe CHCs partially mediated the PA-neurocognitive associations, but the mediation effects were small (change in β ≤ 0.4). CONCLUSION Adult survivors of childhood cancer who report more consistent PA have fewer neurocognitive problems and larger improvements in these concerns many years after treatment.

Positive Impact of Organized Physical Exercise on Quality of Life and Fatigue in Children and Adolescents With Cancer

“…For adolescents especially, the benefits of engaging in sports might include regaining a sense of having a lively, properly-functioning body, enhancing relationship with peers and a spirit of independence. These findings are in line with research demonstrating positive relationships between physical activity and cognitive outcomes ( 25 – 27 , 37 ). We know that adolescents with cancer are less active than their healthy peers (especially when in hospital), and that fatigue is more prevalent in this age group than in children, and might be particularly distressing ( 20 , 38 ).…”

“…Physical activity has favorable effects on various levels of functioning in individuals during and after their treatment for cancer, encompassing aspects of QoL, mood symptoms, fitness level, muscle strength, body composition, and active attainment of social roles ( 5 , 7 , 8 , 12 , 25 , 31 , 32 ). A possible relationship between fitness level and the risk of mortality ( 4 ) and tumor recurrence ( 11 , 33 ) has also emerged, and is worth exploring further.…”

“…Physical vitality is an important marker of any child's and teenager's physical and psychosocial well-being, be they healthy or ill, and higher levels of physical activity have been found to correlate with better cognitive outcomes (25)(26)(27)(28).…”

Extracellular Vesicle Proteome of Breast Cancer Patients with and Without Cognitive Impairment Following Anthracycline-based Chemotherapy: An Exploratory Study

“… 4 Affected patients experienced difficulty resuming pre-cancer responsibilities and activities, which could negatively impact their quality of life. 5 , 6 In managing CRCI, non-pharmacological interventions such as physical activity 7 and cognitive rehabilitative program 8 were shown to improve patients’ psychosocial functioning and neurocognitive performance. However, effective pharmacological treatments for CRCI short- and long-term after cessation of cancer therapy are lacking in view of the poor understanding of the underlying pathophysiology.…”

Biological Aspects of Inflamm-Aging in Childhood Cancer Survivors

“…Studies suggested that the safety and feasibility of lifestyle interventions are significant if introduced while patients are receiving cancer treatment [ 170 ]. Most of the lifestyle interventions in CCS are focused on behavioral interventions in healthy aging like nonsmoking, caloric restriction, and physical activity [ 171 ]. A study demonstrated that both nutrition and physical activity are necessary to counteract the early onset of obesity and chronic diseases in CCS [ 172 , 173 ].…”