Editorial: Exercise and childhood cancer

Abstract

Editorial on the Research Topic Exercise and childhood cancerGlobally, >175,000 children (i.e., individuals aged ≤18-21years) are diagnosed with cancer each year (1). For some of the most common cancers (e.g., acute lymphoblastic leukemia, non-Hodgkin lymphoma), medical advances have led to improved survival rates, with up to 85% expected to survive the disease for at least 5-years (1). 1 Despite improving prognoses, most children affected by cancer experience, or are at elevated risk, for numerous negative effects during and after treatment, with some effects observed decades later (i.e., late effects) (2). Health behaviors, including physical activity (any movement requiring energy expenditure) and exercise (structured or planned physical activity), may help this cohort manage the effects of their disease during and beyond treatment (3). In fact, based on a burgeoning evidence base, guidelines have recently been published suggesting that all children affected by cancer "move more" (4, 5).This Research Topic, Exercise and Childhood Cancer, includes 11 articles that collectively advance the field of "pediatric exercise oncology" ( 6), an area of study exploring physical activity, including exercise, for children affected by cancer. The articles included summarize the current literature, provide further evidence supporting the role of physical activity and exercise for children affected by cancer, and offer insights into forthcoming trials and novel approaches in the field.1 Prognosis varies across cancer types and is lower in middle-and low-income countries.

Musculoskeletal vulnerability and physical frailty during and after treatment for childhood cancer

“…However, none of the muscle ultrasound outcomes was associated with handgrip strength. This was somewhat surprising, because in healthy children hand grip strength is an indicator for general muscle strength 46 . This may not apply to children with ALL, because high-dose corticosteroids (as well as other chemotherapeutic agents) induce proximal muscle weakness rather than distal muscle weakness.…”

“…Sarcopenia is usually known as age-related muscular deterioration, and is currently defined by the European Working Group on Sarcopenia in Older People as the presence of both low muscle mass and low muscle strength. 46 However, over the last decade it is shown that sarcopenia is a progressive and generalized skeletal muscle disorder associated with increased adverse health outcomes and mortality, not only in the elderly but in adults with various diseases as well. 46,47 Moreover, recent studies described this muscle disorder in chronically ill children and found associations between sarcopenia and postcolectomy complications in ulcerative colitis patients 48 , as well as increased perioperative length of stay, ventilator dependency, and readmissions in children after liver transplantation.…”

“…46 However, over the last decade it is shown that sarcopenia is a progressive and generalized skeletal muscle disorder associated with increased adverse health outcomes and mortality, not only in the elderly but in adults with various diseases as well. 46,47 Moreover, recent studies described this muscle disorder in chronically ill children and found associations between sarcopenia and postcolectomy complications in ulcerative colitis patients 48 , as well as increased perioperative length of stay, ventilator dependency, and readmissions in children after liver transplantation. 49 In pediatric cancer patients, sarcopenia is a relatively understudied condition, and causal factors and consequences have not been elucidated.…”

“…The European Working Group on Sarcopenia recommends the use of the SARC-F as a case-finding tool for sarcopenia in the elderly. 46 The SARC-F is a quick self-report score including five questions addressing muscular strength, ability to walk, to rise from a chair, to climb stairs and the occurrence of falls (Figure 5). 84 The SARC-F has shown to be a valid and consistent instrument for detecting sarcopenia in the elderly 85 and in adult cancer patients.…”

“…Raw results will be compared with population-based age-and sex-specific reference values. 44 Handgrip dynamometry showed good validity (intraclass correlation coefficients [ICCs] 0.73-0.91) with high reproducibility in children from the age of 4 years old and has excellent test-retest reliability (ICC 0.91-0.93) 45,46 , and the measurement was feasible in children with leukemia. 47…”