Physical fitness and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime cohort

Phillips, Nicholas S.; Howell, Carrie R.; Lanctot, Jennifer Q.; Partin, Robyn E.; Pui, Ching‐Hon; Hudson, Melissa M.; Robison, Leslie L.; Krull, Kevin R.; Ness, Kirsten K.

doi:10.1002/cncr.32510

Cited by 29 publications

(34 citation statements)

References 45 publications

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“…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 ).…”

Section: Lessons Learned and Discussionsupporting

confidence: 91%

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

et al. 2021

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Background: Cancer and its treatment can cause serious health issues that impair physical and mental well-being in children and adolescents. Exercise may be a valid strategy for managing some symptoms, including fatigue. In the light of our experience, we provide further justification for including exercise as part of routine childhood cancer care.Methods: Forty-four children and adolescents who had solid cancers not contraindicating their movement were invited to join an in-hospital 6-week supervised exercise program, and asked afterwards to complete validated quality of life and fatigue scales. The program consisted of personalized workout sessions of aerobic, resistance and flexibility exercises. The results obtained on the scales were compared between 21 patients who engaged in the exercise program (GYM group) and 23 who refused (No-GYM group), examining the different dimensions of health-related quality of life (physical, emotional, cognitive, social) and fatigue (general, sleep/rest, cognitive) in the two groups.Results: Being diagnosed with cancer initially prompted all but one of the respondents to drop-out of previous routine exercise or sports although their continuation had not been contraindicated. After 6 weeks of exercise, the GYM group's scores for quality of life and fatigue showed a statistically significant better perceived emotional functioning, and a trend toward a better social functioning than in the No-GYM group.Conclusion: We suggest that exercise improves the satisfaction of children and adolescents with cancer with their physical, mental and social functioning. We would emphasize the potential benefits of general practitioners discussing and recommending exercise for their young patients with cancer.

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Section: Lessons Learned and Discussionsupporting

confidence: 91%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Therefore, we propose that early neurocognitive interventions may be warranted in both CNS and non-CNS survivors with seizures, and early physical fitness interventions in non-CNS survivors with seizures may help to improve social outcomes. 46,47 Our results are similar to those of a report demonstrating that seizure freedom in noncancer patients with epilepsy led to improved social attainment, but they differ in that seizure severity did not affect social outcomes. 21 Seizure management in patients with cancer has evolved as newer medications with better efficacy and fewer medication interactions have become available.…”

Section: ------Non-cnssupporting

confidence: 86%

Seizures' impact on cognition and quality of life in childhood cancer survivors

Phillips

Khan

et al. 2021

Cancer

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BACKGROUND:The objective of this study was to determine the impact of seizure-related factors on neurocognitive, health-related quality of life (HRQOL), and social outcomes in survivors of childhood cancer. METHODS: Survivors of childhood cancer treated at St. Jude Children's Hospital (n = 2022; 48.3% female; median age, 31.5 years; median time since diagnosis, 23.6 years) completed neurocognitive testing and questionnaires. The presence, severity, resolution, and treatment history of seizures were abstracted from medical records. Adjusting for the age at diagnosis, sex, and prior cancer therapy, multivariable models examined the impact of seizures on neurocognitive and HRQOL outcomes. Mediation analyses were conducted for social outcomes. RESULTS: Seizures were identified in 232 survivors (11.5%; 29.9% of survivors with central nervous system [CNS] tumors and 9.0% of those without CNS tumors). In CNS tumor survivors, seizures were associated with poorer executive function and processing speed (P < .02); in non-CNS tumor survivors, seizures were associated with worse function in every domain (P < .05). Among non-CNS survivors, seizure severity was associated with worse processing speed (P = .023), and resolution was associated with better executive function (P = .028) and attention (P = .044). In CNS survivors, seizure resolution was associated with improved attention (P = .047) and memory (P < .02). Mediation analysis revealed that the impact of seizures on social outcomes was mediated by neurocognitive function. CONCLUSIONS: Seizures in cancer survivors adversely affect long-term functional and psychosocial outcomes independently of cancer therapy. The resolution of seizure occurrence is associated with better outcomes. Seizure severity is associated with poorer outcomes and should be a focus of clinical management and patient education.

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“…No associations of therapeutic exposures such as cisplatin or methotrexate with neurocognition were identified to explain these differences. We recently demonstrated associations between physical activity and neurocognitive outcomes in survivors of acute lymphoblastic leukemia (45); exercise intolerance and overall poor physical health could contribute to greater risk of neurocognitive changes in osteosarcoma survivors, who demonstrated impaired aerobic function and mobility in our study. Future studies should evaluate interventions for physical performance and associations with neurocognitive outcomes in survivors.…”

Section: Discussionmentioning

confidence: 56%

Cumulative Burden of Chronic Health Conditions in Adult Survivors of Osteosarcoma and Ewing Sarcoma: A Report from the St. Jude Lifetime Cohort Study

Bishop

Ness

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Adult survivors of childhood osteosarcoma and Ewing sarcoma are at risk of developing therapy-related chronic health conditions. We characterized the cumulative burden of chronic conditions and health status of survivors of childhood bone sarcomas.Methods: Survivors (n ¼ 207) treated between 1964 and 2002 underwent comprehensive clinical assessments (history/ physical examination, laboratory analysis, and physical and neurocognitive testing) and were compared with community controls (n ¼ 272). Health conditions were defined and graded according to a modified version of the NCI's Common Terminology Criteria for Adverse Events and the cumulative burden estimated.Results: Osteosarcoma and Ewing sarcoma survivors [median age 13.6 years at diagnosis (range 1.7-24.8); age at evaluation 36.6 years (20.7-66.4)] demonstrated an increased prevalence of cardiomyopathy (14.5%; P < 0.005) compared with controls.Nearly 30% of osteosarcoma survivors had evidence of hypertension. By age 35 years, osteosarcoma and Ewing sarcoma survivors had, on average, 12.0 (95% confidence interval, 10.2-14.2) and 10.6 (8.9-12.6) grade 1-4 conditions and 4.0 (3.2-5.1) and 3.5 (2.7-4.5) grade 3-4 conditions, respectively, compared with controls [3.3 (2.9-3.7) grade 1-4 and 0.9 (0.7-1.0) grade 3-4]. Both survivor cohorts exhibited impaired 6-minute walk test, walking efficiency, mobility, strength, and endurance (P < 0.0001). Accumulation of ≥4 grade 3-4 chronic conditions was associated with deficits in executive function [RR: osteosarcoma 1.6 (1.0-2.4), P ¼ 0.049; Ewing sarcoma 2.0 (1.2-3.3), P ¼ 0.01] and attention [RR: osteosarcoma 2.3 (1.2-4.2); P ¼ 0.008].Conclusions: Survivors of osteosarcoma and Ewing sarcoma experience a high cumulative burden of chronic health conditions, with impairments of physical function and neurocognition.Impact: Early intervention strategies may ameliorate the risk of comorbidities in bone sarcoma survivors.

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Physical fitness and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime cohort

Cited by 29 publications

References 45 publications

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

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

Seizures' impact on cognition and quality of life in childhood cancer survivors

Cumulative Burden of Chronic Health Conditions in Adult Survivors of Osteosarcoma and Ewing Sarcoma: A Report from the St. Jude Lifetime Cohort Study

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