Physical Inactivity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Florin, Todd A.; Fryer, George E.; Miyoshi, Thomas J.; Weitzman, Michael; Mertens, Ann C.; Hudson, Melissa M.; Sklar, Charles A.; Emmons, Karen M.; Hinkle, Andrea S.; Whitton, John; Stovall, Marilyn; Robison, Leslie L.; Oeffinger, Kevin C.

doi:10.1158/1055-9965.epi-07-0048

Cited by 190 publications

(180 citation statements)

References 44 publications

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“…CCSS data do suggest that there are some cancer survivors with increased risks for smoking, less than optimal levels of physical activity, and excessive alcohol consumption. Low income and less education were associated with increased risk of smoking 44 and with an increased risk for an inactive lifestyle 45 in this cohort and, as we have demonstrated,…”

Section: Educational Economic Social Health Care and Lifestyle Cosupporting

confidence: 83%

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Ness

Hudson

Ginsberg

et al. 2009

JCO

Self Cite

157

106

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A B S T R A C TPhysical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatmentbased risk factors include radiation and treatment with a combination of alkylating agents and anthracyclines. Musculoskeletal, neurologic, cardiac, pulmonary, sensory, and endocrine organ system dysfunction also increase the risk of developing a physical performance limitation. In summary, monitoring of physical performance limitations in an aging cohort of childhood cancer survivors is important and will help determine the impact of physical performance limitations on morbidity, mortality, and caregiver burden. In addition, in developing restorative and preventive interventions for childhood cancer survivors, we must take into account the special needs of survivors with physical disability to optimize their health and enhance participation in daily living activities.

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Section: Educational Economic Social Health Care and Lifestyle Cosupporting

confidence: 83%

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Ness

Hudson

Ginsberg

et al. 2009

JCO

Self Cite

157

106

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“…25 Adult long-term survivors of childhood ALL were more likely to be physically inactive than was the general population. 26 In our study, among the patients tested for 4 or more years after SCT, the sports club members had better results in all tests when compared with others. There are several studies of transplanted adults advocating the beneficial effect of physical exercise intervention.…”

Section: Discussionmentioning

confidence: 44%

Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT

Hovi

Kurimo

Taskinen

et al. 2009

Bone Marrow Transplant

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We present a set of tests for physical performance used for annual prospective follow-up after a pediatric transplant. Of the 103 eligible patients transplanted at a mean age of 8.8 years, 94 were included. The results were divided into early, performed 1 (n ¼ 46) or 2 (n ¼ 12) years post transplant, and late tests (n ¼ 66), performed 4-16 (mean 6) years post transplant. A total of 30 patients had tests both at early and late time points (paired tests). The control subjects included 522 healthy age-and gendermatched schoolchildren. Using their test results, the s.d. score (SDS) was calculated for each patient and for each test individually. Both in the early and late tests, patients had the mean SDS for each test significantly lower (Po0.001) than controls, varying from À0.6 to À2.0 SDS. Specifically, tests measuring trunk muscles gave impaired results. In the group with paired tests, the results improved in four of six tests. In late tests, age at SCT, extensive chronic GVHD and being a sports club member correlated with the results. The potential beneficial effect of an exercise intervention program on impaired physical performance after pediatric SCT merits prospective studies.

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“…This therapy, which was used in the last two decades for high-risk acute lymphoblastic leukemia (ALL) (typically at 18 Gy dose), is strongly associated with physical inactivity during adulthood. 9 Boys and girls (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) years) who are long-term ALL survivors (41.5 years posttreatment) have significantly reduced cardiorespiratory fitness, and this reduction is correlated with cumulative chemotherapy dose. 7 Likewise, higher chemotherapy dose is associated with lower cardiac function.…”

Section: Introductionmentioning

confidence: 99%

“…3 Long-term survivors of ALL are more likely to be obese than the general population, which is itself a risk factor for adverse outcomes after disease. 9 Finally, longterm ALL survivors are at increased risk of having several physical inactivity-related diseases, such as cardiovascular disease, and osteoporosis. [10][11][12] Hematopoietic stem cell transplantation (HSCT), which includes both bone marrow and peripheral blood stem cell transplantation, typically occurs after radiation or chemotherapy in the more severe hematological malignancies, but is also used in the treatment of refractory solid tumors.…”

Section: Introductionmentioning

confidence: 99%

Exercise in adult and pediatric hematological cancer survivors: an intervention review

et al. 2010

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Observational research has shown that the physical activity levels of survivors of hematological cancer are low, with deleterious health consequences. This review summarizes the research on exercise interventions in adult and pediatric hematological cancer survivors. We searched MEDLINE, SPORTDiscus, CINAHL, Embase, Cochrane and PEDro through September 2009 for exercise intervention studies in children and adults with any type of hematological cancer. In the 24 adult intervention studies reviewed, we found strong evidence (that is, X3 high-quality studies and X75% reporting a significant benefit) for a benefit on body composition. Weak, but promising, evidence (X3 high-quality studies, but o75% reporting a significant benefit) was found for cardiorespiratory fitness, fatigue, muscle strength, physical functioning and quality of life. In pediatric interventions (13 studies), we found strong evidence for a benefit on muscle strength and cardiorespiratory fitness, particularly, if training was conducted in the hospital setting. Evidence is weak for ankle dorsiflexion, physical functioning and body composition. No exerciserelated risks were identified in adults or children studies. Though more randomized controlled trials are needed, a growing body of literature supports the notion that regular physical activity is safe and has potential benefits for both adult and pediatric hematological cancer survivors.

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Physical Inactivity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Abstract: Purpose: To determine if adult survivors of childhood acute lymphoblastic leukemia (ALL) are less active (and more inactive) than the general population and to identify modifying factors.

Cited by 190 publications

References 44 publications

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT

Exercise in adult and pediatric hematological cancer survivors: an intervention review

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