Exercise Capacity in Long-Term Survivors of Pediatric Cancer: An Analysis From the Cardiac Risk Factors in Childhood Cancer Survivors Study

Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida.
Pediatric Blood & Cancer (Impact Factor: 2.39). 04/2013; 60(4). DOI: 10.1002/pbc.24410
Source: PubMed


Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited.
We assessed maximal myocardial oxygen consumption (, a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity.
Of 72 survivors (mean age, 22 years; range, 8.0–40 years) and 32 siblings (mean age, 20.2 years; range, 8–46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5–31.6 years). In age- and sibling-pair adjusted analyses, was lower in survivors than siblings (males, 28.53 vs. 30.90 ml/kg/minute, P = 0.08; females, 19.81 vs. 23.40 ml/kg/minute, P = 0.03). In males, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower . In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower .
Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring. Pediatr Blood Cancer 2013; 60: 663–668.

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    • "Survivors have higher risk of developing diabetes, high blood pressure and cholesterol, osteonecrosis, cardiovascular complications , and stroke than the general population [43] [44]. Moreover, childhood cancer survivors often do not achieve the recommended guidelines for physical activity [45] and sustaining a healthy diet [46]. Given their susceptibility to certain health problems, the high prevalence of overweight and obesity that we observed among survivors of childhood cancer, although similar to the general population, is of concern. "
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    ABSTRACT: Background. Population-based studies are needed to estimate the prevalence of underweight or overweight/obese childhood cancer survivors. Procedure. Adult survivors (diagnosed ≤20 years) were identified from the linked Utah Cancer Registry and Utah Population Database. We included survivors currently aged ≥20 years and ≥5 years from diagnosis (N = 1060), and a comparison cohort selected on birth year and sex (N = 5410). BMI was calculated from driver license data available from 2000 to 2010. Multivariable generalized linear regression models were used to calculate prevalence relative risks (RR) and 95% confidence intervals (95% CI) of BMI outcomes for survivors and the comparison cohort. Results. Average time since diagnosis was 18.5 years (SD = 7.8), and mean age at BMI for both groups was 30.5 (survivors SD = 7.7, comparison SD = 8.0). Considering all diagnoses, survivors were not at higher risk for being underweight or overweight/obese than the comparison. Male central nervous system tumor survivors were overweight (RR = 1.12, 95% CI 1.01-1.23) more often than the comparison. Female survivors, who were diagnosed at age 10 and under, had a 10% higher risk of being obese than survivors diagnosed at ages 16-20 (P < 0.05). Conclusion. While certain groups of childhood cancer survivors are at risk for being overweight/obese, in general they do not differ from population estimates.
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    ABSTRACT: To summarize and discuss recent research (2011-2013) examining the communication needs of childhood cancer survivors with respect to long-term health risks and considering the developmental needs of children, adolescents and young adults. Survivors' levels of awareness of ongoing health risks are low, indicating that clinical strategies for communicating risks and empowering young people as active partners in their own healthcare are lacking. Research examining the information needs of very young survivors is sparse. Adolescent and young adults may be particularly vulnerable given their lack of health-risk knowledge combined with expected developmental risk-taking behaviors. Strategies to manage individual information preferences of survivors are required, along with strategies to manage the triadic (child, parent, health professional) nature of communications. Internet technologies offer an important mechanism for communication of health risks to survivors, families and primary healthcare providers. International efforts must continue to articulate systematic yet flexible approaches to communication with children, adolescents and young adults that can be applied across the cancer treatment continuum and into surveillance and long-term survivorship. Information and communication needs of this population are complex and reliance on age as a proxy for capacity to participate in healthcare communication is inadequate.
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