Association of Exercise Intolerance With Emotional Distress, Attainment of Social Roles, and Health-Related Quality of Life Among Adult Survivors of Childhood Cancer

Abstract

IMPORTANCEExercise intolerance is associated with increased risk for morbidity and mortality in childhood cancer survivors. However, an association between exercise intolerance and psychosocial outcomes has not been fully explored.OBJECTIVE To examine the associations between exercise intolerance and emotional distress, attainment of social roles, and health-related quality of life in childhood cancer survivors. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study including 1041 adult survivors of childhood cancer and 286 community controls in the St Jude Lifetime Cohort was conducted at St Jude Children's Research Hospital. The study was performed from April 1, 2012, to March 15, 2020.EXPOSURES Exercise intolerance was defined as relative peak oxygen uptake less than 85% of age-and sex-estimated levels from maximal cardiopulmonary exercise testing. MAIN OUTCOMES AND MEASURESEmotional distress was measured with the 18-item Brief Symptom Inventory-18, which includes overall Global Severity Index and depression, anxiety, and somatization subscales. Participants with T scores greater than or equal to 63 were classified as having elevated levels of distress. Social attainment was evaluated using patient-reported educational, employment, and marital status. Health-related quality of life was examined with the Medical Outcomes Survey Short Form-36. Participants with T scores less than or equal to 40 were classified as reporting poor health-related quality of life. RESULTSOf the 1041 participants, 528 were women (50.7%). The prevalence of exercise intolerance among survivors (mean [SD] age, 35.5 [9.2] years) was higher than that among controls (age, 34.5 [10.0] years) (survivors: 634 [60.9%] vs controls: 75 [26.2%], P < .001). After adjusting for age at diagnosis and cardiopulmonary exercise testing, sex, race/ethnicity, smoking, physical activity, and exercise intolerance were associated with an increased risk for anxiety (prevalence rate ratio [PRR], 1.95; 95% CI, 1.20-3.16), somatization (PRR, 1.86; 95% CI, 1.23-2.80), and unemployment (PRR, 1.76; 95% CI, 1.23-2.52); an inverse association was noted with having a college degree (PRR, 0.67; 95% CI, 0.50-0.88). Exercise intolerance was associated with an increased the risk for scoring less than or equal to 40 on the physical component summary of the Medical Outcomes Survey Short Form-36 (PRR, 3.69; 95% CI, 2.34-5.84). These associations persisted when either cancer treatment exposures or chronic health conditions were added to the model. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that exercise intolerance is independently associated with emotional distress, attainment of social roles, and health-related quality of life of long-term survivors of childhood cancer. The results also suggest that improving physiologic capacity may benefit general health and wellness, as well as emotional health, ability to participate in social roles, and health-related quality of life.

Recommendations for the surveillance of education and employment outcomes in survivors of childhood, adolescent, and young adult cancer: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…As a group, survivors of CAYA cancers are at risk for lower educational achievement with respect to comparison groups (Level C), 17‐62 and fewer survivors than comparisons have a university or college education (Level B) 17,18,21,22,24‐27,29,31,35‐37,47,49,58,63‐69 . Specifically, we found 46 studies that compared educational achievement in survivors to that of siblings, peers, or the general population 17‐62 .…”

“…In comparison with control groups, the educational attainment of survivors was lower in 19 studies (13 independent study samples), 17,18,26,32,35‐37,49‐59 higher in 4 studies, 21,22,30,33 and not significantly different in 23 studies (20 samples) 19,20,23‐25,27‐29,31,34,38‐48,61,62 (Supporting Table 11). Among 23 studies that evaluated the proportion of university/college graduates among survivors versus comparisons 17,18,21,22‐27,29,31,35‐37,47,49,58,63‐69 the proportion was lower in 12 studies (7 samples), 17,18,26,35‐37,49,58,63,66,67,69 higher in 1 study, 21 and not significantly different in 10 studies (6 samples) (Supporting Table 11). 22,24,25,27,29,31,47,64,65,68 Survivors of CNS tumors were at increased risk for lower educational achievement 26,57,60,61 and for not getting a college/university degree 37,58,63,67 (both Level B; Table 1 and Supporting Table 10).…”

Does allogeneic stem cell transplantation in survivors of pediatric leukemia impact regular physical activity, pulmonary function, and exercise capacity?

“…The mean time after allo-HSCT in our cohort was more than 5 years; maybe HRQL was lower closer to allo-HSCT. Further studies are needed to see whether an exercise intervention can improve HRQL, as in former studies decreased physical functioning has been shown to impact quality of life in survivors of childhood cancer [15,16].…”

“…Studies demonstrate, though, that regular physical activity can improve the cardiovascular risk profile in pediatric cancer survivors [12] and regular exercise training during and after cancer treatment positively affects body composition, flexibility, cardiorespiratory fitness, muscle strength, and health-related quality of life [13]. Finally, exercise capacity and physical activity are closely related to health-related quality of life in healthy children [14] but data suggests that this applies even more to survivors of childhood cancer [8,15,16].…”

The Relationship Between Physical Activity Level with Quality of Life and General Health among COVID-19 Recovered Individuals

“…These attenuate the immune system; reduce the QoL and GH [12,13]. Various measures are taken to achieve physical and GH and increase public health, including sports and recreational activities.…”