Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Abstract

BACKGROUND: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. METHODS: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor healthrelated quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week −1 ) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. RESULTS: The prevalence of depression at follow-up was 11.4% (95% CI, 10.6%-12.3%), anxiety 7.4% (95% CI, 6.7%-8.2%) and somatization 13.9% (95% CI, 13.0%-14.9%). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95% CI, 0.72-1.05) for 3 to 6 MET hours per week −1 , 0.76 (95% CI, 0.62-0.94) for 9 to 12 MET-hours per week −1 , and 0.74 (95% CI, 0.58-0.95) for 15 to 21 MET-hours per week −1 . Compared with 0 MET hours per week −1 , 15 to 21 MET-hours per week −1 were associated with an adjusted prevalence ratio of 0.79 (95% CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (P trend < .001), emotional role limitations (P trend = .02), and mental health (P trend = .02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P < .05 for all), but not in the domain of cancer pain. CONCLUSIONS: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors. Cancer 2019;125:3059-3067.

Vigorous physical activity and mental health—Associations suggest a link among childhood cancer survivors

“…In this issue of Cancer , Tonorezos and colleagues focus on the relationship between vigorous exercise and psychological well‐being among 6199 adult survivors of childhood cancer within the Childhood Cancer Survivor Study (CCSS) who currently have a median age of 34.3 years. They report that adult childhood cancer survivors who attest to engaging in higher levels of vigorous physical activity (≥9 metabolic equivalent hours per week) experience fewer symptoms of depression (prevalence ratio [PR], 0.80; 95% CI, 0.68‐0.94; P = .009) and somatization (PR, 0.83; 95% CI, 0.72‐0.94; P = .001), fewer cognitive impairments in task completion (PR, 0.79; 95% CI, 0.71‐0.88; P < .001), and lower incidence of poor HRQOL in the domains of physical functioning (PR, 0.77; 95% CI, 0.66‐0.89; P < .001), general health (PR, 0.85; 95% CI, 0.77‐0.92; P < .001), and vitality (PR, 0.82; 95% CI, 0.75‐0.87; P < .001).…”

“…This is particularly important with respect to physical activity, where the underlying issue is, “what came first?” Was depression the reason for inactivity or inactivity the reason for depression? Thus, the title of this article over‐reaches because it describes associations—not “impact.” That being said, observational studies like that of Tonorezos et al are sentinel to developing an understanding of factors that ultimately may lend themselves to interventions that can improve care and treatment.…”

“…In studying the results of Tonorezos et al, with the end goal of developing an intervention, we are first confronted with the intensity of physical activity that is being explored (ie, vigorous physical activity, such as aerobic exercise, jogging, and jumping rope). Although exercise of this intensity is less likely to be inaccurately reported and misclassified, further studies are needed to investigate less intensive levels that ultimately may yield important benefits as well.…”

“…Because cognition was a key factor assessed by Tonorezos et al, there also is a need for future studies to use rigorous neuropsychological measures. In the current study, cognition was assessed using the original CCSS Neurocognitive Questionnaire, a self‐report instrument developed for the CCSS that was revised and revalidated after data collection .…”

“…Perhaps the most salient need for control of BMI comes from the previous analysis on the CCSS cohort in which it was reported that survivors in the obese BMI category were less likely to report that they met the physical activity guidelines (relative risk, 0.80; 95% CI, 0.74‐0.87), and as were those in the underweight category (relative risk, 0.74; 95% CI, 0.76‐0.94) . Therefore, there is ample rationale to support the inclusion of BMI as a covariate in the analysis performed by Tonorezos et al, and we are hopeful that they will provide an addendum to their report that chronicles their findings.…”