Impairments of Lower Extremity Muscle Strength and Balance in Childhood Cancer Patients and Survivors: A Systematic Review

Abstract

This review aims to summarize the evidence for impairments of muscle strength and balance during and after treatment for childhood cancer. Thirty-two articles, identified in scientific databases by means of a structured search for investigations of muscle strength and balance in pediatric cancer patients and survivors, are evaluated. A summary of results is given with respect to matching reporting items to provide a qualitative analysis of the evidence. The majority of the studies reached a level 3 rating according to Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 levels of evidence. Muscle strength and balance seem to be impaired in varying degrees depending on the diagnosis, treatment received, and time elapsed between treatment and evaluation. Drawing specific conclusions from the identified studies is difficult because of heterogeneous study samples and methods of research. Individual targeted exercise therapy programs during treatment and follow-up of childhood cancer could help to prevent and further diminish impairments of muscle strength and balance function among childhood cancer patients and survivors.

Balance in children with acute lymphoblastic leukemia

“…The present results are similar to those of two previously published reviews on balance in pediatric cancers in general. 25,26 In both reviews, the authors concluded that although there was some evidence to support childhood cancer survivors having diminished balance abilities in comparison with healthy peers, there is a need for further studies with greater statistical power.…”

Testing physical function in children undergoing intense cancer treatment—a RESPECT feasibility study

“…Physical function testing in children with cancer is gaining increasing interest as reports of physical function impairment during and after treatment become more prevalent. Function disabilities include reductions in cardiopulmonary function, muscle strength, balance, and general physical weakness, that impact quality of life . The existing topic‐related studies include limited numbers of children (n = 15–128) as well as restricted diagnostic groups and inclusion criteria.…”

Exercise program for children and adolescents with leukemia and lymphoma during treatment: A comprehensive review

“…Cyclophosphamide, methotrexate (MTX), vincristine (VCR), and other chemotherapeutic agents are responsible for several side effects on cognitive, neurological, and motor functions, which negatively impact patients’ development. Patients with leukemia and lymphoma are at risk for developing complications such as decreases in muscular strength, impaired gross and fine motor skills, osteonecrosis, and fatigue . These outcomes are evident at diagnosis and especially at an early stage of treatment .…”