Impairments that Influence Physical Function among Survivors of Childhood Cancer

Abstract

Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with a broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.

Thoracic growth deficiency in childhood cancer survivors may cause overestimation of lung disease

“…Previous studies have demonstrated a significant reduction in stature of childhood cancer survivors (CCS), with multiple contributing factors suggested, including underlying diagnosis, age of diagnosis, cranial and spinal radiation, and a dose of radiation, as recently reviewed . The data from our study confirms a significant decrease in overall stature among CCS as well as a disproportionately greater deficit in thoracic than appendicular growth (ie, reduction in USL:SH ratio), as previously reported in children with leukemia and Wilms’ tumor .…”

Long‐term risk of cardiovascular mortality in lymphoma survivors: A systematic review and meta‐analysis

“…This disparity may also reflect differences in treatment regimens as participants treated during childhood would have received treatment in an earlier era when the dose of anthracyclines and the prevalence of mantle field radiation were higher compared to more recent eras . Cancer treatment could also indirectly affect the risk of cardiovascular disease mortality by impacting various behavioral and psychosocial determinants of health . These indirect pathways may play a lesser role in mediating the relation between lymphoma treatment and cardiovascular disease risk among those treated later in life which could partially account for this heterogeneity.…”

“…81 Cancer treatment could also indirectly affect the risk of cardiovascular disease mortality by impacting various behavioral and psychosocial determinants of health. 82,83 These indirect pathways may play a lesser role in mediating the relation between lymphoma treatment and cardiovascular disease risk among those treated later in life which could partially account for this heterogeneity. Regardless of the underlying mechanism, our results suggest that childhood Hodgkin lymphoma survivors are a population with a particularly high risk of experiencing a fatal cardiovascular event.…”

The effects of radiation therapy in musculoskeletal system of children

“…The therapeutic procedures are questioned due to the long-term implications for the children whose skeleton is growing. On the other hand, osteonecrosis occurs rarely in solid tumors 6 . 2.…”