Muscle strength and quality of life in patients with childhood cancer at early phase of primary treatment

Abstract

Cancer- and treatment-related side effects in patients with childhood cancer may cause limitations in motor performance affecting activities of daily living (ADLs). Data focusing on long-term effects are available, but little is known with regard to the short-term perspective. Therefore, the purpose of this study was to assess muscle strength performance and quality of life (QoL) in children and adolescents with cancer at the beginning of primary treatment. Forty children and adolescents aged 5-18 years (mean: 11.39 ± 4.08 years) with different types of childhood cancer were enrolled. On average 36 ± 20.5 days after diagnosis, strength performance in 7 muscle groups was assessed by handheld dynamometry. KINDL questionnaires were completed to evaluate QoL (children's self-report and parents' report). All parameters were compared with age- and gender-matched reference values. Patients with childhood cancer showed significantly lower strength values in all muscle groups (P < .01) compared with age- and gender-matched controls. Most affected were the lower extremities, with a -57.1% ± 10.4%, median: -59.2%, minimum: -75.4%, maximum: -41.4% percentage deviation in knee flexion from healthy peers. Children themselves and parents assessed total QoL significantly below age- and gender-matched reference values (P < .01). Correlation between elbow flexion and self-reported QoL was detected. Broader correlations were found for the parents' report. Muscle weakness and decreased QoL in children and adolescents seem to persist already at the beginning of anticancer treatment. This underlines the need of counteracting measures, such as exercise intervention programs, starting as early as possible during the treatment process. Efforts on this topic are currently being carried out by our group.

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

“…Abbreviations: ALL, acute lymphoblastic leukemia; CNS, central nervous system; CPET, cardiopulmonary exercise test and general physical weakness, 3,6,8 that impact quality of life. 3,5,9 The existing topic-related studies include limited numbers of children (n = 15-128) as well as restricted diagnostic groups and inclusion criteria. Furthermore, the testing methodologies during the treatment trajectory were not standardized across different studies.…”

“…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.…”

“…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, 1-3 muscle strength, [4][5][6]…”

Physical activity for children undergoing acute cancer treatment: A qualitative study of parental perspectives

“…Children with cancer have reduced physical activity levels during treatment compared with their peers 1‐3 . Children can also experience a range of adverse treatment effects that compromise their physical function 2,4‐7 . These adverse effects, in addition to reduced levels of physical activity, have implications for their development and their health and well‐being.…”

The Role of Exercise in Pediatric and Adolescent Cancers: A Review of Assessments and Suggestions for Clinical Implementation

“…As a result of the numerous LAE related to pediatric cancer treatment, an interest in using exercise as a therapeutic measure to attenuate or reverse many cancer-related LAE in the pediatric population has surfaced. While comparatively less studied, the research suggests that there is a positive effect of physical activity on organ system function, fatigue, and physical well-being in children during and after cancer treatment [39][40][41][42][43][44][45][46][47][48][49]. It is clear that children who exercise can increase aerobic fitness and strength, with the latter a result of neuromuscular adaptations rather than skeletal muscle hypertrophy.…”