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Cardiorespiratory fitness and physical function in children with cancer from diagnosis throughout treatment
Troels Thorsteinsson1, Hanne Baekgaard Larsen1, Kjeld Schmiegelow1,2
1Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Pediatric cancer patients show significantly reduced physical fitness and function during and after treatment. Strenuous exercise and testing are safe and feasible interventions for these children.
Area of Science:
- Pediatric Oncology
- Rehabilitation Medicine
- Exercise Physiology
Background:
- Children undergoing cancer treatment experience significant declines in physical fitness and functionality.
- These reductions in physical capacity can negatively impact their quality of life.
- Early assessment and intervention are crucial for improving outcomes in pediatric cancer patients.
Purpose of the Study:
- To assess the physical capacity and functionality of children with cancer during and after treatment.
- To evaluate the feasibility of a physical activity intervention program for children with cancer.
- To provide data for the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer (ReSPECT) study.
Main Methods:
- Seventy-five children with pediatric cancer or Langerhans cell histiocytosis treated with chemotherapy were included.
- Physical capacity was measured through tests of strength, balance, and cardiorespiratory fitness at diagnosis, 3 and 6 months post-diagnosis, and 1 year post-treatment.
- Feasibility of the physical activity intervention was assessed using established healthcare intervention reporting criteria.
Main Results:
- All participants completed the physical intervention program without dropouts, indicating high feasibility.
- Strenuous physical exercise and testing were found to be safe, with only minor adverse events.
- Children with cancer demonstrated significantly lower cardiorespiratory fitness compared to healthy peers at all measured time points, with a pronounced decline in physical function.
Conclusions:
- Performing strenuous physical exercise and testing during pediatric cancer treatment is safe and feasible.
- Children with cancer exhibit significantly impaired physical capacity and functionality compared to healthy, age-matched children.
- The findings support the integration of physical activity interventions into the care of children with cancer.
Background:
Children with cancer experience severe reductions in physical fitness and functionality during and following intensive treatment. This may negatively impact their quality of life.
Purpose:
To describe the physical capacity and functionality of children with cancer during and after treatment as well as the feasibility of physical activity intervention in the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer study.
Patients And Methods:
The study included children diagnosed from January 2013 to April 2016 with paediatric cancer or Langerhans cell histiocytosis, all treated with chemotherapy. Seventy-five of 78 consecutively eligible children (96.2%) were included. Median age was 11 years (range 6‒18). The physical capacity and function were assessed based on testing of physical strength, balance and cardiorespiratory fitness. Children were tested at diagnosis, 3 and 6 months after diagnosis and 1 year after cessation of treatment. The feasibility evaluation was inspired by the criteria for reporting the development and evaluation of complex interventions in healthcare.
Results:
All children participated in the physical intervention programme with no dropouts. Strenuous physical exercise and physiological testing during paediatric cancer treatment was safe and feasible, with only five minor adverse events during the intervention. Cardiorespiratory fitness was significantly lower in children with cancer than norms for healthy age-matched children at diagnosis (difference 19.1 mL/kg/min, 95% CI 15.4 to 22.7; p <0.0001), during treatment 3 and 6 months from diagnosis (difference 21.0 mL/kg/min, 95% CI 17.4 to 24.6; p <0.0001 and difference 21.6 mL/kg/min, 95% CI 17.3 to 25.8; p <0.0001, respectively) and 1 year after cessation of treatment (difference 6.9 mL/kg/min, 95% CI 1.1 to 12.7; p <0.0072). Furthermore, children with cancer experienced a pronounced decline in physical function.
Conclusion:
This study shows that it is safe and feasible to perform strenuous physical exercise and testing during paediatric cancer treatment and that children with cancer have significantly lower physical capacity and functionality than healthy age-matched norms.
Trial Registration Number:
ClinicalTrials.gov: NCT01772862.
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