Physical performance limitations in adolescent and adult survivors of childhood cancer and their siblings

Abstract

Purpose: This study investigates physical performance limitations for sports and daily activities in recently diagnosed childhood cancer survivors and siblings.

Methods: The Swiss Childhood Cancer Survivor Study sent a questionnaire to all survivors (≥ 16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2003 aged <16 years. Siblings received similar questionnaires. We assessed two types of physical performance limitations: 1) limitations in sports; 2) limitations in daily activities (using SF-36 physical function score). We compared results between survivors diagnosed before and after 1990 and determined predictors for both types of limitations by multivariable logistic regression.

Results: The sample included 1038 survivors and 534 siblings. Overall, 96 survivors (9.5%) and 7 siblings (1.1%) reported a limitation in sports (Odds ratio 5.5, 95%CI 2.9-10.4, p<0.001), mainly caused by musculoskeletal and neurological problems. Findings were even more pronounced for children diagnosed more recently (OR 4.8, CI 2.4-9.6 and 8.3, CI 3.7-18.8 for those diagnosed <1990 and ≥ 1990, respectively; p=0.025). Mean physical function score for limitations in daily activities was 49.6 (CI 48.9-50.4) in survivors and 53.1 (CI 52.5-53.7) in siblings (p<0.001). Again, differences tended to be larger in children diagnosed more recently. Survivors of bone tumors, CNS tumors and retinoblastoma and children treated with radiotherapy were most strongly affected.

Conclusion: Survivors of childhood cancer, even those diagnosed recently and treated with modern protocols, remain at high risk for physical performance limitations. Treatment and follow-up care should include tailored interventions to mitigate these late effects in high-risk patients.

Conflict of interest statement

Competing Interests: The governemental bodies (Schweizerische Konferenz der kantonalen Gesundheitsdirektorinnen und-direktoren), non-governemental organizations and charities (the Swiss Paediatric Oncology Group, Kinderkrebshilfe Schweiz, Stiftung für krebskranke Kinder Regio Basiliensis) and commercial funders of the Swiss Childhood Cancer Registry (Novartis Oncology Switzerland, Interpharma, Axa Wintherthur, Glaxo Smithkline, Amgen and Bristol Myers Squibb) support the daily running of the registry and have not had and will not have any role in the design, conduct, interpretation or publication of the Swiss Childhood Cancer Registry itself as well as the related research projects. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Limitations in sports (proportions) and daily activities (mean SF-36 physical function score) by type of diagnosis.

aDiagnosis is classified according to the International Classification of Childhood Cancer – third edition . Abbreviations: CNS, Central Nervous System. Figure 1A shows the proportion of survivors reporting a limitation for sporting activities within each diagnostic group. The dotted line indicates the proportion in the sibling controls. Figure 1B shows limitations for daily activities (mean scores of the physical function score from the SF-36) stratified by type of diagnosis. Lower scores indicate increased limitations for daily tasks such as walking fast, carry heavy things, move a table, carry grocery bags, climbing stairs, bending down, walking a certain distance, bathing and clothing. The dotted line indicates the mean score of the sibling controls.