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Velentza L, Filis P, Wilhelmsson M, Kogner P, Herold N, Sävendahl L. Bone Mineral Density in Survivors of Childhood Cancer: A Meta-Analysis. Pediatrics 2024; 154:e2024066081. [PMID: 39076127 DOI: 10.1542/peds.2024-066081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 07/31/2024] Open
Abstract
CONTEXT There is an increasing population of childhood cancer survivors (CCS) at risk for treatment-related toxicities, including skeletal morbidities. Bone mineral density (BMD) is a proxy for bone health and reductions are associated with osteoporosis and fractures. OBJECTIVE To investigate bone health in CCS by conducting a systematic review and meta-analysis of BMD after completed treatments. DATA SOURCES We searched Medline, Embase, Cochrane, and Web of Science in May 2019 and updated in May 2023. STUDY SELECTION Studies reporting BMD Z-scores measured with dual-energy x-ray absorptiometry in CCS after treatment completion. DATA EXTRACTION We performed a pooled analysis of studies reporting BMD Z-scores and thereafter we analyzed studies comparing BMD in survivors and healthy controls. All analyses were performed based on the site of BMD measurement. RESULTS Of 4243 studies, 84 were included (N = 8106). The mean time off-treatment across the studies ranged from 2 months to 24 years. The overall pooled mean Z-score was -0.57 (95% confidence interval [CI] -0.59 to -0.55) in the whole-body, -0.84 (95% CI -0.86 to -0.83) in the lumbar spine, -0.79 (95% CI -0.81 to -0.77) in the femoral neck and -0.14 (95% CI -0.18 to -0.11) in the total hip. When comparing survivors with controls, BMD was significantly lower in survivors at all sites. LIMITATIONS English publications, study-level meta-analysis. CONCLUSIONS We showed a significant reduction of BMD Z-scores in CCS. Given the increased fracture risk already within -1 SD, these results emphasize the need for BMD surveillance and secondary prevention in CCS.
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Affiliation(s)
- Lilly Velentza
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Panagiotis Filis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Mari Wilhelmsson
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Per Kogner
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Nikolas Herold
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Sävendahl
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Marmol-Perez A, Gil-Cosano JJ, Ubago-Guisado E, Llorente-Cantarero FJ, Pascual-Gázquez JF, Ness KK, Martinez-Vizcaino V, Ruiz JR, Gracia-Marco L. Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The iBoneFIT project. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:419-427. [PMID: 38219958 PMCID: PMC11117007 DOI: 10.1016/j.jshs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density (aBMD). However, the prevalence of muscle strength deficits is not well documented, and the associations of muscle strength with aBMD are unknown in this population. Therefore, this study aimed to investigate the prevalence of upper- and lower-body muscle strength deficits and to examine the associations of upper- and lower-body muscle strength with age-, sex, and race-specific aBMD Z-scores at the total body, total hip, femoral neck, and lumbar spine. METHODS This cross-sectional study included 116 pediatric cancer survivors (12.1 ± 3.3 years old, mean ± SD; 42.2% female). Upper- and lower-body muscle strength were assessed by handgrip and standing long jump test, respectively. Dual‑energy X‑ray absorptiometry was used to measure aBMD (g/cm2). Associations between muscle strength and aBMD were evaluated in multivariable linear regression models. Logistic regression was used to evaluate the contribution of muscle strength (1-decile lower) to the odds of having low aBMD (Z-score ≤ 1.0). All analyses were adjusted for time from treatment completion, radiotherapy exposure, and body mass index. RESULTS More than one-half of survivors were within the 2 lowest deciles for upper- (56.9%) and lower- body muscle strength (60.0%) in comparison to age- and sex-specific reference values. Muscle strength deficits were associated with lower aBMD Z-scores at all sites (B = 0.133-0.258, p = 0.001-0.032). Each 1-decile lower in upper-body muscle strength was associated with 30%-95% higher odds of having low aBMD Z-scores at all sites. Each 1-decile lower in lower-body muscle strength was associated with 35%-70% higher odds of having low aBMD Z-scores at total body, total hip, and femoral neck. CONCLUSION Muscle strength deficits are prevalent in young pediatric cancer survivors, and such deficits are associated with lower aBMD Z-scores at all sites. These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.
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Affiliation(s)
- Andres Marmol-Perez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jose J Gil-Cosano
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Department of Communication and Education, Loyola University Andalusia, Seville 41704, Spain
| | - Esther Ubago-Guisado
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Biosanitary Research Institute, ibs.Granada, Granada 18012, Spain
| | - Francisco J Llorente-Cantarero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba 14004, Spain; CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid 28029, Spain; Department of Specific Didactics, Faculty of Education, University of Cordoba, Cordoba 14071, Spain
| | - Juan Francisco Pascual-Gázquez
- Pediatric and adolescent hematology and oncology service, Pediatrics and Pediatric Surgery Clinical Management Unit, Virgen de las Nieves University Hospital, Granada 18014, Spain
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Jonatan R Ruiz
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Biosanitary Research Institute, ibs.Granada, Granada 18012, Spain; CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid 28029, Spain
| | - Luis Gracia-Marco
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18011, Spain; Biosanitary Research Institute, ibs.Granada, Granada 18012, Spain; CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid 28029, Spain.
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Marmol-Perez A, Ubago-Guisado E, Llorente-Cantarero FJ, Vlachopoulos D, Rodriguez-Solana A, Gil-Cosano JJ, Ruiz JR, Gracia-Marco L. Determinants of bone parameters in young paediatric cancer survivors: the iBoneFIT project. Pediatr Res 2023; 94:1538-1546. [PMID: 37202528 DOI: 10.1038/s41390-023-02645-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Bone health is remarkably affected by endocrine side effects due to paediatric cancer treatments and the disease itself. We aimed to provide novel insights into the contribution of independent predictors of bone health in young paediatric cancer survivors. METHODS This cross-sectional multicentre study was carried out within the iBoneFIT framework in which 116 young paediatric cancer survivors (12.1 ± 3.3 years old; 43% female) were recruited. The independent predictors were sex, years from peak height velocity (PHV), time from treatment completion, radiotherapy exposure, region-specific lean and fat mass, musculoskeletal fitness, moderate-vigorous physical activity and past bone-specific physical activity. RESULTS Region-specific lean mass was the strongest significant predictor of most areal bone mineral density (aBMD), all hip geometry parameters and Trabecular Bone Score (β = 0.400-0.775, p ≤ 0.05). Years from PHV was positively associated with total body less head, legs and arms aBMD, and time from treatment completion was also positively associated with total hip and femoral neck aBMD parameters and narrow neck cross-sectional area (β = 0.327-0.398, p ≤ 0.05; β = 0.135-0.221, p ≤ 0.05), respectively. CONCLUSION Region-specific lean mass was consistently the most important positive determinant of all bone parameters, except for total hip aBMD, all Hip Structural Analysis parameters and Trabecular Bone Score. IMPACT The findings of this study indicate that region-specific lean mass is consistently the most important positive determinant of bone health in young paediatric cancer survivors. Randomised clinical trials focused on improving bone parameters of this population should target at region-specific lean mass due to the site-specific adaptations of the skeleton to external loading following paediatric cancer treatment. After paediatric cancer diagnosis, years from peak height velocity (somatic maturity) is critical for bone development.
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Affiliation(s)
- Andres Marmol-Perez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain.
| | - Francisco J Llorente-Cantarero
- Instituto de Investigación Biomédica Maimonides (IMIBIC), Córdoba, España
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Didácticas Específicas, Facultad de Educación, Universidad de Córdoba, Córdoba, España
| | - Dimitris Vlachopoulos
- Centro de Investigación sobre Ejercicio y Salud Infantil, Universidad de Exeter, Exeter, UK
| | - Andrea Rodriguez-Solana
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Jose J Gil-Cosano
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - Jonatan R Ruiz
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Gracia-Marco
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Zang W, Fang M, Chen H, Huang X, Li D, Yan J, Shu H, Zhao M. Effect of concurrent training on physical performance and quality of life in children with malignancy: A systematic review and meta-analysis. Front Public Health 2023; 11:1127255. [PMID: 37006540 PMCID: PMC10063894 DOI: 10.3389/fpubh.2023.1127255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveThis study aims to evaluate the intervention effect of concurrent training on children with malignant tumors to provide evidence for prescribing exercise for children with malignant tumors.MethodsTwelve databases were searched from inception to October 15, 2022. Two researchers independently screened the literature, evaluated the quality, extracted the data, and performed the meta-analysis using R.ResultA total of nine randomized controlled trials involving 371 children were included in this study. The meta-analysis revealed that muscle strength was significantly greater in the exercise group compared to the usual care group [SMD = 0.26, 95% CI (0.04, 0.48), P = 0.023], with subgroup analysis showing no significant difference in upper limb [SMD = 0.13, 95% CI (−0.17, 0.43), P = 0.318] and a considerable difference in lower limb strength [SMD = 0.41, 95% CI (0.08, 0.74), P = 0.015]. Physical activity [SMD = 0.57, 95% CI (0.03, 1.1), P = 0.038], timed up and down stairs test [SMD = −1.22, 95% CI (−2.04, −0.4), P = 0.004], 6-min walking ability [SMD = 0.75, 95% CI (0.38, 1.11), P < 0.01], quality of life [SMD = 0.28, 95% CI (0.02, 0.53), P = 0.033], and cancer-related fatigue [SMD = −0.53, 95% CI (−0.86, −0.19), P = 0.002] were significantly better than the usual care group. There were no significant differences in peak oxygen uptake [SMD = 0.13, 95% CI (−0.18, 0.44), P = 0.397], depression [SMD = 0.06, 95% CI (−0.38, 0.5), P = 0.791], and withdrawal rates [RR = 0.59, 95% CI (0.21, 1.63), P = 0.308] between the two groups.ConclusionConcurrent training could improve physical performance for children with malignancy but had no significant effect on mental health. Because the quality level of evidence is mostly very low, future high-quality randomized controlled trials are required to confirm these findings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364140, identifier CRD42022308176.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - Haohao Chen
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Xinmeng Huang
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Dong Li
- Department of International Culture Education, Chodang University, Muan-gun, Republic of Korea
| | - Jin Yan
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
- College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
| | - Heng Shu
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingyuan Zhao
- Winter Olympic School, Harbin Sport University, Harbin, China
- *Correspondence: Mingyuan Zhao
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Marmol-Perez A, Ubago-Guisado E, Rodriguez-Solana A, Gil-Cosano JJ, Martinez-Vizcaino V, Cavero-Redondo I, Ruiz JR, Gracia-Marco L. Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis. Front Physiol 2023; 14:1088740. [PMID: 37035662 PMCID: PMC10081564 DOI: 10.3389/fphys.2023.1088740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions.Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment.Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1–19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.Results: A total of eight trials with 341 participants were included. The meta-analyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: −0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: −0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: −0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: −0.17, 0.25) and after the ES was 0.07 (95%CI: −0.20, 0.33).Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment.Systematic Review Registration: PROSPERO registration number: CRD42022310876
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Affiliation(s)
- Andres Marmol-Perez
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- *Correspondence: Esther Ubago-Guisado,
| | - Andrea Rodriguez-Solana
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Jose J. Gil-Cosano
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Communication and Education, Universidad Loyola Andalucía, Sevilla, Spain
| | - Vicente Martinez-Vizcaino
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Ivan Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Jonatan R. Ruiz
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Gracia-Marco
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Rapti C, Dinas PC, Chryssanthopoulos C, Mila A, Philippou A. Effects of Exercise and Physical Activity Levels on Childhood Cancer: An Umbrella Review. Healthcare (Basel) 2023; 11:healthcare11060820. [PMID: 36981477 PMCID: PMC10048410 DOI: 10.3390/healthcare11060820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Patients and survivors of childhood cancer experience adverse effects related to the disease and its treatment. These adverse effects are associated with both physiological and psychological health. Exercise helps manage the side effects and improve the health outcomes. The objective of this umbrella review is to search the current literature in the context of exercise and physical activity as complementary interventions on pediatric cancer and to provide comprehensive information about the derived health outcomes. A literature search was conducted on the Cochrane, PubMed, and Embase databases for systematic reviews published up to January 2023. Moreover, a hand search of reference lists was performed. We included participants under 19 years of age at diagnosis of any type of childhood cancer, without restriction on the type or phase of treatment, who participated in exercise interventions. The results showed a beneficial impact on fatigue, muscle strength, aerobic capacity, activity and participation levels, psychosocial health, cardiovascular/cardiorespiratory fitness, physical function, bone mineral density, and brain volume and structure, with limited and not serious adverse effects. These findings documented that exercise interventions had a positive effect on many physiological and psychological health outcomes in pediatric cancer patients and survivors.
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Affiliation(s)
- Christina Rapti
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros C. Dinas
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Costas Chryssanthopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexandra Mila
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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Ciancia S, Högler W, Sakkers RJB, Appelman-Dijkstra NM, Boot AM, Sas TCJ, Renes JS. Osteoporosis in children and adolescents: how to treat and monitor? Eur J Pediatr 2023; 182:501-511. [PMID: 36472650 DOI: 10.1007/s00431-022-04743-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED Osteoporosis is a condition of increased bone fragility associated with fractures. Apart from primary genetic osteoporotic conditions, secondary osteoporosis in children is being increasingly recognized. As a result, there is growing interest in its prevention and treatment. Important goals of care are to prevent fractures, increase bone mass and trabecular and cortical thickness, reshape vertebral fractures, prevent (or correct) skeletal deformities, and improve mobility, independence, and quality of life. Secondary pediatric osteoporosis is often of multifactorial origin since affected children frequently have more than one acquired factor that is detrimental to bone health. Typical conditions causing osteoporosis are leukemias, progressive muscle or neurological disorders, as well as chronic inflammatory conditions and their treatment. Management of children with osteoporosis involves a multidisciplinary team involving pediatric experts from different subspecialties. With regard to prevention and early intervention, it is important to provide optimal management of any underlying systemic conditions including avoidance, or dose-reduction, of osteotoxic medications. Basic supporting life-style measures, such as appropriate nutrition, including adequate calcium intake and vitamin D, and physical activity are recommended, where possible. When pediatric treatment criteria for osteoporosis are met, antiresorptive drugs constitute the first pharmacological line treatment. CONCLUSION This clinical review focuses on the prevention, treatment, and follow-up of children with, or at risk of developing, osteoporosis and the transition from pediatric to adult care. WHAT IS KNOWN • Osteoporosis and associated fractures can cause significant morbidity and reduce the quality of life. • The developing skeleton has huge potential for recovery and reshaping, thus early detection of fractures, assessment of recovery potential, and treatment of children with osteoporosis can prevent future fractures, deformities, and scoliosis, improve function and mobility, and reduce pain. WHAT IS NEW • Osteoporosis in children and adolescents requires a multidisciplinary approach with a thorough assessment of recovery potential, and indication for therapy should be personalized. • Although bisphosphonates still represent the drug most commonly used to increase bone mass, improve mobility, and reduce pain and recurrence of fractures, new agents are being developed and could be beneficial in children with specific conditions.
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Affiliation(s)
- Silvia Ciancia
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Ralph J B Sakkers
- Department of Orthopedic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Subdivision of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke M Boot
- Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, Beatrix Childrens Hospital, University of Groningen, Groningen, The Netherlands
| | - Theo C J Sas
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands
| | - Judith S Renes
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,Dutch Growth Research Foundation, Rotterdam, The Netherlands
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Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:47-58. [PMID: 36309037 DOI: 10.1016/s2352-4642(22)00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. METHODS In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. FINDINGS We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. INTERPRETATION There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. FUNDING Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. COPYRIGHT © 2022 Published by Elsevier Ltd. All rights reserved.
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9
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Van der Looven R, De Vos E, Vandekerckhove K, Coomans I, Laureys G, Dhooge C. Efficacy of interdisciplinary rehabilitation in child cancer survivors: Impact on physical fitness, fatigue and body composition after 1-year follow-up. Eur J Cancer Care (Engl) 2022; 31:e13761. [PMID: 36330596 DOI: 10.1111/ecc.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Childhood cancer survivors experience reduced physical activity level, participation as well as health-related quality of life. This prospective, pre-/post-intervention and follow-up cohort study aims to determine the efficacy of an interdisciplinary rehabilitation on improving physical fitness, fatigue and body composition. METHODS A total of 24 childhood cancer survivors (mean age: 12.15 years ± 3.2; 14 females; 10 males) were recruited 6 months after medical treatment and received a 4-month interdisciplinary intervention. Cardiorespiratory fitness (PredVO2peak and PredLoadmax ), body composition (dry lean weight) and quality of life (general fatigue) were assessed at baseline, post-intervention and 1-year follow-up. Linear mixed models were used to analyse data. RESULTS Linear mixed modelling revealed a significant main effect of time on predicted maximal load (F = 13.189, df = 36.179, p < 0.001), dry lean weight (F = 64.813, df = 37.019, p < 0.001) but also significant improvement of general fatigue score (-9.039 ± 4.300, 95% CI -17.741 to -0.336, p = 0.042), indicating a decline in general fatigue. CONCLUSION With emerging evidence that physical activity is safe and feasible, together with increasing numbers of childhood cancer survivors at risk for long-term chronic co-morbidities, this study advocates for better access to interdisciplinary rehabilitation programmes in order to improve their physical condition and their body composition and reduce fatigue.
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Affiliation(s)
- Ruth Van der Looven
- Child Rehabilitation Centre, Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Elise De Vos
- Child Rehabilitation Centre, Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Geneviève Laureys
- Department of Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Catharina Dhooge
- Department of Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
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10
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Kim Y, Chae H, Park SJ. Feasibility and benefits of a videoconferencing-based home exercise programme for paediatric cancer survivors during the coronavirus disease 2019 pandemic. Eur J Cancer Care (Engl) 2022; 31:e13624. [PMID: 35606331 PMCID: PMC9347713 DOI: 10.1111/ecc.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/17/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
Objective We aimed to determine the feasibility and benefits of a videoconferencing‐based home exercise programme to improve health‐related quality of life (HRQOL), posttraumatic growth and physical strength levels of paediatric cancer survivors during the coronavirus disease 2019 (COVID‐19). Methods Eight paediatric cancer survivors participated in the intervention for 8 weeks. The programme comprised home exercise sessions administered using Zoom, a videoconferencing platform. The supervised exercise sessions were performed two times per week; the participants were taught to perform joint exercises at home for the remaining 5 days of the week. HRQOL, posttraumatic growth and physical strength levels were assessed at baseline and after the intervention. Results The rates of recruitment, retention and attendance were 52.9%, 88.9% and 98.4%, respectively. There were no cases of adverse events. The programme significantly improved flexibility (z = −2.21, p = 0.03), muscle strength (z = −2.67, p = 0.01) and power (z = −2.41, p = 0.02) among five domains of physical fitness measured using a physical activity promotion system and also improved total physical strength (z = −2.67, p = 0.01). Posttraumatic growth decreased slightly, whereas HRQOL improved slightly; however, the change was not statistically significant. Conclusion The study findings present preliminary evidence of the feasibility and benefits of this videoconferencing‐based home exercise programme among paediatric cancer survivors.
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Affiliation(s)
- Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Heemin Chae
- Department of Nursing, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Sung Je Park
- College of sport science, Chung-Ang University, Anseong, South Korea
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11
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Smith C, Farhat R, Fern-Buneo A, Purrington H, Cobb E, Matson L, Kang P, Beebe K, Campbell C, Schwalbach C, Salzberg D, Miller H, Adams R, Ngwube A. Effects of an exercise program during pediatric stem cell transplantation: A randomized controlled trial. Pediatr Blood Cancer 2022; 69:e29618. [PMID: 35195344 DOI: 10.1002/pbc.29618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND During pediatric hematopoietic stem cell transplant (HSCT), there is significant reduction in physical activity, leading to loss of strength and function, along with decline in quality of life (QoL). This study evaluates the effects of a supervised exercise program on functional ability, mobility, strength, and QoL during and following pediatric HSCT. METHODS Patients ages 4-21 years presenting for HSCT were randomized to either an intervention group, who underwent exercise routines three times weekly and once weekly on discharge for 6 weeks supervised by a physical therapist, or the control group, which was treated per standard of care. Forty subjects were recruited for the study, 20 in each arm. Physical therapy and QoL assessments were conducted at three time points: pre-HSCT (baseline), on the day of hospital discharge, and 6 weeks after discharge. RESULTS Exercise capacity and endurance using Six-Minute Walk test (p = .023) and strength using manual muscle testing (p = .005) were improved in the exercise group, compared to the control group. There was evidence that some QoL outcomes (measured using the Patient Reported Outcomes Measurement Information System) were improved 6 weeks post discharge, with observed decreases in anxiety (p = .0009) and fatigue (p = .037). CONCLUSION Supervised exercise program during pediatric HSCT has positive effects on endurance, functional mobility, and muscle strength, and may also result in improvements in some aspects of QoL. This trial was registered at www. CLINICALTRIALS gov as NCT04663503.
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Affiliation(s)
- Charles Smith
- Department of child health, The University of Arizona, College of Medicine, Phoenix, Arizona, USA
| | - Ryan Farhat
- Department of child health, The University of Arizona, College of Medicine, Phoenix, Arizona, USA
| | - Anna Fern-Buneo
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Heidi Purrington
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Ellie Cobb
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Laura Matson
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Paul Kang
- Department of child health, The University of Arizona, College of Medicine, Phoenix, Arizona, USA
| | - Kristen Beebe
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Courtney Campbell
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Charlotte Schwalbach
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Dana Salzberg
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Holly Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Roberta Adams
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Alexander Ngwube
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
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Söntgerath R, Däggelmann J, Kesting SV, Rueegg CS, Wittke TC, Reich S, Eckert KG, Stoessel S, Chamorro-Viña C, Wiskemann J, Wright P, Senn-Malashonak A, Oschwald V, Till AM, Götte M. Physical and functional performance assessment in pediatric oncology: a systematic review. Pediatr Res 2022; 91:743-756. [PMID: 33859367 PMCID: PMC9064803 DOI: 10.1038/s41390-021-01523-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Research indicates reduced physical performance from diagnosis into survivorship of pediatric cancer patients. However, there is no systematic information or guideline available on the methods to assess physical performance and function in this population. The purpose was to systematically compile and describe assessments of physical performance and function in patients and survivors of pediatric cancer, including cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait and motor performance test batteries. METHODS We searched the databases PubMed, SPORTDiscus, and Cochrane Database and performed abstract and full-text selection of 2619 articles according to the Cochrane Handbook of Systematic Reviews. Information on patients characteristics, assessments, information on validity and reliability, and relevant references was extracted. RESULTS In summary, 63 different assessments were found in 149 studies including 11639 participants. Most studies evaluated cardiorespiratory fitness and muscle strength with the majority conducted off treatment. Some outcomes (e.g. speed) and diagnoses (e.g. neuroblastoma) were severely underrepresented. With the exception of gait, leukemia patients represented the largest group of individuals tested. CONCLUSIONS Insufficient data and patient heterogeneity complicate uniform recommendations for assessments. Our results support researchers and practitioners in selecting appropriate assessment to meet their specific research questions or individual daily practice needs. IMPACT This systematic review includes 149 studies and provides a comprehensive summary of 63 assessments to evaluate cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait or motor performance test batteries in patients and survivors of pediatric cancer. We present the most studied fields within the pediatric cancer population, which are cardiorespiratory fitness and muscle strength, off treatment phase, and leukemia patients. We propose research priorities by identification of subgroups in terms of cancer type, phase of treatment, and outcome of interest that are underrepresented in studies currently available.
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Affiliation(s)
- Regine Söntgerath
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Däggelmann
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Sabine V Kesting
- Institute of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Kinderklinik München Schwabing, TUM School of Medicine, Department of Pediatrics and Children's Cancer Research Center, Technical University of Munich, Munich, Germany
| | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Simon Reich
- Working Group Exercise Oncology Division of Medical Oncology, University Clinic Heidelberg and National Centre for Tumor Diseases (NCT), Heidelberg, Germany
| | - Katharina G Eckert
- Department of Health Management & Public Health, IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Sandra Stoessel
- Center for Pediatric and Adolescent Medicine, Childhood Cancer Center, University Medical Center Mainz, Mainz, Germany
| | | | - Joachim Wiskemann
- Working Group Exercise Oncology Division of Medical Oncology, University Clinic Heidelberg and National Centre for Tumor Diseases (NCT), Heidelberg, Germany
| | - Peter Wright
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Anna Senn-Malashonak
- Department of Pediatric Oncology, Hematology and Hemostaseology, Goethe University Clinic Frankfurt, Frankfurt am Main, Frankfurt, Germany
| | - Vanessa Oschwald
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Anne-Marie Till
- Department of Pediatric Hematology and Oncology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Miriam Götte
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Pediatrics III, Essen, Germany.
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13
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Pugh G, Petrella A, Pabary A, Cross A, Hough R, Soanes L, Sabiston C, Fisher A. Health Professionals' Views on Lifestyle Advice Delivery to Teenage and Young Adult Cancer Patients: A Qualitative Study. Cancer Nurs 2022; 45:E238-E245. [PMID: 33252408 DOI: 10.1097/ncc.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many health professionals working with teenage and young adult cancer patients (TYA-HPs) do not provide advice on physical activity, dietary intake, smoking cessation, and alcohol consumption as part of routine cancer care. OBJECTIVE The aim of this study was to understand TYA-HPs' perspectives on the provision of health behavior advice and preferences on an intervention to help develop their health promotion skills. METHODS In-depth, semistructured interviews were conducted with 26 TYA-HPs (12 nurses, 8 clinicians, and 6 allied health professionals) whose average time working with teenage and young adult (TYA) cancer patients was 8 years. Each interview followed the same semistructured guide, which was based upon constructs of the COM-B model of behavior change (capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation), transcribed verbatim, and analyzed using the Framework analysis. RESULTS Overall, TYA-HPs recognized the value and importance of promoting health behaviors but felt that their capability to provide health behavior advice was limited by the availability of, and access to, good-quality evidence linking health behavior to cancer outcomes. The TYA-HPs expressed confusion over professional responsibility to provide choices. CONCLUSIONS The TYA-HPs recognize health behavior promotion to be a core part of TYA cancer care but feel ill-equipped to provide such advice to patients. IMPLICATIONS FOR PRACTICE Mapped to constructs of the COM-B model of behavior, these findings suggest that TYA-HPs would benefit from cross-multidisciplinary team support for improved access to TYA-specific resources covering key health behaviors and skills-based training on delivering lifestyle advice.
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Affiliation(s)
- Gemma Pugh
- Author Affiliations: Centre for Sports & Exercise Medicine, Queen Mary University of London, London, United Kingdom (Dr Pugh and Mr Pabary); Department of Behavioural Science & Health, University College London, London, United Kingdom (Dr Pugh, Mr Cross, and Dr Fisher); Faculty of Kinesiology & Physical Education, University of Toronto (Dr Petrella and Dr Sabiston); Teenage and Young Adult Cancer Services, United Kingdom (Dr Soanes), University College London Hospital (Dr Hough)
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van Atteveld JE, Mulder RL, van den Heuvel-Eibrink MM, Hudson MM, Kremer LCM, Skinner R, Wallace WH, Constine LS, Higham CE, Kaste SC, Niinimäki R, Mostoufi-Moab S, Alos N, Fintini D, Templeton KJ, Ward LM, Frey E, Franceschi R, Pavasovic V, Karol SE, Amin NL, Vrooman LM, Harila-Saari A, Demoor-Goldschmidt C, Murray RD, Bardi E, Lequin MH, Faienza MF, Zaikova O, Berger C, Mora S, Ness KK, Neggers SJCMM, Pluijm SMF, Simmons JH, Di Iorgi N. Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Diabetes Endocrinol 2021; 9:622-637. [PMID: 34339631 PMCID: PMC8744935 DOI: 10.1016/s2213-8587(21)00173-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023]
Abstract
Childhood, adolescent, and young adult cancer survivors are at increased risk of reduced bone mineral density. Clinical practice surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could improve bone mineral density parameters and prevent fragility fractures. Discordances across current late effects guidelines necessitated international harmonisation of recommendations for bone mineral density surveillance. The International Late Effects of Childhood Cancer Guideline Harmonization Group therefore established a panel of 36 experts from ten countries, representing a range of relevant medical specialties. The evidence of risk factors for very low and low bone mineral density and fractures, surveillance modality, timing of bone mineral density surveillance, and treatment of very low and low bone mineral density were evaluated and critically appraised, and harmonised recommendations for childhood, adolescent, and young adult cancer survivors were formulated. We graded the recommendations based on the quality of evidence and balance between potential benefits and harms. Bone mineral density surveillance is recommended for survivors treated with cranial or craniospinal radiotherapy and is reasonable for survivors treated with total body irradiation. Due to insufficient evidence, no recommendation can be formulated for or against bone mineral density surveillance for survivors treated with corticosteroids. This surveillance decision should be made by the survivor and health-care provider together, after careful consideration of the potential harms and benefits and additional risk factors. We recommend to carry out bone mineral density surveillance using dual-energy x-ray absorptiometry at entry into long-term follow-up, and if normal (Z-score > -1), repeat when the survivor is aged 25 years. Between these measurements and thereafter, surveillance should be done as clinically indicated. These recommendations facilitate evidence-based care for childhood, adolescent, and young adult cancer survivors internationally.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Sue C Kaste
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathalie Alos
- Department of Pediatrics, Endocrinology Division, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Danilo Fintini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Eva Frey
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Vienna, Austria
| | | | - Vesna Pavasovic
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Seth E Karol
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nadia L Amin
- Department of Paediatric Haematology, Leeds Children's Hospital, Leeds, UK
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, and Boston Children's Hospital, Boston, MA, USA
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Demoor-Goldschmidt
- INSERM U1018, Paris-Sud XI University, Paris-Saclay University, Centre for Research in Epidemiology and Population Health, Cancer & Radiations Group, Gustave Roussy Cancer Campus, Villejuif, France; Department of Pediatric Onco-hematology, CHU Angers, Angers, France; Department of Radiotherapy, François Baclesse Center, Caen, France
| | - Robert D Murray
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Kepler Universitätsklinikum, Linz, Austria
| | - Maarten H Lequin
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University A Moro, Bari, Italy
| | - Olga Zaikova
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Claire Berger
- Department for Pediatric Hematology and Oncology CHU Nord, University Hospital Saint-Etienne, Saint-Priest en Jarez, France; 28U1059 Sainbiose, University Jean Monnet, Saint-Etienne, France
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology and Pediatric Bone Density Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy and Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Kohler BE, Baque E, Sandler CX, Brookes DSK, Terranova CO, Rixon M, Hassall T, Trost SG. Physical ACTivity in Survivorship (PACTS): study protocol for a randomized controlled trial evaluating a goal-directed therapeutic exercise program in pediatric posterior fossa brain tumor survivors. BMC Pediatr 2021; 21:105. [PMID: 33648474 PMCID: PMC7919081 DOI: 10.1186/s12887-021-02566-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Posterior fossa brain tumors (PFBT) are the most common solid tumor in children. Recent increases in survival rates are encouraging; however, survivors may experience a plethora of disease- and treatment-related complications that can persist into adulthood. Therapeutic exercise interventions have been shown to improve quality of survivorship in other pediatric cancer diagnoses. There is also evidence that goal-directed interventions are effective at improving motor activities, function, and self-care in children with complex health conditions. Yet, there is currently no evidence on the efficacy of goal-directed therapeutic exercise in pediatric PFBT survivors. The Physical ACTivity in Survivorship (PACTS) study aims to investigate the effects of a novel goal-directed therapeutic exercise program on cardiorespiratory fitness and physical activity-related goal attainment in pediatric survivors of PFBT. METHOD PFBT survivors, aged five to 17 years, who underwent surgery at least 12 months earlier and completed radiation therapy and/or chemotherapy at least 6 months prior will be recruited from the Queensland Children's Hospital (Brisbane, Australia) (target n = 48). Following baseline assessment, participants are randomized into either the intervention or usual care group. The intervention group will receive weekly individualized, goal-directed exercise therapy delivered face-to-face for 12 weeks, along with an accompanying home-based program (three sessions per week). Outcomes will be assessed at baseline, immediately post-intervention, and at 6- and 12-months post-intervention. The primary outcomes are cardiorespiratory fitness (Peak VO2) and physical activity-related goal attainment. Secondary outcomes are cardiorespiratory endurance, high-level mobility skills, functional muscle strength, habitual physical activity, gait, balance, quality of life, fatigue, participation, perceived movement skill competence and parameters of body composition. DISCUSSION PACTS is the first study to investigate the efficacy of goal-directed therapeutic exercise in children with PFBT and provide evidence needed to inform clinical practice recommendations for managing quality of survivorship in PFBT survivors. TRIAL REGISTRATION ACTRN12619000841178 .
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Affiliation(s)
- Brooke E Kohler
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Exercise and Nutrition Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Emmah Baque
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Carolina X Sandler
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Exercise and Nutrition Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- UNSW Fatigue Research Program, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Denise S K Brookes
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Exercise and Nutrition Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Caroline O Terranova
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Exercise and Nutrition Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Matthew Rixon
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Tim Hassall
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stewart G Trost
- Institute of Health and Biomedical Innovation at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
- School of Exercise and Nutrition Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
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16
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Lago ASDD, Zaffarani C, Mendonça JFB, Moran CA, Costa D, Gomes ELDFD. Effects of physical exercise for children and adolescents undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis. Hematol Transfus Cell Ther 2020; 43:313-323. [PMID: 33288491 PMCID: PMC8446237 DOI: 10.1016/j.htct.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.
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Affiliation(s)
| | - Caroline Zaffarani
- Faculdade do Bico do Papagaio (FABIC)-Physiocursos, São Paulo, SP, Brazil
| | | | | | - Dirceu Costa
- Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Evelim Leal de Freitas Dantas Gomes
- Faculdade do Bico do Papagaio (FABIC)-Physiocursos, São Paulo, SP, Brazil; Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil; Universidade Ibirapuera (UNIB), São Paulo, SP, Brazil.
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17
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Galindo-Zavala R, Bou-Torrent R, Magallares-López B, Mir-Perelló C, Palmou-Fontana N, Sevilla-Pérez B, Medrano-San Ildefonso M, González-Fernández MI, Román-Pascual A, Alcañiz-Rodríguez P, Nieto-Gonzalez JC, López-Corbeto M, Graña-Gil J. Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children. Pediatr Rheumatol Online J 2020; 18:20. [PMID: 32093703 PMCID: PMC7041118 DOI: 10.1186/s12969-020-0411-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. METHODS An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. RESULTS Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. CONCLUSION In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future.
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Affiliation(s)
- Rocío Galindo-Zavala
- UGC Pediatría. Sección Reumatología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Rosa Bou-Torrent
- 0000 0001 0663 8628grid.411160.3Unidad de Reumatología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Berta Magallares-López
- 0000 0004 1768 8905grid.413396.aServicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Concepción Mir-Perelló
- 0000 0004 1796 5984grid.411164.7Unidad de Pediatría, Sección Reumatología Pediátrica, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Natalia Palmou-Fontana
- 0000 0001 0627 4262grid.411325.0Unidad de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Belén Sevilla-Pérez
- UGC Pediatría, Sección Reumatología Pediátrica, Hospital Campus de la Salud, Granada, Spain
| | | | - Mª. Isabel González-Fernández
- 0000 0001 0360 9602grid.84393.35Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital La Fe, Valencia, Spain
| | | | - Paula Alcañiz-Rodríguez
- Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital Virgen de la Arriaxaca, Murcia, Spain
| | - Juan Carlos Nieto-Gonzalez
- 0000 0001 0277 7938grid.410526.4Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mireia López-Corbeto
- 0000 0001 0675 8654grid.411083.fServicio de Reumatología Hospital Vall d’Hebron, Barcelona, Spain
| | - Jenaro Graña-Gil
- 0000 0004 1771 0279grid.411066.4Servicio de Reumatología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain ,Osteogenesis Imperfecta and Secondary Osteoporosis Working Group from the Spanish Pediatric Rheumatology Society, Madrid, Spain
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18
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What are the effects of exercise training in childhood cancer survivors? A systematic review. Cancer Metastasis Rev 2020; 39:115-125. [DOI: 10.1007/s10555-020-09852-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Abstract
Youth with inflammatory bowel disease (IBD) demonstrate deficits in lean mass (LM) placing them at increased risk for future health problems, including reduction of bone mass and impaired bone architecture. Research suggests that deficits in LM are multifactorial, including influences from the disease and its treatment, and health behaviors such as diet and physical activity. Based on a systematic literature review examining factors related to LM deficits in IBD, this article presents a conceptual model to explain the development of LM in youth with IBD. The model considers predictors of LM across 4 domains: demographic; medical; diet; and physical activity. Much existing research is cross-sectional, but suggests multiple factors work together to promote or inhibit LM accrual in youth with IBD. The conceptual model, developed based on empirical findings to date, can be used to understand and further elucidate the process through which LM is developed and maintained, to inform the development of empirically supported clinical interventions, and to guide future research objectives and priorities.
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20
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Aerobic exercise and cardiopulmonary fitness in childhood cancer survivors treated with a cardiotoxic agent: a meta-analysis. Support Care Cancer 2018; 26:2113-2123. [PMID: 29671063 DOI: 10.1007/s00520-018-4208-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/09/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The main purpose of this review was to synthesize evidence from existing childhood cancer survivor studies that report the effect of aerobic exercise on cardiopulmonary fitness (a marker of cardiovascular health), in survivors that were currently receiving or had been treated with a cardiotoxic agent. METHODS Studies were identified for this review by searching both electronic databases of peer-reviewed articles, as well as various sources of gray literature. Risk of bias was qualitatively assessed in these studies using the domains outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data was analyzed quantitatively using random-effects meta-analyses and subgroup analyses in RevMan Software. RESULTS Meta-analysis of pooled evidence from the nine included studies suggests that aerobic exercise has a statistically and clinically significant positive effect on cardiopulmonary fitness (effect estimate = 6.92%, p value = 0.02). Findings from subgroup analyses of clinical characteristics and exercise parameters were not significant. CONCLUSIONS The findings from this review, although not directly demonstrating a cardioprotective effect, are a preliminary step towards establishing the putative cardioprotective effect of aerobic exercise against the direct cardiotoxic impact of cancer treatments. The significant positive effect estimate in favor of aerobic exercise is a small but important advancement towards the standardization of aerobic exercise in childhood cancer survivors. Further studies are necessary.
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21
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Rath SR, Long TM, Bear NL, Miles GCP, Bullock AM, Gottardo NG, Cole CH, Naylor LH, Choong CSY. Metabolic and Psychological Impact of a Pragmatic Exercise Intervention Program in Adolescent and Young Adult Survivors of Pediatric Cancer-Related Cerebral Insult. J Adolesc Young Adult Oncol 2018; 7:349-357. [PMID: 29565763 DOI: 10.1089/jayao.2017.0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To assess metabolic function among adolescent and young adult (AYA) survivors of childhood cancer-related brain surgery or cranial irradiation (CRT) and to determine feasibility, safety, and metabolic as well as psychological impact of a 6-month exercise program in this cohort. METHODS Twenty AYAs aged 15-23 years were recruited. All had completed cancer treatment by age 15.5 and were more than 1 year after end of treatment. Metabolic function was assessed at baseline (T1), after a 6-month non-intervention period (T2), and after the 6-month intervention (T3). Psychological assessments were performed at T1 and T3. Eight to 12 months after the program (T4), its lasting impact was assessed by questionnaire. The 6-month intervention consisted of small group-based, tailored, supervised exercise sessions combining resistance and aerobic exercise. Sessions were offered up to thrice per week and adherence defined as participation in ≥24 sessions. Flexibility was built into the design with an alternative home-based program offered to those who could not attend the gymnasium. RESULTS Thirteen of the 20 recruited participants were adherent to the program. There was one fall during exercise, but no injury was sustained. Higher rates of metabolic impairment than would be expected in a healthy cohort were found at baseline both among brain tumor survivors and survivors of total body irradiation. Central adiposity reduced post-intervention (p = 0.014) and improvements in adaptive function were seen. Participants enjoyed the program, but work and study commitments limited attendance. CONCLUSION AYA survivors of childhood brain tumors and CRT should be screened for metabolic and psychological well-being. Small group-based exercise is safe, feasible, and enjoyable for this cohort and may benefit them both metabolically and psychologically. TRIAL REGISTRATION ACTRN12614000796684. Retrospectively registered July 28, 2014.
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Affiliation(s)
- Shoshana R Rath
- 1 Department of Diabetes and Endocrinology, Princess Margaret Hospital , Perth, Australia
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Treya M Long
- 3 School of Human Sciences, Exercise and Sport Science, The University of Western Australia , Perth, Australia
| | - Natasha L Bear
- 4 Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Australia
| | - Gordon C P Miles
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
| | - Andrew M Bullock
- 6 Department of Cardiology, Princess Margaret Hospital , Perth, Australia
| | - Nicholas G Gottardo
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
- 7 Telethon Kids Cancer Centre, Telethon Kids Institute , Perth, Australia
| | - Catherine H Cole
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
- 5 Department of Haematology and Oncology, Princess Margaret Hospital for Children , Perth, Australia
- 7 Telethon Kids Cancer Centre, Telethon Kids Institute , Perth, Australia
- 8 Haematology, PathWest Laboratory Services , Perth, Australia
| | - Louise H Naylor
- 3 School of Human Sciences, Exercise and Sport Science, The University of Western Australia , Perth, Australia
| | - Catherine S Y Choong
- 1 Department of Diabetes and Endocrinology, Princess Margaret Hospital , Perth, Australia
- 2 Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
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22
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Pugh G, Hough R, Gravestock H, Williams K, Fisher A. Lifestyle advice provision to teenage and young adult cancer patients: the perspective of health professionals in the UK. Support Care Cancer 2017; 25:3823-3832. [PMID: 28726067 DOI: 10.1007/s00520-017-3814-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/03/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Health professionals are an important source of information for teenage and young adult (TYA) cancer patients. However, little is known about health professionals' provision of lifestyle advice to young people with cancer who are in their care. METHODS An online survey was distributed to health professionals within the UK who identified themselves as working with TYA cancer patients. Health professional awareness of lifestyle guidance, provision of lifestyle advice to young people and views on lifestyle information format and delivery were explored. RESULTS Ninety-five health professionals (44% nurses; 28% allied health professionals; 17% physicians) completed the survey. The majority (72%) of respondents were aware of some lifestyle guidance for cancer patients. However, less than half of TYA health professionals (46%) were able to successfully recall the source of the guidelines and less than a third reported proving specific advice to the majority of their patients on weight management, smoking, alcohol consumption and sun safety. Many health professionals (38%) felt that they were not the right person to provide advice and cited lack of resources as a key barrier to advice provision. The majority (95%) reported being interested in a resource containing relevant lifestyle information that could be given to young people with cancer. CONCLUSIONS TYA health professionals' awareness of lifestyle guidance and provision of advice regarding health behaviour is sub-optimal. Clear and comprehensive guidance written specifically for TYA health professionals could overcome the reported barriers and improve professionals' confidence in addressing and providing advice on lifestyle to young people with cancer.
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Affiliation(s)
- Gemma Pugh
- Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Rachael Hough
- University College Hospital's NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
| | - Helen Gravestock
- CLIC Sargent, No. 1 Farriers Yard, Assembly London, 77-85 Fulham Palace Road, London, W6 8JA, UK
| | - Kate Williams
- Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Abigail Fisher
- Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Abstract
This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects. There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.
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Affiliation(s)
- L M Ward
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
| | - V N Konji
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - J Ma
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Affiliation(s)
- Robert M. Siegel
- The Center for Better Health and Nutrition; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Mary Kate Lockhart
- The Center for Better Health and Nutrition; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Christopher Kist
- The Center for Better Health and Nutrition; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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