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Brochu A, Kairy D, Alos N, Laverdière C, Sinnett D, Sultan S, Curnier D, Miron MC, El-Jalbout R, Fiscaletti M, Hébert LJ. Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis: a PETALE cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01585-4. [PMID: 38787491 DOI: 10.1007/s11764-024-01585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. METHODS This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. RESULTS Survivors (n = 97, 24.2 ± 6.7 years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8% male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39-0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. CONCLUSIONS Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. IMPLICATIONS FOR CANCER SURVIVORS These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.
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Affiliation(s)
- Annie Brochu
- CHU Sainte-Justine, Montréal, Canada.
- Université de Montréal, Montréal, Canada.
| | - Dahlia Kairy
- Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Nathalie Alos
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Caroline Laverdière
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Sinnett
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Serge Sultan
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Curnier
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Marie-Claude Miron
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Ramy El-Jalbout
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Melissa Fiscaletti
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Luc J Hébert
- Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada
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Lovell AL, Gardiner B, Henry L, Bate JM, Brougham MFH, Iniesta RR. The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review. J Hum Nutr Diet 2024. [PMID: 38185902 DOI: 10.1111/jhn.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment. METHODS This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. RESULTS The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. CONCLUSIONS With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.
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Affiliation(s)
- Amy L Lovell
- Department of Nutrition and Dietetics, The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
| | - Breeana Gardiner
- Department of Nutrition and Dietetics, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Louise Henry
- Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jessica M Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Mark F H Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Raquel Revuelta Iniesta
- Children's Health and Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, Public Health and Sport Sciences, Medical School, St Luke's Campus, University of Exeter, Exeter, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
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3
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Guolla L, Barr R, Jaworski M, Farncombe T, Gordon C. Sarcopenia in long-term survivors of cancer in childhood and adolescence: A cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle-bone unit. Pediatr Blood Cancer 2024; 71:e30705. [PMID: 37807928 DOI: 10.1002/pbc.30705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Sarcopenia, a loss of systemic skeletal muscle mass (SMM), is prevalent in childhood cancer survivors and often accompanied by increased fat mass (sarcopenic obesity [SO]). We examined whether calf muscle cross-sectional area (CSA), measured by peripheral quantitative computed tomography (pQCT), can identify sarcopenia and SO in long-term survivors of pediatric acute lymphoblastic leukemia (ALL), and explored its relationship with adjacent bone geometry. PROCEDURES Calf muscle CSA and CSA Z scores at the 38% tibia in 70 subjects (median survival 15 years) were compared between sexes and ALL risk group, and their association with sarcopenia and SO evaluated. Relationships between bone strength and muscle mass were assessed further using linear regression and methods described by Schoenau et al. for evaluation of a functional muscle-bone unit. RESULTS A calf muscle CSA Z score of less than or equal to zero is 73.81% sensitive and 84.62% specific for detecting sarcopenia defined by height-adjusted appendicular lean mass measured by dual-energy x-ray absorptiometry. No significant difference in CSA Z scores was noted between sexes or ALL risk groups; however, Z scores were markedly higher in those without SO (adjusted odds ratio 0.529, 95% confidence interval [CI]: 0.340-0.824). Ratios of calf muscle mass to height and total bone mineral content at the 38% tibia are "sufficient" and consistent with estimated reference ranges for a healthy population. CONCLUSIONS CSA Z scores may represent a useful clinical measure of SMM and are predictive of SO in this population. Our results are supportive of a functional muscle-bone unit in long-term survivors of pediatric ALL.
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Affiliation(s)
- Louise Guolla
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maciej Jaworski
- Department of Biochemistry, RadioImmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Troy Farncombe
- Departments of Nuclear Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Detecting Sarcopenic Obesity in Survivors of Pediatric Acute Lymphoblastic Leukemia: An Exploration of Body Mass Index and Triponderal Mass Index as Potential Surrogate Markers. J Pediatr Hematol Oncol 2023; 45:e70-e74. [PMID: 36251889 DOI: 10.1097/mph.0000000000002566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/08/2022] [Indexed: 02/03/2023]
Abstract
Survivors of pediatric acute lymphoblastic leukemia (ALL) often have altered body composition secondary to treatment effects, including sarcopenic obesity (SO), which increases the risk of both metabolic complications and frailty. SO is difficult to detect without using advanced imaging techniques to which access is often limited. To explore whether common clinical indices can reliably identify the presence of SO in a cohort of long-term survivors of ALL, the discriminatory capacity of body mass index (BMI) or triponderal mass index (TMI, kg/m 3 ) for detecting SO was assessed. Thresholds of BMI and TMI associated with overweight or obesity status had poor sensitivity (<50%) and specificity for detecting SO. Total misclassification rates at these thresholds exceeded 50% and positive likelihood ratios were nonsignificant. Notably, TMI is more strongly correlated with elevated adiposity than is BMI in this survivor population ( R2 =0.73 vs. 0.57), suggesting further exploration is warranted. Our study is limited by the sample size, precluding detailed regression analysis. This study highlights the challenges of identifying SO in survivors of pediatric ALL using common clinical indices. Prospective evaluation of additional potential surrogate markers in survivors, in conjunction with the component features of SO, should be a key focus of future research.
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5
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Barr RD, Inglis D, Athale U, Farncombe T, Gordon CL. The Influence of Body Composition on Bone Health in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence: Analyses by Dual-energy Radiograph Absorptiometry and Peripheral Quantitative Computed Tomography. J Pediatr Hematol Oncol 2022; 44:423-431. [PMID: 35482464 DOI: 10.1097/mph.0000000000002470] [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: 09/13/2021] [Accepted: 03/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The normal interrelationship of body composition with bone health is less clear in the context of disease. Survivors of acute lymphoblastic leukemia (ALL) exhibit sarcopenic obesity and osteopenia. The impact of body composition on bone health in such survivors was examined. SUBJECTS AND METHODS Survivors of ALL (N=74), >10 years from diagnosis, underwent dual-energy radiograph absorptiometry and peripheral quantitative computed tomography. RESULTS Whole-body bone mineral content (WB BMC) Z scores were greater in males than females, but WB BMC indices (WB BMC/height 2 ) were comparable (0.74±0.125 and 0.72±0.069, respectively). WB BMC index (I) and fat-free mass index correlated significantly with trabecular bone mineral density, only in males. Fat mass index and appendicular lean mass index showed no such correlations. WB BMCI and fat-free mass index also correlated, again predominantly in males, with measures of strength in both trabecular and cortical bone. WB BMCI also correlated strongly with trabecular number, thickness, and hole size, also only in males. CONCLUSIONS The results point to the need for enhancing muscle mass, measured by appendicular lean mass index, while reducing fat mass and maintaining good bone mineralization in long-term survivors of ALL to ensure the integrity of healthy bones.
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Affiliation(s)
| | - Dean Inglis
- Canadian Longitudinal Study on Aging, Department of Health Research Methods, Evidence, and Impact, McMaster University
| | | | - Troy Farncombe
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Christopher L Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
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6
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Barr RD, Inglis D, Athale U, Jaworski M, Farncombe T, Gordon CL. Bone health in long-term survivors of pediatric acute lymphoblastic leukemia. An assessment by peripheral quantitative computed tomography. Pediatr Blood Cancer 2021; 68:e29218. [PMID: 34264535 DOI: 10.1002/pbc.29218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Loss of bone mineral is a common concomitant of the treatment of acute lymphoblastic leukemia (ALL) due mainly to chemotherapy, especially with corticosteroids. Osteopenia/osteoporosis may be encountered long into survivorship. Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry is limited to two-dimensionality and cannot distinguish trabecular from cortical bone. METHODS A sample of 74 subjects, ages 13.5-38.3 years more than 10 years from diagnosis, underwent peripheral quantitative computed tomography (pQCT) at metaphyseal (trabecular bone) and diaphyseal (cortical bone) sites in the radius and tibia. pQCT provides three-dimensional assessment of bone geometry, density, and architecture. RESULTS Average values in multiple metrics were similar to those in healthy individuals, but deficits in both trabecular and cortical bones were revealed by lower Z scores using an ethnically comparable sample of healthy individuals. Connectivity, a measure of bone architecture and a surrogate measure of bone strength, was lower in females than males. Survivors of standard-risk ALL had greater connectivity in and more compact trabecular bone than high-risk survivors who had received more intensive osteotoxic chemotherapy. There were no statistically significant differences in any of the metrics at any of the sites between subjects who had or had not a history of fracture, cranial irradiation, or use of a bisphosphonate. CONCLUSIONS These long-term survivors of ALL have somewhat compromised bone health, but data in comparable healthy populations are limited. Longitudinal studies in larger and more ethnically diverse cohorts will provide greater insight into bone health in this vulnerable population.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dean Inglis
- Canadian Longitudinal Study on Aging, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maciej Jaworski
- Department of Biochemistry, RadioImmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Troy Farncombe
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Christopher L Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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7
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Kottlors J, Große Hokamp N, Fervers P, Bremm J, Fichter F, Persigehl T, Safarov O, Maintz D, Tritt S, Abdullayev N. Early extrapulmonary prognostic features in chest computed tomography in COVID-19 pneumonia: Bone mineral density is a relevant predictor for the clinical outcome - A multicenter feasibility study. Bone 2021; 144:115790. [PMID: 33301962 PMCID: PMC7720732 DOI: 10.1016/j.bone.2020.115790] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Besides throat-nose swab polymerase chain reaction (PCR), unenhanced chest computed tomography (CT) is a recommended diagnostic tool for early detection and quantification of pulmonary changes in COVID-19 pneumonia caused by the novel corona virus. Demographic factors, especially age and comorbidities, are major determinants of the outcome in COVID-19 infection. This study examines the extra pulmonary parameter of bone mineral density (BMD) from an initial chest computed tomography as an associated variable of pre-existing comorbidities like chronic lung disease or demographic factors to determine the later patient's outcome, in particular whether treatment on an intensive care unit (ICU) was necessary in infected patients. METHODS We analyzed 58 PCR-confirmed COVID-19 infections that received an unenhanced CT at admission at one of the included centers. In addition to the extent of pulmonary involvement, we performed a phantomless assessment of bone mineral density of thoracic vertebra 9-12. RESULTS In a univariate regression analysis BMD was found to be a significant predictor of the necessity for intensive care unit treatment of COVID-19 patients. In the subgroup requiring intensive care treatment within the follow-up period a significantly lower BMD was found. In a multivariate logistic regression model considering gender, age and CT measurements of bone mineral density, BMD was eliminated from the regression analysis as a significant predictor. CONCLUSION Phantomless assessed BMD provides prognostic information on the necessity for ICU treatment in course of COVID-19 pneumonia. We recommend using the measurement of BMD in an initial CT image to facilitate a potentially better prediction of severe patient outcomes within the 22 days after an initial CT scan. Consequently, in the present sample, additional bone density analysis did not result in a prognostic advantage over simply considering age. Significantly larger patient cohorts with a more homogenous patient age should be performed in the future to illustrate potential effects. CLINICAL RELEVANCE While clinical capacities such as ICU beds and ventilators are more crucial than ever to help manage the current global corona pandemic, this work introduces an approach that can be used in a cost-effective way to help determine the amount of these rare clinical resources required in the near future.
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Affiliation(s)
- Jonathan Kottlors
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Nils Große Hokamp
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Philipp Fervers
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Johannes Bremm
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Florian Fichter
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | | | - David Maintz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
| | | | - Nuran Abdullayev
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
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8
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Athale UH, Marriott CJC, Cranston A, McDonald P, Webber CE, Farncombe TH, Barr RD. Relationships of Bone Mineral Density to Whole Body Mass, Fat Mass and Fat-free Mass in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood. J Pediatr Hematol Oncol 2021; 43:12-17. [PMID: 32675554 DOI: 10.1097/mph.0000000000001863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Body size influences bone mineral density (BMD) in health. Relationships of BMD with body mass index, fat mass (FM), fat-free mass, and appendicular lean mass were explored in acute lymphoblastic leukemia (ALL) survivors (n=75; 41 males; 45 standard risk ALL) >10 years from diagnosis. Dual energy radiograph absorptiometry performed body composition analysis. Relationships were assessed by regression analyses and Pearson correlation coefficients (r). Twenty subjects (26.3%) were osteopenic; lumbar spine (LS) BMD Z score <-1.00. Age at diagnosis, sex, ALL risk-category, type of post-induction steroid or cranial radiation did not correlate with LS or whole body (WB) BMD. Body mass index correlated significantly with LS BMD (r=0.333, P=0.004) and WB BMD (r=0.271, P=0.033). FM index (FM/height²) Z score showed no significant correlation with LS or WB BMD. Fat-free mass index Z score correlated strongly with LS BMD (r=0.386, P=0.013) and WB BMD (r=0.605, P<0.001) in males but not in females. The appendicular lean mass index, a surrogate for skeletal muscle mass, correlated significantly with LS BMD (r=0.367, P=0.018) and WB BMD (r=0.604, P<0.001) in males but not in females. Future studies to evaluate interventions to enhance BMD focused on improving body composition particularly skeletal muscle mass are warranted.
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Affiliation(s)
- Uma H Athale
- Departments of Pediatrics
- McMaster Children's Hospital
| | - Christopher J C Marriott
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Colin E Webber
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Troy H Farncombe
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ronald D Barr
- Departments of Pediatrics
- McMaster Children's Hospital
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9
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Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results). Clin Nutr ESPEN 2020; 38:242-252. [DOI: 10.1016/j.clnesp.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 03/09/2020] [Accepted: 04/05/2020] [Indexed: 12/23/2022]
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10
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Yang HR, Choi HS. A prospective study on changes in body composition and fat percentage during the first year of cancer treatment in children. Nutr Res Pract 2019; 13:214-221. [PMID: 31214289 PMCID: PMC6548708 DOI: 10.4162/nrp.2019.13.3.214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/25/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUNDS/OBJECTIVES Cancer treatment may lead to significant body composition changes and affect growth and disease outcomes in pediatric cancer patients. This prospective study aimed to evaluate short- and long-term body compositions changes focused on body fat during the first year of cancer treatment in children. SUBJECTS/METHODS A prospective study was conducted in 30 pediatric cancer patients (19 hematologic malignancies and 11 solid tumors) and 30 age- and sex-matched healthy controls. Anthropometric measurements and body composition analysis using whole body dual energy X-ray absorptiometry were performed at baseline and 1, 6, and 12 month(s) of cancer treatment. Kruskal-Wallis tests, Wilcoxon paired t tests, and generalized estimation equation (GEE) were applied for statistical analysis. RESULTS At baseline, no differences in weight, height, body mass index, abdominal circumferences, body fat, and fat-free mass were observed between 30 controls and 30 pediatric cancer patients. Total fat mass (P < 0.001) and body fat percentage (P = 0.002) increased significantly during the first month, but no changes were observed from 1 to 12 months; however, no changes in the total mass were observed during the first year of cancer treatment. Meanwhile, the total fat-free mass decreased during the first month (P = 0.008) and recovered between 6 and 12 months of follow-up (P < 0.001). According to GEE analysis, there was a significant upward trend in body fat percentage during the first year, especially the first month, of cancer treatment in children with hematologic malignancies, but not in those with solid tumors. CONCLUSIONS Our results indicate that cancer treatment is related to significant body composition changes and rapid body fat gain, particularly during the first month after initiating cancer treatment, in children with hematologic malignancies. Therefore, individualized dietary strategies to prevent excessive fat gain are needed in pediatric cancer patients for better outcomes.
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Affiliation(s)
- Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi 13620, Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi 13620, Korea
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11
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Joffe L, Dwyer S, Glade Bender JL, Frazier AL, Ladas EJ. Nutritional status and clinical outcomes in pediatric patients with solid tumors : A systematic review of the literature. Semin Oncol 2018; 46:48-56. [PMID: 30655021 DOI: 10.1053/j.seminoncol.2018.11.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Nutritional status (NS), defined by undernutrition (body mass index [BMI] <5th percentile) or overnutrition (BMI ≥ 85th percentile), is a poor prognostic indicator in pediatric oncology patients. The impact of NS has been primarily studied in hematologic malignancies. This review is intended to summarize literature reporting on the association of NS and treatment-related outcomes in pediatric solid tumors. METHODS We searched four electronic databases from inception through August 2018 without language restriction, and included studies of children with cancers arising from renal, bone, liver, eye, muscle, vascular, germ cell, and neural crest tissues, reporting on NS as a predictor for toxicity, survival or relapse. Due to data heterogeneity and limited availability of studies, formal statistical analysis was not achievable. Descriptive statistics were summarized in table format. RESULTS Of 8,991 reports identified, 75 full-text articles were evaluated, 10 of which met inclusion criteria. Up to 62% of patients were over- or undernourished at diagnosis. Abnormal BMI was associated with worse overall survival in Ewing sarcoma (hazard ratio (HR): 3.46, P = .022), osteosarcoma (HR: 1.6, P < .005), and a trend toward poorer overall survival in rhabdomyosarcoma (HR: 1.70, P = .0596). High BMI in osteosarcoma was associated with increased nephrotoxicity (odds ratio: 2.8, P = .01) and postoperative complications. NS was not a significant predictor of outcomes in other included disease categories. CONCLUSIONS Existing literature supports the prognostic significance of NS in pediatric solid tumor patients and underscores the need for prospective studies to better elucidate underlying physiological changes in this population.
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Affiliation(s)
- Lenat Joffe
- Department of Pediatric Hematology, Oncology and Stem Cell Transplant, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Sarah Dwyer
- Institute of Human Nutrition, Columbia University Medical Center, New York, New York
| | - Julia L Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Elena J Ladas
- Department of Pediatric Hematology, Oncology and Stem Cell Transplant, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
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12
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Collins L, Athale U, Cranston A, Barr R. Impact of short stature on health-related quality of life in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence. J Patient Rep Outcomes 2018; 2:59. [PMID: 30535818 PMCID: PMC6286289 DOI: 10.1186/s41687-018-0084-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Purpose Some survivors of acute lymphoblastic leukemia (ALL) in childhood and adolescence exhibit short stature, especially if their treatment included cranial irradiation. The impact of this outcome on health-related quality of life (HRQL) is uncertain and so formed the basis for the investigation reported here. Methods This study examined the association between self-reported HRQL and measured height in a cohort (n = 75) of survivors of ALL more than 10 years from diagnosis. HRQL was expressed as utility scores generated from a multi-attribute preference-based measure, the Health Utilities Index (HUI) which includes the complementary systems HUI2 and HUI3. For single attributes the range is from 1.00 (no limitations) to 0.00 (lowest level of function). For overall HRQL the range is 1.00 (perfect health) to 0.00 (equivalent to being dead). A negative score is associated with states of health worse than being dead. Results There were no statistically significant differences in overall HRQL between subjects <25th (n = 16, 21%), 15th (n = 11, 15%) and 10th (n = 10, 13%) centiles. A greater amount of emotional morbidity, focused on anger and depression, was manifest in those <25th and 15th centiles, with clinically important differences of 0.07 (p = 0.03) and 0.077 (p = 0.016) respectively, but not in the shortest group who were < 10th centile. Conclusions Studies in large cohorts of young adults in the general population has reported an inconsistent relationship between height and HRQL. Results from the current study suggest that no such relationship exists in long-term survivors of ALL in childhood and adolescence.
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Affiliation(s)
- Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Uma Athale
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Room 3N27, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, L8S 4J9, Canada
| | - Amy Cranston
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ronald Barr
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada. .,Department of Pediatrics, McMaster University, Room 3N27, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, L8S 4J9, Canada.
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13
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Orgel E, Mueske NM, Sposto R, Gilsanz V, Freyer DR, Mittelman SD. Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy. Leuk Lymphoma 2018; 59:138-145. [PMID: 26818609 PMCID: PMC5362342 DOI: 10.3109/10428194.2015.1136741] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Obesity as defined by body mass index percentile (BMI%) is strongly associated with relapse and poorer survival in childhood ALL. Whether BMI% accurately reflects body fat percentage (BF%) in this population is unknown. We conducted a prospective study assessing body composition during frontline ALL therapy. Dual-energy X-ray absorptiometry measured BF% and lean muscle mass (LMM) at diagnosis, end of Induction, and end of Delayed Intensification. Sarcopenic obesity (gain in BF% with loss of LMM) was surprisingly common during ALL treatment, resulting in poor correlation between changes in BMI% (expressed as Z-score) and BF% overall (r = -0.05) and within patients (r = -0.09). BMI Z-score and BF% changed in opposite directions in >50% of interval assessments. While BMI% at diagnosis is a suitable predictor of obesity/BF% for epidemiological studies, change in BMI% (as expressed as Z-score) does not reflect body composition. Studies evaluating obesity in leukemia should consider using direct measures of body composition.
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Affiliation(s)
- Etan Orgel
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
- Jonathan Jaques Children’s Cancer Center, Miller Children’s Hospital Long Beach, Long Beach, CA
- University of Southern California, Los Angeles, CA
| | - Nicole M Mueske
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Richard Sposto
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Vicente Gilsanz
- University of Southern California, Los Angeles, CA
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA
| | - David R Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Steven D Mittelman
- University of Southern California, Los Angeles, CA
- Center for Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA
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14
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Insights into defective serological memory after acute lymphoblastic leukaemia treatment: The role of the plasma cell survival niche, memory B-cells and gut microbiota in vaccine responses. Blood Rev 2018; 32:71-80. [DOI: 10.1016/j.blre.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
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15
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Marriott CJC, Beaumont LF, Farncombe TH, Cranston AN, Athale UH, Yakemchuk VN, Webber CE, Barr RD. Body composition in long-term survivors of acute lymphoblastic leukemia diagnosed in childhood and adolescence: A focus on sarcopenic obesity. Cancer 2017; 124:1225-1231. [DOI: 10.1002/cncr.31191] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Christopher J. C. Marriott
- Department of Radiology; McMaster University; Hamilton Ontario Canada
- Department of Nuclear Medicine; Hamilton Health Sciences and St. Joseph's Hospital; Hamilton Ontario Canada
| | - Lesley F. Beaumont
- Department of Nuclear Medicine; Hamilton Health Sciences and St. Joseph's Hospital; Hamilton Ontario Canada
| | - Troy H. Farncombe
- Department of Radiology; McMaster University; Hamilton Ontario Canada
- Department of Nuclear Medicine; Hamilton Health Sciences and St. Joseph's Hospital; Hamilton Ontario Canada
| | - Amy N. Cranston
- Division of Hematology-Oncology; McMaster Children's Hospital; Hamilton Ontario Canada
| | - Uma H. Athale
- Division of Hematology-Oncology; McMaster Children's Hospital; Hamilton Ontario Canada
- Department of Pediatrics; McMaster University; Hamilton Ontario Canada
| | - Valerie N. Yakemchuk
- Department of Radiology; McMaster University; Hamilton Ontario Canada
- Department of Nuclear Medicine; Hamilton Health Sciences and St. Joseph's Hospital; Hamilton Ontario Canada
| | - Colin E. Webber
- Department of Radiology; McMaster University; Hamilton Ontario Canada
- Department of Nuclear Medicine; Hamilton Health Sciences and St. Joseph's Hospital; Hamilton Ontario Canada
| | - Ronald D. Barr
- Division of Hematology-Oncology; McMaster Children's Hospital; Hamilton Ontario Canada
- Department of Pediatrics; McMaster University; Hamilton Ontario Canada
- Department of Pathology; McMaster University; Hamilton Ontario Canada
- Department of Medicine; McMaster University; Hamilton Ontario Canada
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16
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Collins L, Beaumont L, Cranston A, Savoie S, Nayiager T, Barr R. Anthropometry in Long-Term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence. J Adolesc Young Adult Oncol 2017; 6:294-298. [DOI: 10.1089/jayao.2016.0091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Laura Collins
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lesley Beaumont
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amy Cranston
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Stefanie Savoie
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Trishana Nayiager
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ronald Barr
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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17
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Physical Activity in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence: A Cross-sectional Cohort Study. J Pediatr Hematol Oncol 2017; 39:15-19. [PMID: 27571119 DOI: 10.1097/mph.0000000000000667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inadequate physical activity (PA) and elevated overweight/obesity (OW/OB) rates are common in survivors of cancer in childhood, especially acute lymphoblastic leukemia (ALL). Bony morbidity, including fractures, is also prevalent among survivors of ALL. This study examined the interrelationships of PA, measured in hours by the Habitual Activity Estimation Scale; OW/OG, defined by body mass index; and fractures (yes/no) in survivors of ALL (n=75) more than 10 years after diagnosis. All had been treated using protocols of the Dana Farber Cancer Institute Childhood ALL Consortium. The median age was 21.15 years and time from diagnosis 15.07 years, and 27 subjects had experienced fractures. More than 30% of the total sample were OW/OB. There was no correlation of body mass index with present PA. There were no significant differences between those with/without fractures in terms of age, sex, time from diagnosis, and the prevalence of OW/OB. Subjects with fractures during treatment reported more total activity on typical weekend days than those without fractures (mean 8.8 vs. 6.9 h, P<0.01). There was no significant difference on weekdays. Higher activity on weekends suggests that fractures may have occurred more commonly in those who had a more active lifestyle before, during, and after treatment.
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18
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Nayiager T, Anderson L, Cranston A, Athale U, Barr RD. Health-related quality of life in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence. Qual Life Res 2016; 26:1371-1377. [PMID: 27885548 DOI: 10.1007/s11136-016-1462-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Children with acute lymphoblastic leukemia (ALL), the commonest form of cancer in this age group, suffer considerable morbidity during treatment, with the majority returning to good health soon after therapy has been completed, as reflected in health-related quality of life (HRQL). However, survivors are at risk of many adverse health outcomes later, including obesity, measured by body mass index (BMI), that is compounded by limited physical activity. This study examined the HRQL of long-term survivors of ALL and its relationship to BMI and physical activity. METHODS A cohort of 75 subjects who were more than 10 years from diagnosis was assessed for BMI (weight in kg/height in m2) and completed two questionnaires. HRQL was measured by the multi-attribute, preference-based Health Utilities Index (HUI) instrument HUI23S4.15Q designed for self-report, and physical activity was quantified by the Habitual Activity Estimation Scale. RESULTS The mean utility scores for overall HRQL (HUI2 = 0.88, HUI3 = 0.83) were similar to those in the Canadian and US general population segments of equivalent age (HUI2 = 0.86, HUI3 = 0.85). However, the minimum scores (HUI2 = 0.23, HUI3 = -0.09) revealed a group of survivors with notable disabilities in the attributes of hearing, emotion, cognition, and pain. There were no statistically significant correlations between HRQL and BMI or between HRQL and physical activity, except for deafness and inactivity on weekdays. CONCLUSIONS Overall, long-term survivors of ALL in childhood enjoy good HRQL but some experience appreciable disability, though this is not associated with BMI or, in the main, with physical activity.
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Affiliation(s)
- T Nayiager
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - L Anderson
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - A Cranston
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - U Athale
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, ON, Canada.,Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - R D Barr
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, ON, Canada. .,Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada. .,Health Sciences Centre, Room 3N27, 1200 Main Street West, Hamilton, ON, L8S 4J9, Canada.
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19
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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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