Exercise Intolerance, Mortality, and Organ System Impairment in Adult Survivors of Childhood Cancer.
Publication/Presentation Date
1-1-2020
Abstract
PURPOSE: Exercise intolerance, associated with heart failure and death in general populations, is not well studied in survivors of childhood cancer. We examined prevalence of exercise intolerance in survivors exposed or not to cardiotoxic therapy, and associations among organ system function, exercise intolerance, and mortality.
METHODS: Participants consisted of 1,041 people who had survived cancer ≥ 10 years (and had or did not have exposure to anthracyclines and/or chest-directed radiation) and 285 control subjects. Exercise intolerance was defined as peak oxygen uptake < 85% predicted from maximal cardiopulmonary exercise testing; organ functions were ascertained with imaging or clinical testing. Multivariable regression of the data was performed to compare exercise capacity between survivors exposed or unexposed to cardiotoxic therapy and control subjects, and to evaluate associations between treatment and organ function, and organ function and exercise intolerance. Propensity score methods in time-to-event analyses evaluated associations between exercise intolerance and mortality.
RESULTS: Survivors (mean age ± standard deviation [SD], 35.6 ± 8.8 years) had lower mean (± SD) peak oxygen uptake (exposed: 25.74 ± 8.36 mL/kg/min; unexposed: 26.82 ± 8.36 mL/kg/min) than did control subjects (32.69 ± 7.75 mL/kg/min;
CONCLUSION: Exercise intolerance is prevalent among childhood cancer survivors and associated with all-cause mortality. Treatment-related cardiac (detected by global longitudinal strain), autonomic, pulmonary, and muscular impairments increased risk. Survivors with impairments may require referral to trained specialists to learn to accommodate specific deficits when engaging in exercise.
Volume
38
Issue
1
First Page
29
Last Page
42
ISSN
1527-7755
Published In/Presented At
Ness, K. K., Plana, J. C., Joshi, V. M., Luepker, R. V., Durand, J. B., Green, D. M., Partin, R. E., Santucci, A. K., Howell, R. M., Srivastava, D. K., Hudson, M. M., Robison, L. L., & Armstrong, G. T. (2020). Exercise Intolerance, Mortality, and Organ System Impairment in Adult Survivors of Childhood Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38(1), 29–42. https://doi.org/10.1200/JCO.19.01661
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31622133
Department(s)
Administration and Leadership
Document Type
Article