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Exercise capacity in long-term survivors of pediatric cancer: An analysis from the cardiac risk factors in childhood cancer survivors study

Authors

  • Angela M. Miller MSPH,

    1. Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
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  • Gabriela Lopez-Mitnik MS,

    1. Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
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  • Gabriel Somarriba DPT,

    1. Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
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  • Stuart R. Lipsitz DSc,

    1. Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Andrea S. Hinkle MD,

    1. Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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  • Louis S. Constine MD,

    1. Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
    2. Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
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  • Steven E. Lipshultz MD,

    1. Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
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  • Tracie L. Miller MD

    Corresponding author
    1. Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida
    • Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101.
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited.

Procedure

We assessed maximal myocardial oxygen consumption (equation image, a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between equation image and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity.

Results

Of 72 survivors (mean age, 22 years; range, 8.0–40 years) and 32 siblings (mean age, 20.2 years; range, 8–46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5–31.6 years). In age- and sibling-pair adjusted analyses, equation image was lower in survivors than siblings (males, 28.53 vs. 30.90 ml/kg/minute, P = 0.08; females, 19.81 vs. 23.40 ml/kg/minute, P = 0.03). In males, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower equation image. In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower equation image.

Conclusions

Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower equation image in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring. Pediatr Blood Cancer 2013; 60: 663–668. © 2012 Wiley Periodicals, Inc.

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