Physical performance limitations in the Childhood Cancer Survivor Study cohort

Abstract

Physical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatment-based risk factors include radiation and treatment with a combination of alkylating agents and anthracyclines. Musculoskeletal, neurologic, cardiac, pulmonary, sensory, and endocrine organ system dysfunction also increase the risk of developing a physical performance limitation. In summary, monitoring of physical performance limitations in an aging cohort of childhood cancer survivors is important and will help determine the impact of physical performance limitations on morbidity, mortality, and caregiver burden. In addition, in developing restorative and preventive interventions for childhood cancer survivors, we must take into account the special needs of survivors with physical disability to optimize their health and enhance participation in daily living activities.

Fig 1.

The interaction between the components of the International Classification of Functioning, Disability, and Health.

Fig 2.

(A) Percent of childhood cancer survivors with a physical performance limitation by diagnosis as reported on the baseline questionnaire in 1995 to 1996. (B) Age- and gender-adjusted score on the physical function subscale of the Medical Outcomes Survey Short Form-36 by diagnosis in 2002. The horizontal dashed line indicates the age- and gender-adjusted sibling mean score on this instrument.