Original article
Functional Outcomes and Life Satisfaction in Long-Term Survivors of Pediatric Sarcomas

https://doi.org/10.1016/j.apmr.2006.08.341Get rights and content

Abstract

Gerber LH, Hoffman K, Chaudhry U, Augustine E, Parks R, Bernad M, Mackall C, Steinberg S, Mansky P. Functional outcomes and life satisfaction in long-term survivors of pediatric sarcomas.

Objectives

To describe the inter-relationships among impairments, performance, and disabilities in survivors of pediatric sarcoma and to identify measurements that profile survivors at risk for functional loss.

Design

Prospective, cross-sectional.

Setting

Research facility.

Participants

Thirty-two participants in National Cancer Institute clinical trials.

Interventions

Not applicable.

Main Outcome Measures

Range of motion (ROM), strength, limb volume, grip strength, walk velocity, Assessment of Motor and Process Skills (AMPS); Human Activity Profile (HAP), Sickness Impact Profile (SIP), standard form of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36); and vocational attitudes and leisure satisfaction.

Results

Twenty of 30 survivors tested had moderate or severe loss of ROM; 13 of 31 tested had 90% or less of predicted walk velocity; all of whom had trunk or lower-extremity lesions. Women with decreased ROM (r=.50, P=.06) or strength (r=.74, P=.002) had slow gait velocity. Sixteen of 31 tested were more than 1 standard deviation below normal grip strength. Eighteen had increased limb volume. These 18 had low physical competence (SF-36) (r=−.70, P=.001) and high SIP scores (r=.73, P=.005). AMPS scores were lower than those of the matched normed sample (P<.001). HAP identified 15 of 30 who had moderately or severely reduced activity. Leisure satisfaction was higher in the subjects (P<.001). Eight reported cancer had negatively impacted work and 17 reported that it negatively impacted vocational plans.

Conclusions

Survivors with lower-extremity or truncal lesions and women with decreased ROM and strength likely have slow walk velocity, low exercise tolerance, and high risk for functional loss. They should be identified using ROM, strength, limb volume, and walk time measures.

Section snippets

Methods

There were 108 identified survivors of pediatric sarcoma who had been treated with one of several treatment protocols for sarcoma at the National Cancer Institute (NCI), NIH, who participated in this institutional review board approved protocol. Subjects received no remuneration for participating. Eligible subjects provided informed consent to participate in this study. They were in remission were without evidence of cancer recurrence for at least 24 months; and had not received chemotherapy,

Results

We retrieved information that enabled us to contact 80 potential participants. Thirty-two agreed to participate, 19 declined, and 29 did not respond. Review of demographic information about the participants and nonparticipants showed no significant differences between the 2 groups in tumor type, age at diagnosis, location of tumor, presence of metastases, or radiation (table 1).

Discussion

Pediatric cancers affect only 1 in 300 to 350 people less than 20 years of age and the survival rate exceeds 75%.1 The prevalence of cancer survivors 20 to 35 years of age is estimated at 1 in 500, a sizable group. This is a population that survives into early adulthood, but longevity may require management that is directed toward needs other than cancer treatment. These needs should include mitigation of the sequelae of treatment and its effect on cardiac function, limb swelling, strength, and

Conclusions

We believe there is a profile for pediatric sarcoma patients who are most likely to suffer poor functional outcome. The profile includes those with: (1) lower-extremity lesions (including pelvis and trunk), (2) limb edema, and (3) women with loss of ROM and weakness. Age is another risk factor for slow walk time, suggesting fitness should be a lifelong goal.

Women who have weakness and decreased ROM have decreased velocity, making them at greater risk than men for decreased mobility and poor

References (49)

  • T.D. Elkin et al.

    Psychological functioning of adolescent and young adult survivors of pediatric malignancy

    Med Pediatr Oncol

    (1997)
  • A.T. Meadows et al.

    Psychosocial status of young adult survivors of childhood cancer: a survey

    Med Pediatr Oncol

    (1989)
  • C.K. Tebbi et al.

    Long-term vocational adjustment of cancer patients diagnosed during adolescence

    Cancer

    (1989)
  • R. Nagarajan et al.

    Education, employment, insurance, marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study

    Cancer

    (2003)
  • K.K. Boman et al.

    Life after cancer in childhood: social adjustment, educational and vocational status of young adult survivors

    J Pediatr Hematol Oncol

    (2004)
  • L. Hovi et al.

    Impaired muscle strength in female adolescents and young adults surviving leukemia in childhood

    Cancer

    (1993)
  • M.H. Lampert et al.

    Soft tissue sarcoma: functional outcome after wide local excision and radiation therapy

    Arch Phys Med Rehabil

    (1984)
  • H. Nybo et al.

    Predictors of mortality in 224 nonagenarians—the Danish 1905 Cohort Survey

    J Am Geriatr Soc

    (2003)
  • M.C. Morey et al.

    Exercise adherence and 10-year mortality in chronically ill older adults

    J Am Geriatr Soc

    (2002)
  • E.W. Gregg et al.

    Relationship of walking to mortality among US adults with diabetes

    Arch Intern Med

    (2003)
  • R.W. Bohannon et al.

    Postadmission function best predicts acute hospital outcomes after stroke

    Am J Phys Med Rehabil

    (2002)
  • E.J. Metter et al.

    Skeletal muscle strength, as a predictor of all-cause mortality in healthy men

    J Gerontol A Biol Sci Med Sci

    (2002)
  • D. Melzer et al.

    The predictive validity for mortality of the index of mobility-related limitation—results from the EPESE study

    Age Ageing

    (2003)
  • P.J. Mansky et al.

    Preserved functionality and increased cardiovascular risk in pediatric sarcoma long term survivors

    Proc Am Soc Clin Oncol

    (2003)
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    Supported by the National Institutes of Health (intramural grant).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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