Performance-based physical function in long-term survivors of Hodgkin lymphoma.

Abstract

9532 Background: Survivors of pediatric Hodgkin lymphoma (HL) are at increased risk for late effects including loss of physical function, which may interfere with an active lifestyle. The aims of these analyses were to describe the prevalence of physical performance limitations, and to determine associations between treatment exposures and long-term functional loss. Methods: Clinical assessment including measures of ankle flexibility and strength, quadriceps strength, and walking endurance were completed in HL survivors 10+ years from diagnosis. Those with ankle motion < 5 degrees of dorsiflexion (required for foot clearance during walking), and isokinetic strength or distances on the six minute walk in the lowest 10th percentiles of age/sex predicted norms were classified as having severe limitations. The prevalence of severe loss was calculated for each measure. Associations between HL treatment and functional loss were evaluated in regression models. Results: Among the first 196 eligible HL participants randomly recruited to participate in a large cohort study, 188 (median age 40 (26-61) years; median time since diagnosis 26 (11-45) years) completed the performance measures. Severe limitations were present in ankle motion for 29.0%, ankle strength for 22.3%, quadriceps strength for 21.8%, and endurance for 31.9% of survivors. Among those with severe limitations, 53.3% had limitations on 2+ performance measures. Those treated with vinca alkaloids had mean ankle dorsiflexion age/sex specific z-scores of -0.35±1.0 vs. 0.19±1.3 (p=0.007) among those not exposed. Mean quadriceps z-scores were -0.45±1.0 among those exposed to vinca alkaloids vs. -0.29±0.97 (p=0.01) among those not exposed. After adjusting for anthracycline and radiation exposure, those treated were 2.4 (95% CI 1.1-5.2) times more likely than those not treated with glucocorticoids to have poor endurance. Conclusions: Severe physical performance limitations are present in 20-30% of long-term HL survivors. Exposure to vinca alkaloids and glucocorticoids are associated with decreased strength and walking ability, respectively. Losses in lower extremity motion and strength, and in sustained walking ability, may provide targets for intervention.