Physical Fitness In Survivors Of Childhood Hodgkin Lymphoma

Abstract

PURPOSE: Survival rates following a diagnosis of childhood Hodgkin Lymphoma (HL) have surpassed 90%. However, cancer therapies increase the risk for late effects, potentially limiting survivor’s abilities to participate in physical activity (PA). This analysis evaluated objective markers of physical fitness among adult survivors of HL and compared them to matched peers without a history of childhood cancer. METHODS: Participants included HL survivors (n=340, 53.5% male, 84.4% Caucasian) from the St. Jude Lifetime Cohort and a comparison group members (n=340) without a history of cancer, frequency matched on age, sex and race. Participants completed physical fitness testing including anthropometrics, vital signs, isokinetic quadriceps and isometric hand grip strength, low back and hamstring flexibility (sit and reach test), and cardiorespiratory endurance (six minute walk test). Survivors also completed the Medical Outcomes Survey Short-Form-36 (SF-36). Linear regression was used to compare HL survivor to peers, and to evaluate associations between fitness and score on the SF-36, adjusting for age and sex. RESULTS: Survivors and comparison group members were a mean age of 37±8 and 36±9 years respectively. Survivors were a mean age of 14±4 years at diagnosis and had survived, on average 23±8 years. Survivors and the comparison group were overweight (28.0 ± 5.6 vs. 28.4±5.6 kilograms/meter squared respectively). Resting heart rate (HR) and respirations (RR) were higher among survivors than among comparison group members (HR 82.0±10.4 vs. 73.1±10.5 beats per minute, p < 0.001; RR 18.2±1.5 17.8±1.5 breaths per minute, p <0.001). Performance on the sit and reach test (29.5±6.6 vs. 25.4±6.8 centimeters, p < 0.001) and six minute walk test (586±83.7 vs. 618.4±82.1 meters, p < 0.001) were lower among HL survivors than among comparison group members. There were no differences in mean strength values between groups. Survivors who walked < 490 meters on the six minute walk test scored 10.31 ± 1.36 points lower on the physical component summary scale of the SF-36 than those who walked ≥490 meters. CONCLUSION: Survivors of childhood HL have impaired performance on several cardiorespiratory fitness markers when compared to peers which influences quality of life and may make it difficult to participate in regular PA.