Rehabilitation assessments of pediatric sarcoma survivors

Abstract

8528 Background: Improved diagnosis and comprehensive treatment of childhood cancers has increased the overall survival rate. This study assesses physical impairments, functional limitations, health status and behaviors; and vocational and occupational histories of adult survivors of pediatric sarcomas. Methods: Physical impairment assessment: Joint range of motion (ROM); manual muscle testing (MMT); hand grip strength (HGS). Functional limitations: Assessment of motor and process skills (AMPS); 6-minute walk (6MWT); and human activity performance (HAP) questionnaire. Health status and behaviors: Leisure satisfaction measure (LSM); SF-36; sickness impact profile (SIP). Vocational and occupational histories: The Goldberg Scale (GS). Statistics: Standardized measures compared patients with norms. The results were evaluated by Wilcoxon signed rank two-sided p-values, unadjusted for multiple comparisons. Results: 32 survivors were diagnosed at median age 15.4 years (male:female=17:15, Ewing's sarcoma in 24/32). ROM of 22 subjects tested was >40% reduced in 12/13 with lower extremity (LE) lesions. HGS equaled matched norms. 28 /32 performed the 6MWT. 3/4 non-ambulatory subjects were LE amputees. Velocity in 9 was <90% predicted. HAP maximum score/maximum adjusted scores were lower than matched norms (p=0.015 and p=0.043 respectively). Motor and process scores for performance of routine daily tasks were lower than normal matched controls (p<0.0001). SF36 physical competency subscale trended lower (p=0.065), mental competency scores trended higher (p=0.058) than normal, respectively. Overall LSM was higher than the control group (p<0.001). Preliminary GS evaluation suggests higher work satisfaction. Conclusion: Survivors of childhood sarcoma have residual impairment of strength and motion, more likely of the lower extremity. Performance(mobility and daily routines), was reduced. Leisure satisfaction and self-reported mental competency higher than matched normal subjects, despite significant physical limitations, may reflect an augmented sense of well-being. Vocational drive and occupational behaviors were above average compared to people with disabilities. No significant financial relationships to disclose.