Originally published as JCO Early Release 10.1200/JCO.2008.21.1482 on March 30 2009

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Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

From the Departments of Epidemiology and Cancer Control, Oncology, and Radiologic Sciences, St Jude Children's Research Hospital; Department of Radiology, University of Tennessee, Memphis, TN; The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA; Cincinnati Children's Hospital, Cincinnati, OH; Stanford University Medical Center & Lucile Packard Children's Hospital, Palo Alto, CA; Fred Hutchinson Cancer Research Center, Seattle, WA; and University of Michigan Department of Pediatrics and Comprehensive Cancer Center, Ann Arbor, MI.

Corresponding author: Kirsten K. Ness, PhD, St Jude Children's Research Hospital, Mail Stop 735, 262 Danny Thomas Place, Memphis, TN 38105; e-mail: kiri.ness{at}stjude.org.

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.

Supported by Grant No. CA 55727 (L.L.R., Principal Investigator), National Cancer Institute, Bethesda, MD, with additional support provided to St Jude Children's Research Hospital by American Lebanese Syrian Associated Charities.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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