Oral Presentation Cancer Survivorship 2019

Cardiovascular fitness and physical activity in childhood survivors of cancer, potential role for exercise physiology services (#23)

Lauren Ha 1 2 , David Mizrahi 1 2 , Joanna Fardell 2 3 , Richard Cohn 2 3 , Claire Wakefield 2 3 , David Simar 1
  1. School of Medical Sciences , UNSW Sydney, Sydney, NSW, Australia
  2. Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
  3. School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia

Background: Childhood cancer survivors (CCS) are at increased risk of cardiovascular diseases. This risk is likely exacerbated by low physical activity levels and low cardiovascular fitness. This study aimed to explore cardiovascular fitness and physical activity in CCS and to determine the acceptability of an exercise physiology consultation.

Methods: We measured physical activity levels and cardiovascular fitness in survivors aged 8-18 years and ≥1-year post-treatment completion. We assessed fitness using the 6-Minute Walk Test (6MWT) and predicted their maximal cardiovascular fitness using an algorithm based on their age, waist-to-height ratio, gender and 6MWT performance. Survivors received an exercise physiology consultation and a feedback report, additionally provided to treating physicians. Acceptability of the consultation was surveyed one month later.

Results: One-hundred and two survivors (mean age=12.9±3.3 years, mean=6.0±4.0 years post-treatment) reported median physical activity levels of 235min/week (0-1470min/week), with only 37.6% meeting the recommended levels. Survivors completed 665±83.5m on 6MWT and had low fitness levels (mean=38.5th±23.4 percentile) based on the algorithm. Forty-five survivors and 59 parents (65 unique families) completed follow-up surveys. Most parents (86%) found the consultation helpful particularly the information and education received, and 91% reported it was not burdensome. The majority of parents (96%) and survivors (95%) recommended other survivors to participate in the study. Most survivors (93%) reported they would be happy to repeat the fitness assessments at their next follow-up visit. 

Conclusion: Survivors have low fitness, with only one-third meeting the recommended physical activity levels. Considering the risk of cardiovascular late-effects in survivors, there is a need for early intervention to reduce cardiovascular morbidity. Parents and survivors confirmed the acceptability of fitness testing and exercise physiology services, which are not standard of care in this cohort. Assessing fitness in CCS is vital as it allows clinicians to monitor patients at risk and promote behavioural changes.