Impairments that Influence Physical Function among Survivors of Childhood Cancer
Abstract
:1. Introduction
2. Endocrine Complications
2.1. Body Composition
System | Condition | Risk Factors |
---|---|---|
Endocrine | Obesity | Cranial irradiation, high caloric intake, low levels of physical activity, female sex |
Short stature | Cranial, spinal, or total body irradiation, young age at treatment | |
Musculoskeletal | Reduced bone mineral density | Methotrexate, dexamethasone, prednisone, HSCT, growth hormone deficiency, estrogen deficiency, testosterone deficiency, reduced physical activity, low calcium or vitamin D intake, treatment during adolescence |
Deformity (including scoliosis, kyphosis, limb-length discrepancy) | Surgery, spinal, flank, or whole-abdomen irradiation, younger age at treatment | |
Osteonecrosis | Dexamethasone, prednisone, HSCT, older age at treatment | |
Neurosensory | Cataract | Busulfan, dexamethasone, prednisone, eye irradiation |
Other ocular toxicities (e.g., keratitis, telangiectasia, retinopathy, optic chiasm neuropathy, enophthalmos, maculopathy, papillopathy, glaucoma) | Orbital irradiation | |
Vertigo | Carboplatin, cisplatin | |
Peripheral sensory neuropathy | Carboplatin, cisplatin | |
Neuromotor | Peripheral motor neuropathy (including areflexia, weakness, foot drop, paresthesia) | Vinblastine, vincristine |
Motor deficits (e.g., hemiparesis paralysis, ataxia, dysarthria, dysphagia, paralysis, seizures) | Cranial irradiation, neurosurgery | |
Cardiovascular | Cardiomyopathy | Anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, mitoxantrone), chest radiation, female sex, younger age at treatment |
Arrhythmias | Anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, mitoxantrone), chest irradiation | |
Atherosclerotic heart disease, congestive heart failure, hypertension, pericarditis, pericardial fibrosis, valvular disease, myocardial infarction | Chest irradiation | |
Carotid artery disease | Chest, cervical, or cranial irradiation | |
Dyslipidemia | Carboplatin, cisplatin | |
Pulmonary | Acute respiratory distress | Bleomycin |
Interstitial pneumonitis | Bleomycin, chest irradiation | |
Fibrosis | Busulfan, BCNU, CCNU, bleomycin, chest radiation | |
Restrictive lung disease, obstructive lung disease | Chest radiation | |
Bronchial obliterans, bronchiectasis, chronic bronchitis | HSCT with history of chronic GVHD | |
Pulmonary dysfunction | Lobectomy, wedge resection | |
Chronic sinusitis | Orbital or nasopharyngeal radiation |
2.2. Height
3. Musculoskeletal Defects
3.1. Bone Density
3.2. Deformity
3.3. Limb Sparing and Amputation
3.4. Osteonecrosis
3.5. Muscle Weakness
4. Neurosensory Deficits
4.1. Vision
4.2. Vestibular Function and Balance
4.3. Peripheral Neuropathy
5. Neuromotor Deficits
6. Cardiopulmonary Impairments
Condition | Screening Recommendations |
---|---|
Arrhythmia, cardiomyopathy | Fasting glucose and lipid profile every 2 years, refer as indicated. ECHO and/or MUGA at baseline, then periodically as indicated. EKG at baseline. |
Left ventricular dysfunction | ECHO or MUGA at baseline, then periodically as indicated. EKG at baseline, repeat as indicated. |
Atherosclerotic heart disease, congestive heart failure, myocardial infarction, pericardial fibrosis, pericarditis, valvular disease | Fasting glucose and lipid profile every 2 years, refer as indicated. ECHO at baseline, then periodically as indicated. EKG at baseline, repeat as indicated. |
Hypertension | Yearly physical, blood pressure, screening blood work at baseline, repeat as clinically indicated. |
Acute respiratory distress, bronchial obliterans, bronchiectasis, chronic bronchitis, fibrosis, interstitial pneumonitis, pulmonary dysfunction, obstructive lung disease, restrictive lung disease | Chest X-ray. PFTs (including DLCO and spirometry) at baseline, repeat as clinically indicated. |
Chronic sinusitis | Annual history and physical, nasal/sinuses exam. |
7. Conclusions
Acknowledgement
Author Contributions
Conflicts of Interest
References
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Wilson, C.L.; Gawade, P.L.; Ness, K.K. Impairments that Influence Physical Function among Survivors of Childhood Cancer. Children 2015, 2, 1-36. https://doi.org/10.3390/children2010001
Wilson CL, Gawade PL, Ness KK. Impairments that Influence Physical Function among Survivors of Childhood Cancer. Children. 2015; 2(1):1-36. https://doi.org/10.3390/children2010001
Chicago/Turabian StyleWilson, Carmen L., Prasad L. Gawade, and Kirsten K. Ness. 2015. "Impairments that Influence Physical Function among Survivors of Childhood Cancer" Children 2, no. 1: 1-36. https://doi.org/10.3390/children2010001