Exercise Intolerance Linked to Emotional Distress, HRQoL in Adult Survivors of Childhood Cancer

For adults who are survivors of childhood cancer, exercise intolerance may be correlated with emotional health, the ability to take part in social roles, and health-related quality of life (HRQoL), a study found.

“Exercise intolerance is associated with increased risk for morbidity and mortality in childhood cancer survivors. However, an association between exercise intolerance and psychosocial outcomes has not been fully explored,” the study authors explained.

Patients from the St. Jude Lifetime Cohort, which took place at St. Jude Children’s Research Hospital, were identified. A total of 1,041 adult survivors of childhood cancer and 286 community controls were included in the study, which took place from April 1, 2012, through March 15, 2020. The main exposure was exercise intolerance, defined as relative peak oxygen uptake <85% of estimated levels based on age and sex from cardiopulmonary exercise testing. The primary outcomes were emotional distress (per the 18-item Brief Symptom Inventory-18), social attainment (per patient-reported educational, employment, and marital status), and HRQoL (per the Medical Outcomes Survey Short-Form 36). Emotional distress was defined as a T score ≤63 on the Brief Symptom Inventory-18, and poor HRQoL was defined as a T score ≤40 on the Medical Outcomes Survey Short Form-36.

In the adult survivors of childhood cancer cohort, the mean [SD] age was 35.5 [9.2] years, and 528 patients (50.7) were women. The controls had a mean [SD] age of 34.5 [10.0] years. The cohort of survivors had a higher rate of exercise intolerance than the control group (survivors, n=634 (60.9%) vs. controls, n=75 (26.2%); P<0.001). When adjusting for age at diagnosis and cardiopulmonary exercise testing, sex, race/ethnicity, smoking, physical activity, and exercise intolerance were correlated with an increased risk for anxiety (prevalence rate ratio [PRR], 1.95; 95% confidence interval [CI], 1.20 to 3.16), somatization (PRR, 1.86; 95% CI, 1.23 to 2.80), and unemployment (PRR, 1.76; 95% CI, 1.23 to 2.52), while the risk was lower among those with a college degree (PRR, 0.67; 95% CI, 0.50 to 0.88). Those with exercise intolerance were more likely to score ≤40 on the physical component summary of the Medical Outcomes Survey Short Form-36 (PRR, 3.69; 95% CI, 2.34 to 5.84).

The study was published in JAMA Oncology.

“The findings of this study suggest that exercise intolerance is independently associated with emotional distress, attainment of social roles, and health-related quality of life of long-term survivors of childhood cancer. The results also suggest that improving physiologic capacity may benefit general health and wellness, as well as emotional health, ability to participate in social roles, and health-related quality of life,” the study authors summarized.