Kirsten K. Ness, PT, PhD, on Ensuring Adequate Fitness in Childhood Hodgkin Lymphoma Survivors
Survivors of childhood Hodgkin lymphoma have an increased risk of impaired physical fitness and health-related quality of life, new research suggests.
This finding comes from a study conducted by Kirsten K. Ness, PT, PhD, FAPTA, associate member of the Department of Epidemiology and Cancer Control at St Jude Children’s Research Hospital, and colleagues. They evaluated 336 survivors of childhood-onset Hodgkin lymphoma who were treated at St Jude, along with 327 controls who did not have cancer during childhood.
Ultimately, they found that male survivors had lower endurance and worse neuropathy and female survivors had lower endurance, quadriceps strength, and worse neuropathy compared with controls.
Survivors with neurological, cardiac, and pulmonary conditions demonstrated an especially elevated risk for impaired fitness and health-related quality of life.
Consultant360 discussed this study further with Dr Ness, who explained how clinicians should apply the findings in practice.
Consultant360: Why does childhood Hodgkin lymphoma require such a specialized approach even after treatment has ended? What long-term health risks does this population face compared with other populations?
Dr Ness: Children diagnosed with Hodgkin lymphoma often receive radiation and chemotherapy agents for their disease, which can damage normal tissue. This damage makes them vulnerable to earlier onset of chronic diseases, including heart and lung issues. They also may have weak muscles or peripheral nerve problems, which can make it difficult to exercise after therapy.
Although the majority of survivors do not report poor quality of life, those with poor fitness seem to have an increased risk for poor quality of life.
C360: Your study found that survivors of childhood Hodgkin lymphoma, especially patients with neurological, cardiac, and pulmonary chronic conditions, have an elevated risk for impaired fitness and health-related quality of life. Did you anticipate these findings?
Dr Ness: From our experiences in our clinic with Hodgkin lymphoma survivors, we suspected that this patient population would have difficulty with fitness and that there might be underlying problems that would explain this.
C360: With the findings from your study in mind, how can clinicians help improve fitness and health-related quality of life in adult survivors of childhood Hodgkin lymphoma?
Dr Ness: Exercise interventions work to improve health and fitness, even in people with chronic disease. Hodgkin lymphoma survivors who have significant impairment can still benefit. Those who are having a lot of difficulty will need to have their interventions individualized at first so they can be successful and keep moving. A physical therapist or exercise specialist can help with this.
C360: What is the main clinical message that you would like our audience to take away from this study?
Dr Ness: It is difficult for some Hodgkin lymphoma survivors to exercise because of health issues. When encouraging physical activity, referral for individualized intervention should be considered.
—Christina Vogt
Reference:
Wogksch MD, Howell CR, Wilson CL, et al. Physical fitness in survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort [Published online October 25, 2018]. Pediatr Blood Cancer. https://doi.org/10.1002/pbc.27506.