Pediatric Cancer Patients: The ‘How’ and ‘Why’ of Preventing Sequelae
INTRODUCTION
Imagine this: you put up the fight of your life during your championship game and win. The overwhelming sensation of victory washes over you and joy fills your entire body. Now picture that being jeopardized due to a technical difficulty and fear starts to slowly consume your mind. Something that you fought so hard for, might be ripped away. That is how a child in remission feels when they get diagnosed with a secondary illness that could impact the rest of their life. Your championship game is equivalent to their cancer and when that is in peril, they are going to do everything they can to survive and beat it. So how do you prevent something that you don’t know will even happen?
The Effect of Physical Activity in Pediatric Cancer Treatments
The risk of developing secondary illnesses is much higher in cancer patients due to the strain it puts on their health at such a young age. Studies have shown that incorporating physical activity can greatly reduce the risk of these secondary illnesses not only during treatment, but continuing well after the patient is in remission. Researchers found that a combination of aerobic and strength training exercises are most effective. Each individual study showed a marked increase in performance with the different exercises over a longer period of time.
Which Workouts Are Most Beneficial?
It is only within the past 10 years that researchers have started to examine which exercises provide the most benefits to the patient. However, they have found that exercise gives the pediatric cancer patients a better chance to thrive and become fully functional if exercise is somehow incorporated into their treatment plan. Two of the most well known types of exercises are:
1. Strength Training
These workouts typically include seated bench rows, leg press machines, lat pull-downs, and leg extensions. In a study published in the Frontiers of Pediatrics, in-hospital strength training showed an 80%, 88%, and 93% increase in positive performances of specific strength training exercises compared to baseline testing over the course of 19 weeks. They also found that specialized workout plans for individuals can also show many benefits.
2. Aerobic Training
This is used in coordination with strength training, and typically involves the treadmill. It is easy to control and easy to monitor. This helps improve cardiovascular fitness and contributes to building up muscular strength as well.
Understanding Sequelae
There are 43 children diagnosed everyday with a type of pediatric cancer in the United States. 12% of the pediatric cancer patients that are diagnosed, do not survive into adulthood. However, 60% of the patients who survive the cancer, suffer from secondary illnesses further down the line that pose greater health risks. This is what researchers refer to as “sequelae,” which is a condition that results from the cancer that the children had. Here are 8 forms of sequelae a child can potentially face later in their life:
1. Impaired Growth and Development
2. Cognitive Dysfunction
3. Diminished Neurological Function
4. Cardiopulmonary Compromise
5. Musculoskeletal Sequelae
6. Secondary Malignancy
7. Increased Fat Mass (Obesity)
8. Diabetes
Is It Really Working?
You might be thinking “How much of a difference can exercise really make for them, and doesn’t it wear them out?” but you’d be surprised as to how much a child benefits from these exercises. A study published in Medicine and Science in Sports and Exercise, examined the relationship between how effective strength and aerobic training has in pediatric cancer patients compared to control groups. They studied 49 patients between ages 4-18, 25 received the intervention exercises (seated bench rows, leg press machines and treadmill), and 24 were control, which received no exercise. The results showed significant differences between baseline data and result of the intervention group, whereas the control group showed no change. Another study conducted by M.E. Slater, researched 319 pediatric patients between ages 9-18, were asked to examine the levels of their physical activity over the course of the year. The results showed that the high physical activity group showed a lower percentage of fat mass, abdominal subcutaneous fat, and abdominal visceral fat compared to low physical activity group. Exercise has been shown to have no harmful effects to any pediatric cancer patient that has incorporated it into their treatment plan, it only shows beneficial effects.
What Else Can Be Done?
Due to the recent discoveries of many pediatric cancers, we are seeing an astonishing rate of children surviving their diagnosis. However, this means that the evidence of developing sequelae is also new to researchers. There are very few studies examining the importance physical activity can have on preventing sequelae for the pediatric patients. We need to bring attention to the expansion of treatments and how chemotherapy and radiotherapy treatments aren’t always the only option. Physical activity should be mandatory for all pediatric cancer patient treatment plans, and there should be more studies examining different types of exercise. The Exercise Program at the Nationwide Children’s Hospital illustrates their focus of physical activity in pediatric cancer patients through this video:
The Nationwide Children’s Hospital is only one of the many places who have begun to shift their attention to the aftermath of the cancer. Let’s make sure that once that championship game is won, there will be no technical difficulties that might change the score of the game. Let’s continue to change children's lives for the better and improve their quality of life.
Author Bio:
Jocelyn Hill is a senior at Westfield State University, studying Movement Science with a concentration in Sports Medicine and a minor in Psychology. She plans to continue working with children in the medical field and do further research into childhood cancer treatments. You can contact her via email at jocelyn.hill2@gmail.com
References:
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Fiuza-Lucas, C., Herrera-Olivares, A., Lucia, A., Madero, L., Morales, J., Padilla, J., Rincón-Castanedo, C., San Juan, A., Santana-Sosa, E., Santos-Lozano, A., Valensuela, P., (2018). Inhospital Exercise Training in Children with Cancer: Does It Work For All? Frontiers in Pediatrics, 6, 404.
Huang, T. T., & Ness, K. K. (2011). Exercise interventions in children with cancer: a review. International journal of pediatrics, 2011, 461512.
Perondi, M. B., Gualano, B., Guilherme, G. A., Vítor de, S. P., Vicente, O. F., Netto, G., . . . Ana Lúcia, d. S. (2012). Effects of a combined aerobic and strength training program in youth patients with acute lymphoblastic leukemia.Journal of Sports Science & Medicine, 11(3), 387-392.
San Juan, A.,F., Fleck, S. J., Chamorro-Viña, C., Maté-Muñoz, J.,L., & al, e. (2007). EARLY-PHASE ADAPTATIONS TO INTRAHOSPITAL TRAINING IN STRENGTH AND FUNCTIONAL MOBILITY OF CHILDREN WITH LEUKEMIA.Journal of Strength and Conditioning Research, 21(1), 173-7.
Slater, M. E. (2014). Physical activity in childhood cancer survivors (Order No. 3643690). Available from ProQuest Central. (1622415796).
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