No Reduction in the Prevalence of Poor Physical Function in Survivors of ALL and NHL Seen Across Three Decades

Despite changes in therapy for childhood acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL), the prevalence of poor physical function among these patients remained constant between the 1970s and 1990s, according to research published in Journal of Cancer Survivorship.

Researchers described the prevalence of reduced function among survivors of ALL and NHL by treatment decade (1970-1979, 1980-1989, and 1990-1999) using data from the Childhood Cancer Survivor Study (CCSS; ClinicalTrials.gov Identifier: NCT01120353).

CCSS participants include survivors of childhood ALL and NHL (≥5 years from diagnosis) and a cohort of their siblings. The primary outcomes of the new study were self-reported physical performance limitations, assessed using a questionnaire.

The investigators compared prevalence of reduced function between the survivors and their siblings, overall and stratified by treatment decade. They also evaluated associations between organ system-specific chronic conditions and function.

The study included 6511 survivors (mean age, 25.9 years) and 4127 siblings (mean age, 29.9 years; P <.01). Compared with siblings, survivors more often were male (56.3% vs 46.7%), failed to complete high school (8.4% vs 4.2%), and to have never smoked (70.6% vs 60.5%; P <.001 for all).

Overall, compared with siblings, survivors had increased risk of performance limitations (15.2% vs 12.5%; prevalence ratio [PR], 1.5, 95% CI, 1.3-1.6) and restrictions in personal care (2.0% vs 0.6%; PR, 3.1; 95% CI, 2.0-4.8), routine activities (5.5% vs 1.6%; PR, 3.6; 95% CI, 2.7-4.8), and work/school attendance (8.8% vs 2.1%; PR, 4.5; 95% CI, 3.6-5.7). The prevalence of reduced function among survivors did not decrease between the 1970s and 1990s. 

The presence of neurological and cardiovascular conditions were associated with reduced function across all decades. The presence of musculoskeletal and endocrine conditions were associated with personal care and attendance at school/work in the 1970s and with performance limitations and participation restrictions in the 1980s and 1990s.

“Understanding the factors associated with performance limitations and participation restrictions is important because deficits in physical function are associated with poor health-related quality of life and reduced societal attainment (e.g., not graduating high school, being unemployed or unmarried and low income) among survivors,” the study authors explained in their report. “Our findings support screening for reduced physical function so that early interventions to improve physical performance and mitigate chronic disease can be initiated.”

Limitations of the study included potential participation bias that could lead to under- or overestimation of effect estimates, reliance on a self-report questionnaire, and use of treatment decade as a surrogate measure of changes in therapy over time.

Reference

Wilson CL, Bjornard KL, Partin RE, et al. Trends in physical functioning in acute lymphoblastic leukemia and non-Hodgkin lymphoma survivors across three decades. J Cancer Surviv. Published online November 8, 2023. doi:10.1007/s11764-023-01483-1

This article originally appeared on Hematology Advisor