Association of Exercise with Mortality in Adult Survivors of Childhood Cancer

Jessica M. Scott, Nan Li, Qi Liu, Yutaka Yasui, Wendy Leisenring, Paul C. Nathan, Todd Gibson, Saro H. Armenian, Tormod S. Nilsen, Kevin C. Oeffinger, Kirsten K. Ness, Scott C. Adams, Leslie L. Robison, Gregory Armstrong, Lee W. Jones

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Importance: Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. Objective: To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. Design, Setting, and Participants: Multicenter cohort analysis among 15450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. Exposures: Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. Results: The 15450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8% male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7% (95% CI, 10.6%-12.8%) for those who exercised 0 MET-h/wk, 8.6% (95% CI, 7.4%-9.7%) for 3 to 6 MET-h/wk, 7.4% (95% CI, 6.2%-8.6%) for 9 to 12 MET-h/wk, and 8.0% (95% CI, 6.5%-9.5%) for 15 to 21 MET-h/wk (P <.001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P =.02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40% reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95% CI, 0.44-0.82; P =.001). Conclusions and Relevance: Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer..

Original languageEnglish (US)
Pages (from-to)1352-1358
Number of pages7
JournalJAMA Oncology
Volume4
Issue number10
DOIs
StatePublished - Oct 1 2018

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Survivors
Metabolic Equivalent
Exercise
Mortality
Neoplasms
Health
Recurrence
Pediatric Hospitals
Tertiary Care Centers
Canada
Cohort Studies
Regression Analysis
Maintenance
Outcome Assessment (Health Care)
Interviews
Incidence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Scott, J. M., Li, N., Liu, Q., Yasui, Y., Leisenring, W., Nathan, P. C., ... Jones, L. W. (2018). Association of Exercise with Mortality in Adult Survivors of Childhood Cancer. JAMA Oncology, 4(10), 1352-1358. https://doi.org/10.1001/jamaoncol.2018.2254

Association of Exercise with Mortality in Adult Survivors of Childhood Cancer. / Scott, Jessica M.; Li, Nan; Liu, Qi; Yasui, Yutaka; Leisenring, Wendy; Nathan, Paul C.; Gibson, Todd; Armenian, Saro H.; Nilsen, Tormod S.; Oeffinger, Kevin C.; Ness, Kirsten K.; Adams, Scott C.; Robison, Leslie L.; Armstrong, Gregory; Jones, Lee W.

In: JAMA Oncology, Vol. 4, No. 10, 01.10.2018, p. 1352-1358.

Research output: Contribution to journalArticle

Scott, JM, Li, N, Liu, Q, Yasui, Y, Leisenring, W, Nathan, PC, Gibson, T, Armenian, SH, Nilsen, TS, Oeffinger, KC, Ness, KK, Adams, SC, Robison, LL, Armstrong, G & Jones, LW 2018, 'Association of Exercise with Mortality in Adult Survivors of Childhood Cancer', JAMA Oncology, vol. 4, no. 10, pp. 1352-1358. https://doi.org/10.1001/jamaoncol.2018.2254
Scott JM, Li N, Liu Q, Yasui Y, Leisenring W, Nathan PC et al. Association of Exercise with Mortality in Adult Survivors of Childhood Cancer. JAMA Oncology. 2018 Oct 1;4(10):1352-1358. https://doi.org/10.1001/jamaoncol.2018.2254
Scott, Jessica M. ; Li, Nan ; Liu, Qi ; Yasui, Yutaka ; Leisenring, Wendy ; Nathan, Paul C. ; Gibson, Todd ; Armenian, Saro H. ; Nilsen, Tormod S. ; Oeffinger, Kevin C. ; Ness, Kirsten K. ; Adams, Scott C. ; Robison, Leslie L. ; Armstrong, Gregory ; Jones, Lee W. / Association of Exercise with Mortality in Adult Survivors of Childhood Cancer. In: JAMA Oncology. 2018 ; Vol. 4, No. 10. pp. 1352-1358.
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abstract = "Importance: Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. Objective: To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. Design, Setting, and Participants: Multicenter cohort analysis among 15450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. Exposures: Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. Results: The 15450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8{\%} male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7{\%} (95{\%} CI, 10.6{\%}-12.8{\%}) for those who exercised 0 MET-h/wk, 8.6{\%} (95{\%} CI, 7.4{\%}-9.7{\%}) for 3 to 6 MET-h/wk, 7.4{\%} (95{\%} CI, 6.2{\%}-8.6{\%}) for 9 to 12 MET-h/wk, and 8.0{\%} (95{\%} CI, 6.5{\%}-9.5{\%}) for 15 to 21 MET-h/wk (P <.001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P =.02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40{\%} reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95{\%} CI, 0.44-0.82; P =.001). Conclusions and Relevance: Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer..",
author = "Scott, {Jessica M.} and Nan Li and Qi Liu and Yutaka Yasui and Wendy Leisenring and Nathan, {Paul C.} and Todd Gibson and Armenian, {Saro H.} and Nilsen, {Tormod S.} and Oeffinger, {Kevin C.} and Ness, {Kirsten K.} and Adams, {Scott C.} and Robison, {Leslie L.} and Gregory Armstrong and Jones, {Lee W.}",
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T1 - Association of Exercise with Mortality in Adult Survivors of Childhood Cancer

AU - Scott, Jessica M.

AU - Li, Nan

AU - Liu, Qi

AU - Yasui, Yutaka

AU - Leisenring, Wendy

AU - Nathan, Paul C.

AU - Gibson, Todd

AU - Armenian, Saro H.

AU - Nilsen, Tormod S.

AU - Oeffinger, Kevin C.

AU - Ness, Kirsten K.

AU - Adams, Scott C.

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Jones, Lee W.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Importance: Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. Objective: To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. Design, Setting, and Participants: Multicenter cohort analysis among 15450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. Exposures: Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. Results: The 15450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8% male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7% (95% CI, 10.6%-12.8%) for those who exercised 0 MET-h/wk, 8.6% (95% CI, 7.4%-9.7%) for 3 to 6 MET-h/wk, 7.4% (95% CI, 6.2%-8.6%) for 9 to 12 MET-h/wk, and 8.0% (95% CI, 6.5%-9.5%) for 15 to 21 MET-h/wk (P <.001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P =.02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40% reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95% CI, 0.44-0.82; P =.001). Conclusions and Relevance: Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer..

AB - Importance: Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. Objective: To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. Design, Setting, and Participants: Multicenter cohort analysis among 15450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. Exposures: Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. Results: The 15450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8% male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7% (95% CI, 10.6%-12.8%) for those who exercised 0 MET-h/wk, 8.6% (95% CI, 7.4%-9.7%) for 3 to 6 MET-h/wk, 7.4% (95% CI, 6.2%-8.6%) for 9 to 12 MET-h/wk, and 8.0% (95% CI, 6.5%-9.5%) for 15 to 21 MET-h/wk (P <.001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P =.02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40% reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95% CI, 0.44-0.82; P =.001). Conclusions and Relevance: Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer..

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