Impact of exercise on psychological burden in adult survivors of childhood cancer

A report from the Childhood Cancer Survivor Study

Emily S. Tonorezos, Jennifer S. Ford, Linwei Wang, Kirsten K. Ness, Yutaka Yasui, Wendy Leisenring, Charles A. Sklar, Leslie L. Robison, Kevin C. Oeffinger, Paul C. Nathan, Gregory Armstrong, Kevin Krull, Lee W. Jones

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. Methods: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor health-related quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week−1) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. Results: The prevalence of depression at follow-up was 11.4% (95% CI, 10.6%-12.3%), anxiety 7.4% (95% CI, 6.7%-8.2%) and somatization 13.9% (95% CI, 13.0%-14.9%). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95% CI, 0.72-1.05) for 3 to 6 MET hours per week−1, 0.76 (95% CI, 0.62-0.94) for 9 to 12 MET-hours per week−1, and 0.74 (95% CI, 0.58-0.95) for 15 to 21 MET-hours per week−1. Compared with 0 MET hours per week−1, 15 to 21 MET-hours per week−1 were associated with an adjusted prevalence ratio of 0.79 (95% CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (Ptrend <.001), emotional role limitations (Ptrend =.02), and mental health (Ptrend =.02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P <.05 for all), but not in the domain of cancer pain. Conclusions: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors.

Original languageEnglish (US)
Pages (from-to)3059-3067
Number of pages9
JournalCancer
Volume125
Issue number17
DOIs
StatePublished - Jan 1 2019

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Metabolic Equivalent
Survivors
Exercise
Psychology
Depression
Neoplasms
Anxiety
Short-Term Memory
Self Report
Cognition
Mental Health
Quality of Life
Demography
Organizations
Equipment and Supplies
Health
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Tonorezos, E. S., Ford, J. S., Wang, L., Ness, K. K., Yasui, Y., Leisenring, W., ... Jones, L. W. (2019). Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer, 125(17), 3059-3067. https://doi.org/10.1002/cncr.32173

Impact of exercise on psychological burden in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. / Tonorezos, Emily S.; Ford, Jennifer S.; Wang, Linwei; Ness, Kirsten K.; Yasui, Yutaka; Leisenring, Wendy; Sklar, Charles A.; Robison, Leslie L.; Oeffinger, Kevin C.; Nathan, Paul C.; Armstrong, Gregory; Krull, Kevin; Jones, Lee W.

In: Cancer, Vol. 125, No. 17, 01.01.2019, p. 3059-3067.

Research output: Contribution to journalArticle

Tonorezos, ES, Ford, JS, Wang, L, Ness, KK, Yasui, Y, Leisenring, W, Sklar, CA, Robison, LL, Oeffinger, KC, Nathan, PC, Armstrong, G, Krull, K & Jones, LW 2019, 'Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study', Cancer, vol. 125, no. 17, pp. 3059-3067. https://doi.org/10.1002/cncr.32173
Tonorezos, Emily S. ; Ford, Jennifer S. ; Wang, Linwei ; Ness, Kirsten K. ; Yasui, Yutaka ; Leisenring, Wendy ; Sklar, Charles A. ; Robison, Leslie L. ; Oeffinger, Kevin C. ; Nathan, Paul C. ; Armstrong, Gregory ; Krull, Kevin ; Jones, Lee W. / Impact of exercise on psychological burden in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. In: Cancer. 2019 ; Vol. 125, No. 17. pp. 3059-3067.
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abstract = "Background: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. Methods: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor health-related quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week−1) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. Results: The prevalence of depression at follow-up was 11.4{\%} (95{\%} CI, 10.6{\%}-12.3{\%}), anxiety 7.4{\%} (95{\%} CI, 6.7{\%}-8.2{\%}) and somatization 13.9{\%} (95{\%} CI, 13.0{\%}-14.9{\%}). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95{\%} CI, 0.72-1.05) for 3 to 6 MET hours per week−1, 0.76 (95{\%} CI, 0.62-0.94) for 9 to 12 MET-hours per week−1, and 0.74 (95{\%} CI, 0.58-0.95) for 15 to 21 MET-hours per week−1. Compared with 0 MET hours per week−1, 15 to 21 MET-hours per week−1 were associated with an adjusted prevalence ratio of 0.79 (95{\%} CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (Ptrend <.001), emotional role limitations (Ptrend =.02), and mental health (Ptrend =.02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P <.05 for all), but not in the domain of cancer pain. Conclusions: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors.",
author = "Tonorezos, {Emily S.} and Ford, {Jennifer S.} and Linwei Wang and Ness, {Kirsten K.} and Yutaka Yasui and Wendy Leisenring and Sklar, {Charles A.} and Robison, {Leslie L.} and Oeffinger, {Kevin C.} and Nathan, {Paul C.} and Gregory Armstrong and Kevin Krull and Jones, {Lee W.}",
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T1 - Impact of exercise on psychological burden in adult survivors of childhood cancer

T2 - A report from the Childhood Cancer Survivor Study

AU - Tonorezos, Emily S.

AU - Ford, Jennifer S.

AU - Wang, Linwei

AU - Ness, Kirsten K.

AU - Yasui, Yutaka

AU - Leisenring, Wendy

AU - Sklar, Charles A.

AU - Robison, Leslie L.

AU - Oeffinger, Kevin C.

AU - Nathan, Paul C.

AU - Armstrong, Gregory

AU - Krull, Kevin

AU - Jones, Lee W.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. Methods: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor health-related quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week−1) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. Results: The prevalence of depression at follow-up was 11.4% (95% CI, 10.6%-12.3%), anxiety 7.4% (95% CI, 6.7%-8.2%) and somatization 13.9% (95% CI, 13.0%-14.9%). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95% CI, 0.72-1.05) for 3 to 6 MET hours per week−1, 0.76 (95% CI, 0.62-0.94) for 9 to 12 MET-hours per week−1, and 0.74 (95% CI, 0.58-0.95) for 15 to 21 MET-hours per week−1. Compared with 0 MET hours per week−1, 15 to 21 MET-hours per week−1 were associated with an adjusted prevalence ratio of 0.79 (95% CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (Ptrend <.001), emotional role limitations (Ptrend =.02), and mental health (Ptrend =.02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P <.05 for all), but not in the domain of cancer pain. Conclusions: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors.

AB - Background: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. Methods: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor health-related quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week−1) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. Results: The prevalence of depression at follow-up was 11.4% (95% CI, 10.6%-12.3%), anxiety 7.4% (95% CI, 6.7%-8.2%) and somatization 13.9% (95% CI, 13.0%-14.9%). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95% CI, 0.72-1.05) for 3 to 6 MET hours per week−1, 0.76 (95% CI, 0.62-0.94) for 9 to 12 MET-hours per week−1, and 0.74 (95% CI, 0.58-0.95) for 15 to 21 MET-hours per week−1. Compared with 0 MET hours per week−1, 15 to 21 MET-hours per week−1 were associated with an adjusted prevalence ratio of 0.79 (95% CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (Ptrend <.001), emotional role limitations (Ptrend =.02), and mental health (Ptrend =.02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P <.05 for all), but not in the domain of cancer pain. Conclusions: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors.

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