R-02. Features of the physical status of a child treated for cancer which determine the personified rehabilitation strategy

Summary

The main targets of toxicity caused by combined anticancer therapy are the nervous, inflammatory and endocrine systems, respiratory organs and the musculoskeletal system. The Sufficient damage to one or more of the above systems affects physical condition of the patient. Late toxic effects lead to decrease of general physical activity, physical performance, daily physical activity of patients compared with healthy children. The process of recovery in such children, due to the multimodal effects of anticancer treatment, should be, generally, personified, being based on objective analysis of their current physical condition.

Materials and methods

The report presents the results of a prospective non-randomized study of a case cohort which included more than 2200 children and adolescents aged 6-18 years who underwent rehabilitation courses at the LRRC “Russian Field” from 2017 to the present, and their healthy brothers and sisters who were at the LRRC over the same period of time. The main group (1881 cases, 1055 boys and 826 girls). The mean age of the children was 9.9±4.1 years for girls and 10.1±4.3 for boys, the average remission period was 5.4±2.7 years. The comparison group consisted of healthy siblings (n=398), of which 185 (47%) were boys and 213 (53%) were girls. The mean age of the examined siblings was 9.1±3.8 years (females) and 9.7±3.9 (males).

Results

In general, physical development of children treated for oncological diseases corresponds to that of their healthy siblings. Overweight is recorded more often among children treated for benign brain tumors, on average of 3.5 kilograms more than among healthy peers. In patients with malignant brain tumors, growth retardation was registered more often than in other nosological subgroups. Their average height is 3.2 cm lower than in healthy peers and patients of other nosological subgroups. The share of skeletal muscle mass (SMM) in the body composition of children treated for oncological diseases is much less likely to match the standard values. With complex anticancer treatment, the proportion of SMM was lower by an average of 4.91% compared with healthy persons. Increased indices of the fat mass proportion prevailed in the body composition. This feature was most pronounced in the children aged 9-14 years. More than 40% of children treated for cancer showed a decrease in exercise tolerance at the 6-minute walk test. A decrease in strength endurance of the main muscle groups in children treated for cancer was typical at the age of 6 to 11 years. In older age subgroups, we did not find statistically significant differences in these parameters versus healthy peers. Disturbances of postural stability was registered in this cohort. Nearly all indices of stabilometry in children treated for cancer were significantly different from those in healthy peers. When testing basic motor skills according to Bruninks-Ozeretsky, the children treated for cancer showed lower results by 3 scales: motor coordination, gross motor skills, strength and agility.

Conclusion

Follow-up of children treated for cancer should include screening for physical condition, in which physical development, exercise readiness and motor skills are the most important indices. As based on the objective data obtained during the screening, a personal rehabilitation program should be arranged, and its effectiveness evaluated.

Keywords

Oncological diseases, therapy, children, physical state, motor skills.