The association of health status and health quality with physical activity in childhood cancer survivors Open Access

Abstract

Childhood cancer survivors (CCS) are at risk for therapy-related late effects. Physical activity can help minimize this burden, but CCS’ rates of physical activity are lower than those of siblings or age-matched peers. This study aimed to identify cancer-related and demographic factors associated with low physical activity in CCS and to determine how survivor/proxy perception of survivor health status and health quality are associated with physical activity in CCS.

 

This was a cross-sectional, retrospective study of CCS aged 6-21 years and ≥1 year off-therapy. Low self/proxy-reported physical activity was defined as <5 days per week with ≥60 minutes of activity per day. Perceived health status was assessed using the Patient-Reported Outcomes Measurement Information System Global Health measure with poor health status defined as responses of “fair” or “poor” on questions related to overall, physical, and mental health. Late effects were defined as therapy-related or non-cancer chronic conditions present at survey completion; presence of ≥2 late effects was dichotomized as poor health quality. Multivariable logistic regression was performed to identify associations between physical activity and perceived health status or health quality.

 

Of the 285 CCS, 71.6% reported low physical activity. Negative perceived overall, physical, and mental health was present in 5.6%, 10.5%, and 15.8% of CCS, respectively. Poor health quality was found in 49.8% of CCS. Multivariable analyses did not show a significant association between perceived poor overall health status (OR 1.8, 95% CI 0.46-7.03, p=0.396) and low physical activity, but yielded significant associations between perceived poor physical (OR 6.1, 95% CI 1.38-27.44, p=0.017) and mental (OR 3.5, 95% CI 1.27-9.61, p=0.015) health status and low physical activity, controlling for survey respondent, sex, race/ethnicity, treatment intensity, and age at diagnosis. There was no association between health quality and physical activity. Concordance between teen proxy and self-report of physical activity and perceived health status was low.

 

Addressing perceptions of physical and mental health as part of future physical activity interventions in CCS is critical for optimizing CCS’ health outcomes. Additionally, developing validated self-report tools for younger patients is important, given the discordance between proxy and self-report of physical activity and health status.

Table of Contents

Table of Contents

Introduction/Background:

Methods:

Study design and data collection:

Statistical plan:

Results:

Discussion/Conclusions:

References:

Tables and figures:

Table 1. Demographic and cancer-related variables to be studied

Table 2. Late effects and their definitions

Table 3a. Cohort characteristics by respondent type: demographics

Table 3b. Cohort characteristics by respondent type: cancer-related factors

Table 4. Exposures and outcome of interest by respondent type

Table 5. Multivariable analysis of physical activity with demographic and cancer-related factors

Table 6. Multivariable analysis of physical activity with question-specific perceived overall health status

Table 7. Multivariable analysis of physical activity with question-specific perceived physical health status

Table 8. Multivariable analysis of physical activity with question-specific perceived mental health status

Table 9. Multivariable analysis of physical activity with perceived composite health status in children and teens

Table 10a. Multivariable analysis of physical activity with health quality

Table 10b. Multivariable analyses of physical activity by late effect^a,b

Table 11. Outcome and exposures of interest by biologic sex

Table 12. Multivariable analysis of physical activity with demographic and cancer-related factors by biologic sex

Table 13. Multivariable analysis of physical activity with question-specific perceived overall health status by biologic sex

Table 14. Multivariable analysis of physical activity with question-specific perceived physical health status by biologic sex

Table 15. Multivariable analysis of physical activity with question-specific perceived mental health status by biologic sex

Table 16. Multivariable analysis of physical activity with perceived composite health status by biologic sex

Table 17. Multivariable analysis of physical activity with health quality by biologic sex

Table 18. Frequencies of responses for overall teen cohort and stratified by biologic sex

Table 19. Kappa statistics for overall teen cohort and stratified by biologic sex

Figure 1. Consort diagram for creation of study cohort

Figure 2. General approach to identification of co-variables for inclusion in multivariable analyses through the apriori criteria for confounding

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology
Keyword	childhood cancer survivorship pediatrics health outcomes
Committee Chair / Thesis Advisor	Ann Mertens, Emory University
Committee Members	Matthew Magee, Emory University Karen Effinger, Emory University

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