Long-Term Functional Outcomes Among Childhood Survivors of Cancer Who Have a History of Osteonecrosis
Long-Term Functional Outcomes Among Childhood Survivors of Cancer Who Have a History of Osteonecrosis
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DOI：
10.1093/ptj/pzz176
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发表时间：
2020-03-01
期刊：
影响因子：
3.2
通讯作者：
Ness, Kirsten K.
中科院分区：
文献类型：
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作者：
DeFeo, Brian M.;Kaste, Sue C.;Ness, Kirsten K.
背景用于治疗儿童白血病和淋巴瘤的糖皮质激素可导致骨坏死，导致身体功能障碍和疼痛。提高生存率需要对这一人群的长期结果进行研究。本研究的目的是比较有骨坏死病史的儿童癌症幸存者与无骨坏死病史的幸存者以及健康人（对照组）的身体功能和生活质量（QOL）。这是一项横断面研究。这项研究包括圣犹达终身队列研究的参与者，他们被诊断为儿童白血病或淋巴瘤>= 10年，>= 18岁; 135人患有骨坏死（52.5%男性;平均年龄= 27.7 [SD = 6.08]岁）和1560例无骨坏死病史（52.4%男性;平均年龄= 33.3 [SD = 8.54]岁）。这项研究还包括272名来自社区的健康人（社区对照）（47.7%男性;平均年龄= 35.1 [SD = 10.46]岁）。参与者完成功能评估和QOL问卷。骨坏死幸存者的背屈强度评分低于其他幸存者和对照组（平均评分= 16.50 [SD = 7.91] vs 24.17 [SD = 8.61] N.m/kg），并且在坐立前伸测试中的灵活性评分低于对照组（20.61 [SD = 9.70] vs 23.96 [SD = 10.73] cm），物理性能测试功能（平均得分= 22.73 [SD = 2.05]对23.58 [SD = 0.88]），以及定时“起身和行走”测试的移动性（5.66 [SD = 2.25]对5.12 [SD = 1.28]秒）。需要手术的髋关节骨坏死幸存者的背屈强度评分低于没有骨坏死的幸存者（13.75 [SD = 8.82] vs 18.48 [SD = 9.04] N中心点m/kg），柔韧性（15.79 [SD = 8.93] vs 20.37 [SD = 10.14] cm）和6分钟步行试验的耐力（523.50 [SD = 103.00] vs 572.10 [SD = 102.40] m）。由于一些合格的幸存者拒绝参加，可能的选择偏差是本研究的局限性。与对照组相比，儿童白血病和淋巴瘤伴或不伴骨坏死的幸存者表现出身体机能受损，并报告生活质量降低，其中因骨坏死需要手术的患者最有损伤风险。为患有儿科癌症和骨坏死的患者提供强化、灵活性和耐力干预可能有利于长期功能。
Background. Glucocorticoids used to treat childhood leukemia and lymphoma can result in osteonecrosis, leading to physical dysfunction and pain. Improving survival rates warrants research into long-term outcomes among this population.Objective. The objective of this study was to compare the physical function and quality of life (QOL) of survivors of childhood cancer who had an osteonecrosis history with that of survivors who had no osteonecrosis history and with that of people who were healthy (controls).Design. This was a cross-sectional study.Methods. This study included St Jude Lifetime Cohort Study participants who were >= 10 years from the diagnosis of childhood leukemia or lymphoma and >= 18 years old; 135 had osteonecrosis (52.5% men; mean age = 27.7 [SD = 6.08] years) and 1560 had no osteonecrosis history (52.4% men; mean age = 33.3 [SD = 8.54] years). This study also included 272 people who were from the community and who were healthy (community controls) (47.7% men; mean age = 35.1 [SD = 10.46] years). The participants completed functional assessments and questionnaires about QOL.Results. Survivors with osteonecrosis scored lower than other survivors and controls for dorsiflexion strength (mean score = 16.50 [SD = 7.91] vs 24.17 [SD = 8.61] N.m/kg) and scored lower than controls for flexibility with the sit-and-reach test (20.61 [SD = 9.70] vs 23.96 [SD = 10.73] cm), function on the Physical Performance Test (mean score = 22.73 [SD = 2.05] vs 23.58 [SD = 0.88]), and mobility on the Timed "Up & Go" Test (5.66 [SD = 2.25] vs 5.12 [SD = 1.28] seconds). Survivors with hip osteonecrosis requiring surgery scored lower than survivors without osteonecrosis for dorsiflexion strength (13.75 [SD = 8.82] vs 18.48 [SD = 9.04] N center dot m/kg), flexibility (15.79 [SD = 8.93] vs 20.37 [SD = 10.14] cm), and endurance on the 6-minute walk test (523.50 [SD = 103.00] vs 572.10 [SD = 102.40] m).Limitations. Because some eligible survivors declined to participate, possible selection bias was a limitation of this study.Conclusions. Survivors of childhood leukemia and lymphoma with and without osteonecrosis demonstrated impaired physical performance and reported reduced QOL compared with controls, with those requiring surgery for osteonecrosis most at risk for impairments. It may be beneficial to provide strengthening, flexibility, and endurance interventions for patients who have pediatric cancer and osteonecrosis for long-term function.