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Modifying bone mineral density, physical function, and quality of life in children with acute lymphoblastic leukemia
Author(s) -
Cox Cheryl L.,
Zhu Liang,
Kaste Sue C.,
Srivastava Kumar,
Barnes Linda,
Nathan Paul C.,
Wells Robert J.,
Ness Kirsten K.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26929
Subject(s) - medicine , bone mineral , lymphoblastic leukemia , quality of life (healthcare) , bone density , randomized controlled trial , physical therapy , osteoporosis , leukemia , nursing
Background The early effects of childhood acute lymphoblastic leukemia (ALL) include decreased physical function, bone mineral density (BMD/g/cm 2 ), and health‐related quality of life (HRQL). We assessed the capacity of a physical therapy and motivation‐based intervention, beginning after diagnosis and continuing through the end of treatment, to positively modify these factors. Procedure A 2.5‐year randomized controlled trial of 73 patients aged 4–18.99 years within 10 days of ALL diagnosis assessed BMD at baseline (T 0 ) and end of therapy (T 3 ), strength, range of motion, endurance, motor skills, and HRQL at baseline (T 0 ), 8 (T 1 ), 15 (T 2 ), and 135 (T 3 ) weeks. Results There were no significant changes between groups (intervention, n = 33; usual care, n = 40) in BMD ( P = 0.059) at T 3 or physical function and HRQL at T 0 –T 3 . While BMD declined in both the intervention (T 0 = −0.21, T 3 = −0.55) and usual care (T 0 = −0.62, T 3 = −0.78) groups, rates of decline did not differ between groups ( P = 0.56). Univariate analysis (n = 73) showed associations of higher T 3 bone density with body mass index T 1 ( P = 0.01), T 2 ( P = <0.0001), T 3 ( P = 0.01), T 3 ankle flexibility/strength ( P = 0.001), and T 2 parent ( P = 0.02)/T 0 child ( P = 0.03) perceptions of less bodily pain. Conclusions The intervention delivered during treatment was not successful in modifying BMD, physical function, or HRQL. Physical activity, at the level and intensity required to modify these factors, may not be feasible during early treatment owing to the child's responses to the disease and treatment. Future studies will consider intervention implementation during late maintenance therapy, extending into survivorship.