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Assessment of pulmonary outcomes, exercise capacity, and longitudinal changes in lung function in pediatric survivors of high‐risk neuroblastoma
Author(s) -
Stone Anne,
Friedman Danielle Novetsky,
Kushner Brian H.,
Wolden Suzanne,
Modak Shakeel,
LaQuaglia Michael P.,
Costello Jessica,
Wu Xian,
Cheung NaiKong,
Sklar Charles A.
Publication year - 2019
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.27960
Subject(s) - medicine , vital capacity , spirometry , pulmonary function testing , dlco , cohort , lung volumes , diffusing capacity , physical therapy , lung , asthma , lung function
Background/objectives Survivors of high‐risk neuroblastoma (NB) are exposed to multimodality therapies early in life and confront late therapy‐related toxicities. This study assessed respiratory symptoms, exercise capacity, and longitudinal changes in pulmonary function tests (PFTs) among survivors. Design/methods Survivors of high‐risk NB followed in the long‐term follow‐up clinic at Memorial Sloan Kettering Cancer Center were enrolled. Symptom and physical activity questionnaires were completed. Medical records were reviewed for treatments and comorbidities. Participants completed spirometry, plethysmography, diffusion capacity of the lung for carbon monoxide, 6‐minute walk tests (6MWTs), and cardiopulmonary exercise testing. Questionnaires and PFTs were repeated at least one year after enrollment. Results Sixty‐two survivors participated (median age at study: 10.92 years; median age at diagnosis: 2.75 years; median time since completion of therapy: 5.29 years). Thirty‐two percent had chronic respiratory symptoms. Seventy‐seven percent had PFT abnormalities, mostly mild to moderate severity. Thirty‐three completed 6MWTs (median, 634.3 meters); eight completed cardiopulmonary exercise tests (mean VO 2 max: 63% predicted); 23 completed a second PFT revealing declines over a median 2.97 years (mean percent predicted forced vital capacity: 79.9 to 70.0; mean forced expiratory volume in 1 second: 81.6 to 69.9). Risks for abnormalities included thoracic surgery, chest radiation therapy (RT), thoracic surgery plus chest RT, and hematopoietic stem cell transplant. Conclusions In this cohort of survivors of high‐risk NB, PFT abnormalities were common but mostly mild or moderate. Maximal exercise capacity may be affected by respiratory limitations and declines in lung function may occur over time. Continued pulmonary surveillance of this at‐risk population is warranted.