Among adults who have survived childhood cancers, exercise intolerance is independently linked to emotional distress, achievement of social roles, and health-related quality of life (HRQOL), according to study results published in JAMA Oncology.

Samah Hayek, DrPH, of the department of epidemiology and cancer control at St Jude Children’s Research Hospital in Memphis, Tennessee, and associates conducted a cross-sectional study to determine the relation between exercise intolerance and emotional distress, attainment of social roles, and HRQOL in this patient population.

“Exercise intolerance was defined as relative peak oxygen uptake less than 85% of age- and sex-estimated levels from maximal cardiopulmonary exercise testing.”

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A total of 1041 adult survivors of childhood cancer (50.7% women; mean age, 35.5 years) and 286 community controls (51.4% women; mean age, 34.5 years) were included in the analysis.

The primary outcomes were emotional distress, attainment of social roles, and HRQOL. Emotional distress was measured using the Brief Symptom Inventory-18, which included the Global Severity Index and subscales for depression, anxiety, and somatization. Social roles were sorted based on participant responses to a questionnaire that included educational attainment, employment, and marital status.

Compared with survivor participants, control participants were more likely to be non-Hispanic White (85.2% vs 90.2%), were younger (mean age 35.5 years vs 34.5 years), and reported 150 minutes per week of at least moderate physical activity (51.0% vs 62.6%). In addition, control group members were less likely to have exercise intolerance as well as cardiac, pulmonary, and neurosensory conditions.

After adjustment, exercise intolerance was linked to an increased risk for anxiety (prevalence rate ratio [PRR], 1.95), somatization (PRR, 1.86), unemployment (PRR, 1.76), and for scoring ≤40 on the physical portion of the Medical Outcomes Survey Short Form-36 (PRR, 3.69). Exercise intolerance was also inversely related to having a college degree (PRR, 0.67).

The authors noted several study limitations including the cross-sectional format of the study, a lack of information about patients with the most impairments, insufficient racial/ethnic diversity among participants, results are from a single institution, and eligible participants did not complete all components of the questionnaire.

“Because exercise intolerance may be remediated with training, even in populations with significant chronic disease, this finding provides an opportunity for intervention with broad targets. Enhancing physiologic capacity may not only improve general health and wellness, but also emotional health, the ability to participate optimally in social roles, and perception of quality of life among adult survivors of childhood cancer,” the authors concluded.


Hayek S, Brinkman TM, Plana JC, et al. Association of exercise intolerance with emotional distress, attainment of social roles, and health-related quality of life among adult survivors of childhood cancer [published online June 25, 2020]. JAMA Oncol. doi: 10.1001/jamaoncol.2020.2054

This article originally appeared on Hematology Advisor