Mayr Anna K, Zürcher Simeon, Bänteli Iris, Hebestreit Helge, Kasteler Rahel, von der Weid Nicolas X, Kriemler Susi, Schindera Christina, Rueegg Corina S
Department of Medicine, University of Zurich, Zurich, Switzerland.
Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD) and University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Cancer. 2025 Sep 1;131(17):e70051. doi: 10.1002/cncr.70051.
Identifying disease burden among childhood cancer survivors (CCS) can guide tailored care. Physical fitness predicts health and mortality and may help reduce disease burden in CCS. This study aimed to 1) describe the burden of clinically ascertained adverse health outcomes in long-term CCS, and 2) investigate the association between physical fitness and adverse health outcomes.
This study used baseline data of the SURfit study, a randomized controlled physical activity trial. The authors included 163 CCS, diagnosed <16 years, ≥16 years at enrollment, and ≥5 years since last cancer diagnosis. Clinically assessed health outcomes were categorized using the Common Terminology Criteria for Adverse Events. Physical fitness was assessed by cardiopulmonary-exercise-test (CPET), hand-grip strength, and the 1-minute sit-to-stand test (STS). Using multivariable Poisson regression models, this study investigated the association between physical fitness and adverse health outcomes.
Participants (30.5 ± 8.6 years old, time since diagnosis 22.9 ± 9 years) had 1170 adverse health outcomes, with 99% CCS having at least one. Musculoskeletal disorders were most common (130 of 163 [80%]). Higher levels of physical fitness were associated with fewer adverse health outcomes of any grade (CPET: prevalence rate ratio [PRR], 0.71 per watt/kg bodyweight, 95% confidence Interval [CI], 0.63-0.81, p < .001; hand-grip: PRR, 0.60 kg/kg bodyweight; 95% CI, 0.35-1.03, p = .063; STS: PRR, 0.95 per five repetitions; 95% CI, 0.93-0.97, p < .001).
CCS participating in an exercise intervention trial experienced a high burden of adverse health outcomes. Increased physical fitness was associated with reduced disease burden for all survivors, emphasizing the importance of encouraging fitness improvements, regardless of cancer history.
确定儿童癌症幸存者（CCS）的疾病负担有助于指导个性化护理。身体健康状况可预测健康状况和死亡率，并可能有助于减轻CCS的疾病负担。本研究旨在：1）描述长期CCS中经临床确诊的不良健康结局的负担；2）调查身体健康状况与不良健康结局之间的关联。
本研究使用了SURfit研究的基线数据，这是一项随机对照体育活动试验。作者纳入了163例CCS，这些患者在确诊时年龄<16岁，入组时年龄≥16岁，且自上次癌症诊断以来已过去≥5年。使用不良事件通用术语标准对临床评估的健康结局进行分类。通过心肺运动试验（CPET）、握力和1分钟坐立试验（STS）评估身体健康状况。本研究使用多变量泊松回归模型调查身体健康状况与不良健康结局之间的关联。
参与者（年龄30.5±8.6岁，确诊后时间22.9±9年）共有1170例不良健康结局，99%的CCS至少有1例。肌肉骨骼疾病最为常见（163例中有130例[80%]）。较高的身体健康水平与任何等级的不良健康结局较少相关（CPET：患病率比[PRR]，每瓦/千克体重为0.71，95%置信区间[CI]，0.63 - 0.81，p <.001；握力：PRR，每千克体重0.60千克；95% CI，0.35 - 1.03，p = 0.063；STS：PRR，每五次重复为0.95；95% CI，0.93 - 0.97，p <.001）。
参与运动干预试验的CCS经历了较高的不良健康结局负担。身体健康状况的改善与所有幸存者疾病负担的减轻相关，强调了鼓励改善健康状况的重要性，无论癌症病史如何。
