Author(s): LANFRANCONI, F., VILLA, E., PELI, L., MORIGGI, T., CORTI, E., CORTI, M., RADAELLI, G., REDAELLI, R., GUARESCHI, S., NAVA, F., JANKOVIC, M., BALDUZZI, A., Institution: FONDAZIONE MONZA E BRIANZA PER IL BAMBINO E LA SUA MAMMA, Country: ITALY, Abstract-ID: 1515

INTRODUCTION:
Cancer is the leading cause of death from non-communicable diseases in children, adolescents and young adults (CAYA-c) in Europe. During blood cancer treatment, patients exercise tolerance and quality of life (QoL) are reduced due to side effects of therapies, physical inactivity/bed rest, and cancer-related fatigue. Personalized exercise training (PEx) in CAYA-c is a promising therapy to alleviate these problems if started soon after diagnosis. However, there is a lack of scientific evidence to support the use of PEx in pediatric oncology. To build on this rationale, it is compelling to recognize that the efficiency of the CAYA-C performance and QoL could still be reduced in the late phases of cancer treatment.

AIM Identify exercise tolerance and QoL outcomes in CAYA-c to address barriers to their inclusion in life and sports activities as early as possible.
METHODS:
CAYA-c aged 9-21 years, both sexes, with a diagnosis of blood cancer, just after the intensive phases of cancer treatment, underwent a cardiopulmonary evaluation at exhaustion (CPET) and peak values were measured (oxygen uptake-VO2, heart rate-HR, rating of perceived exertion-Borg RPE, skeletal muscle O2 extraction by NIRS-HHb/isch). The following tests were used to determine strength and functional capacity: leg extension (LE), 6-minute walk test (6MWT), time up and down stairs (TUDS), sit to stand (StoS), quick motor function (QMFT). The PedsQL Generic Core Scales questionnaire was used (higher scores indicating better QoL).
RESULTS:
Seventeen CAYA-c completed all evaluations (mean±SD: 14.7±3.3 yrs, 41.0% female). The diagnoses were acute lymphoblastic and myeloid leukemia (41% and 7%), lymphoma (52%), and 17% had undergone bone marrow transplantation, 64% were in the maintenance phase of cancer treatment and had already returned to activities outside the hospital, 46% had been off therapy for 14.4±0.2 months. No major clinically relevant events were observed during the evaluations. CPET peak values were impaired: VO2 28.0±4.9 ml/min/kg (68.2±1.3% of predicted values-range 42-89%); HR 167.5±17.2 bpm (84.5±1.0 of predicted values-range 72-105%); Borg RPM 15.9±2.8; HHb/isch 75.0±3.0% (range 26-102%). Strength and functional capacity were impaired: LE 5RM 51.8±25.0 kg; 6MWT distance 529.4±60.7 m; TUDS 5.6±0.7 sec; StoS 6.0±1.0 sec. QMFT scores were normal 63.0±2.0 on 64. PedsQL scores were 76.6±10.3 and 86.9±11.4 (range 67-91 and 71-100) for children and parents, respectively.
CONCLUSION:
Performance assessments could be safely used even in complex clinical settings. Oxidative pathway, strength and functional capacity are still reduced in the final stages of cancer treatment as a result of the individual clinical history, with varying degrees of severity. QoL is affected. PEx introduced early from diagnosis can be an opportunity to address CAYA-c and their families willingness to participate in life and sports activities throughout their care and during long term follow up.