title: Treatment late effects in long-term survivors of pediatric sarcoma.
abstract: OBJECTIVE
  To assess health and musculoskeletal function in survivors of pediatric sarcomas.
  
  
  METHODS
  Thirty-two individuals treated for Ewing sarcoma family of tumors (ESFT), rhabdomyosarcoma (RMS), or non-rhabdomyosarcoma soft tissue sarcomas (NR-STS) with multi-modality therapy were enrolled on this cross-sectional study. Median age at the time of therapy was 15.4 years (range 7.1-34.2), median age at the time of analysis was 37.4 years (17.5-55.4), and median duration of time elapsed from completion of therapy was 17.3 years (2.9-32.6). Participants underwent assessments of musculoskeletal functioning, cardiac function, metabolic and lipid analyses, renal and gonadal function, and psychological evaluation.
  
  
  RESULTS
  This cohort of sarcoma survivors shows expected locoregional limitations in function of the area affected by sarcoma, and impaired global musculoskeletal functioning as evidenced by limited endurance and limited overall activity levels. The cohort also demonstrated substantial rates of cardiac dysfunction, elevated body fat index, hyperlipidemia, chronic psychological distress, and infertility in men (76%) and premature menopause (49%) in women.
  
  
  CONCLUSIONS
  Sarcoma survivors demonstrate diminished locoregional and global musculoskeletal functioning which likely limit occupational opportunities and socioeconomic health. In addition, the combination of diminished cardiac reserve, limited activity levels, and lipid dysregulation in sarcoma survivors suggests that this population is at increased risk for cardiovascular disease, even many years following completion of sarcoma therapy. Sarcoma survivors may benefit from life long follow-up for cardiovascular disease and from occupational counseling upon completion of therapy.
authors.affiliation: Division of Intramural Research, National Center for Complementary and Alternative Medicine, National Institutes of Health, DHHS, Bethesda, Maryland 20892, USA. manskyp@mail.nih.gov
authors.forename: Patrick
authors.initials: P
authors.lastname: Mansky
authors.forename: Andrew
authors.initials: A
authors.lastname: Arai
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
authors.forename: Donna
authors.initials: D
authors.lastname: Bernstein
authors.forename: Lauren
authors.initials: L
authors.lastname: Long
authors.forename: James
authors.initials: J
authors.lastname: Reynolds
authors.forename: Donna
authors.initials: D
authors.lastname: Chen
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Neil
authors.initials: N
authors.lastname: Lavende
authors.forename: Karen
authors.initials: K
authors.lastname: Hoffman
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Parks
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Augustine
authors.forename: Usha
authors.initials: U
authors.lastname: Chaudhry
authors.forename: Joanne
authors.initials: J
authors.lastname: Derdak
authors.forename: Lori
authors.initials: L
authors.lastname: Wiener
authors.forename: Lynn
authors.initials: L
authors.lastname: Gerber
authors.forename: Crystal
authors.initials: C
authors.lastname: Mackall
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D050218:Body Fat Distribution; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007248:Infertility, Male / Q000209:etiology; D008055:Lipids / Q000097:blood; D008297:Male; D008594:Menopause, Premature; D008875:Middle Aged; D009141:Musculoskeletal System / Q000503:physiopathology; D010807:Physical Endurance / Q000502:physiology; D012509:Sarcoma / Q000503:physiopathology* / Q000628:therapy*; D012512:Sarcoma, Ewing / Q000503:physiopathology / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000503:physiopathology / Q000628:therapy; D017741:Survivors
chemical_list: D008055:Lipids