Treatment late effects in long-term survivors of pediatric sarcoma.
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.
Mansky
Patrick
P
Division of Intramural Research, National Center for Complementary and Alternative Medicine, National Institutes of Health, DHHS, Bethesda, Maryland 20892, USA. manskyp@mail.nih.gov
Arai
Andrew
A
Stratton
Pamela
P
Bernstein
Donna
D
Long
Lauren
L
Reynolds
James
J
Chen
Donna
D
Steinberg
Seth M
SM
Lavende
Neil
N
Hoffman
Karen
K
Nathan
Paul C
PC
Parks
Rebecca
R
Augustine
Elizabeth
E
Chaudhry
Usha
U
Derdak
Joanne
J
Wiener
Lori
L
Gerber
Lynn
L
Mackall
Crystal
C
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
D008055:Lipids