title: Reconsidering Physical Activity Restrictions for Mononephric Survivors of Childhood Cancer: A Report From the Children's Oncology Group.
abstract: Although traditional recommendations for mononephric childhood cancer survivors are to avoid contact sports in order to protect the remaining kidney, review of available evidence suggests that the majority of renal loss is caused by accidents not involving sports. An interdisciplinary team performed a review of the English literature published from 1999 to 2012 within the PubMed, Cochrane, Google Scholar, and National Guidelines Clearinghouse databases. The level of evidence and proposed recommendations were graded according to an established rubric and GRADE criteria. Our review found that kidney loss is most commonly caused by nonsports activities such as motor vehicle accidents and falls, implying that restrictions on sports-related activity in mononephric pediatric survivors are not well supported. This favors encouraging ordinary sports and related activities without restriction in mononephric childhood cancer survivors because the known benefits of exercise outweigh the exceedingly low risk of renal loss. Accordingly, activity recommendations for mononephric patients have been revised in the most current version of the Children's Oncology Group Long-term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. This has important implications for this and similar populations who may now undertake individual and organized sports without undue regard for their mononephric status.
authors.affiliation: Miller Children's & Women's Hospital, Long Beach, CA, USA mokada@memorialcare.org.
authors.forename: Maki
authors.initials: M
authors.lastname: Okada
authors.affiliation: Duke University School of Nursing, Durham, NC, USA.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hockenberry
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA University of Southern California, Los Angeles, CA, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Meeske
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Kasey E
authors.initials: KE
authors.lastname: Rangan
authors.affiliation: Duke University School of Nursing, Durham, NC, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rodgers
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Yael
authors.initials: Y
authors.lastname: Rosenthal
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA University of Southern California, Los Angeles, CA, USA.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Ruccione
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA University of Southern California, Los Angeles, CA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Freyer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002669:Child Welfare; D015444:Exercise; D005221:Fatigue / Q000517:prevention & control; D006801:Humans; D007680:Kidney Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D009043:Motor Activity; D009392:Nephrectomy / Q000009:adverse effects; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: late effects of cancer; oncology; pediatric