J Cancer Surviv. 2025 Aug 15. doi: 10.1007/s11764-025-01877-3. Online ahead of print.
ABSTRACT
PURPOSE: Exercise-induced symptoms (EIS) are common in children and understudied in childhood cancer survivors (CCS). We assessed the prevalence of EIS in CCS and identified associated risk factors.
METHODS: We included CCS aged 6-21 years who were diagnosed with cancer ≥ 1 year before study entry, were treated with systemic anticancer treatment, chest surgery, radiotherapy, or hematopoietic stem cell transplantation, completed cancer treatment, and received pediatric oncology follow-up care. Participants completed a questionnaire on respiratory symptoms and lifestyle. To explore risk factors of EIS, we used multivariable logistic regression and calculated population attributable fractions (PAFs).
RESULTS: Of 196 participants (median age 14 years [IQR 10-17]), 46 (24%) reported EIS, including dyspnea (14%), cough (12%), and wheeze (7%). EIS were more common among females (OR 2.5, 95% CI 1.1-5.9), older survivors (OR 1.2 per year, 95% CI 1.1-1.3,), and those with obesity (OR 4.7, 95% CI 1.1-19.6), asthma (OR 10.1, 95% CI 3.3-31.2), and physical inactivity (OR 2.9, 95% CI 1.3-6.6). Chest-directed radiotherapy tended also to increase the risk (OR 2.4, 95% CI 0.6-9.2). Twenty percent of EIS were attributable to asthma, 18% to physical inactivity, and 7% to obesity, with a combined PAF of 44%.
CONCLUSIONS: EIS affect one in four CCS and are primarily associated with risk factors common in the general population rather than cancer treatments.
IMPLICATIONS FOR CANCER SURVIVORS: Clinical investigation and management of common causes of EIS, particularly asthma, physical inactivity, and obesity, could reduce symptom burden and support long-term health in CCS.
PMID:40817300 | DOI:10.1007/s11764-025-01877-3
