Abstract
The course of care for children with acute lymphoblastic leukemia (ALL) involves chemotherapy, which causes physical deficits in strength, balance, and sensation, as well as psychosocial effects, including risk of depression. This study highlights the successful use of a six-month fitness and wellness program consisting of physical activity, social interaction, and education, for children with ALL and their best friends, to reduce the physical and psychosocial effects of cancer treatment.
Primary Author and Speaker: Kristen Faucett
Additional Authors and Speakers: Jessica Tsotsoros
Contributing Authors: Ken Randall, Michael Norris
Children undergoing treatment for acute lymphoblastic leukemia (ALL) are at risk for long-term health problems including obesity, cardiopulmonary issues, musculoskeletal problems, impaired neurological function, and cognitive dysfunction (Fuemmeler, et al, 2013; Patti, Paoli, Bianco, & Palma, 2013). Adult ALL survivors report fatigue, anxiety, depression, and fear. (Vina, Wurz, & Culos-Reed, 2013). Physical activity has positive effects on ALL and treatment-related side effects, including improvements in fatigue, strength, flexibility, endurance, motor function, physical activity, and quality of life (Fuemmeler, et al, 2013; Patti, Paoli, Bianco, & Palma, 2013). What we do not know is the effect of peer support - the child's friend - on the activity levels, adherence, and motivation of children with ALL. This study examined the effectiveness of a formal fitness-wellness program to offset the physical and psychosocial effects of ALL and to measure how having a “best friend” would influence motivation and adherence to the program.
We utilized a case-comparison-control design with three groups: the case group consisting of children with ALL, a comparison group of “best friends” who were aged-matched peers who do not have ALL, and a control group comprised of children with ALL who, due to geographic remoteness, could not participate in the program. Participants were recruited through a midwestern Children’s Hospital. Participants were chosen based on being within the maintenance phase of treatment for ALL, age (5-16), and motivation for improved wellness. All members of the case and comparison groups lived within a 45-minute radius of the Tulsa area.
Research questions were informed by quantitative measures taken of participants at the beginning, middle, and end of the six-month intervention. Focus groups were conducted with the children at the end of the program. DEXA scans, urine and blood samples were collected at baseline and conclusion. Height, weight, and abdominal girth were taken weekly. Functional movement was measured using the Movement Assessment Battery for Children (Movement ABC). Strength was tested via myometer. Sensation of the extremities was collected with a tuning fork. Quality of life was measured using the PedsQL and hope was measured using the Children’s Hope Scale. Quantitative data will be analyzed using the Statistical Package for the Social Sciences software (SPSSTAT10) using an alpha level of .05. Lab samples were analyzed using a t-test. Sensation was analyzed using chi square goodness of fit. All other data were analyzed using repeated measures ANOVA.
Preliminary results and data analysis- Scores on the Movement ABC at week 1 and week 12 were compared using a paired-samples t-test. There was a significant difference in the pre intervention scores (M= 6.8, SD= 3.5) and post intervention scores (M= 9.6, SD=4.8); t(4)= 2.13, p = .04. There was also a significant difference in the aim and catch pre intervention scores (M= 8.4, SD= 1.8) and post intervention scores (M=13.2, SD= 3.3); t(4)= 2.13, p = .02. All participants demonstrated improvement on the movement ABC from pre to post assessments indicating a clinically significant change.
A majority of participants experienced physical and psychosocial benefits from the six-month fitness-wellness program. However, few therapists are actively engaging their patients in a similar program upon completion of treatment. These findings highlight the importance of determining community programs that are applicable for a pediatric population. Occupational therapy practitioners working in oncology or a community setting may benefit from utilizing an organized fitness-wellness program for improving the physical and psychosocial health of children completing cancer treatment.
Fuemmeler, B.F., Pendzich, M.K., Clark, K., Lovelady, C., Rosoff, P., Blatt, J., & Demark-Wahnefried, W. (2013). Diet, physical activity, and body composition changes during the first year of treatment for childhood acute leukemia and lymphoma. Journal of Pediatric Hematology Oncology, 35(6), 437-443. doi:10.1097/MPH.0b013e318279cd3e
Patti, A., Paoli, A., Bianco, A., & Palma, A. (2013). Pediatric exercise programs in children with haematological cancer: A systematic review. Journal of Exercise and Sports Sciences, 1(2): 71-86. doi: 10.12863/ejssbx1x2-2013x3
Vina, C.C., Wurz, A.J., & Culos-Reed, N. (2013). Promoting physical activity in pediatric oncology. Where do we go from here? Frontiers in Oncology, 3(173), 1-4. doi: 10.3389/fonc.2013.00173