Association of exercise with mortality in adult survivors of childhood cancer Journal Article


Authors: Scott, J. M.; Li, N.; Liu, Q.; Yasui, Y.; Leisenring, W.; Nathan, P. C.; Gibson, T.; Armenian, S. H.; Nilsen, T. S.; Oeffinger, K. C.; Ness, K. K.; Adams, S. C.; Robison, L. L.; Armstrong, G. T.; Jones, L. W.
Article Title: Association of exercise with mortality in adult survivors of childhood cancer
Abstract: IMPORTANCE Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. OBJECTIVE To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter cohort analysis among 15 450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. EXPOSURES Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. MAIN OUTCOMES AND MEASURES The primary outcomewas all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. RESULTS The 15 450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8% male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7%(95% CI, 10.6%-12.8%) for those who exercised 0 MET-h/wk, 8.6%(95% CI, 7.4%-9.7%) for 3 to 6 MET-h/wk, 7.4%(95% CI, 6.2%-8.6%) for 9 to 12 MET-h/wk, and 8.0% (95% CI, 6.5%-9.5%) for 15 to 21 MET-h/wk (P <.001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P =.02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40% reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95% CI, 0.44-0.82; P =.001). CONCLUSIONS AND RELEVANCE Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer.
Keywords: survivors; diagnosis; reliability; therapy; breast-cancer; women; men; physical-activity; life; 5-year; cardiovascular events
Journal Title: JAMA Oncology
Volume: 4
Issue: 10
ISSN: 2374-2437
Publisher: American Medical Association  
Date Published: 2018-10-01
Start Page: 1352
End Page: 1358
Language: English
ACCESSION: WOS:000447066300011
DOI: 10.1001/jamaoncol.2018.2254
PROVIDER: wos
PMCID: PMC6181767
PUBMED: 29862412
Notes: Article; Proceedings Paper -- Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) -- JUN 01-05, 2018 -- Chicago, IL -- Source: Wos
Altmetric
Citation Impact
MSK Authors
  1. Lee Winston Jones
    130 Jones
  2. Scott C Adams
    4 Adams
  3. Jessica M Scott
    25 Scott