Exercise Medicine & Childhood Cancer
What is Childhood Cancer?
Each year, 950 children and adolescents in Australia are diagnosed with cancer. Every week, nearly three children and adolescents in Australia die from cancer.
In most cases, we don’t know exactly why children get cancer. The risk factors that affect adults (e.g. environmental exposures, lifestyle, infections) are possible causes but are far less likely as children are too young for substantial effects to take place. Tumours can develop as a result of a genetic error made in children that affects them before birth or as they are developing.
Children’s bodies have great capacity for healing, and because of this - many children with cancer have high survival rates. With more recent advances in technology and treatment of childhood cancer, over 80% of children are successfully treated and become long-term survivors.
Most research suggest that being a childhood cancer survivor does not substantially reduce the likelihood of living a long life and that most children have a similar survival rate to children who have not had cancer.
Health Effects of Cancer in Children:
The management of childhood cancer may revolve heavily around lengthy treatment cycles, which can include surgical removal of a solid tumour, multiple chemotherapy medications, bursts of radiation every few weeks or other novel treatment approaches.
Needless to say, integration into a normal school/social setting is not an easy task for these children. On top of the side effects of pain, nausea, fatigue, poor balance, reduced strength and flexibility in addition cognitive declines - the emotional burden placed on the child and their family can be huge.
The effects of diabetes, cardiovascular disease and lung/respiratory issues (which are also often present in children with cancer) can complicate physical activity and exercise for many reasons. On the other hand these conditions and their symptoms are also highly responsive to exercise when appropriately prescribed. This is incredibly important in children whom an important goal is to slow the progression of disease and prevent the onset of further complications/ comorbidities.
The effects of bed rest due to fatigue (which often becomes a large part of these types of chemotherapy treatment regimes) can also lead to further reductions in balance, strength and lower limb flexibility. This can turn into a cycle in which reduced physical activity and movement results in progressively less capacity to undertake physical activity and move regularly - which is why it can be useful to have a plan in place to maintain movement and mobility before impairments show up.
How Does Exercise Help Children Living with Cancer ?
While the majority research in children with cancer tends to look at the effect of exercise in those with Leukemia, there is strong evidence to suggest the same outcomes seen in adults with cancer can be induced in children.
Check out our Exercise Oncology intro resource if you haven’t already for more information on how this works.
The key thing is that the prescription of exercise in individualised to the person with cancer - there is no one-size-fits-all approach to exercise oncology.
Exercise can improve breathing and circulation and can also enhance circulating hormones/neurotransmitters responsible for regulating fatigue, pain, mood and cognition/clear thinking.
Research also shows that exercise is also has direct effects on delaying cancer growth and improving responses to chemotherapy and radiation, as well as post surgical recovery.
The key outcomes that can be expected from an exercise physiology intervention in childhood cancer are :
enhancing immune system function
preserving muscle mass
reducing fatigue
improving balance and flexibility
maintaining and improving overall exercise tolerance and capacity to be physically active
decreasing risk for other complications from treatment (such as nerve damage and cardiovascular disease)
developing motor skills and movement patterns for normal growth and participation in physical activity
Goal Setting
In children with cancer, the reasons behind doing exercise are similar to that of adults with cancer, as well as of children without cancer. With their entire lives ahead of them, it can be a challenge to clearly navigate and prioritise the most important things to achieve from a therapeutic exercise program.
A useful method of setting effective goals is the S M A R T approach (see below).
After a general goal (either short term or long term) has been identified, it is much more likely to succeed if you work with someone to make the goal specific, measurable, achievable, relevant/realistic and with a timeframe to stick to.
For younger children it is still important to have goals around normal motor development and attaining motor skills to allow regular movement and physical activity participation to remain an option throughout life.
For older adolescents motor skills and development is still important, although goals may become more focused toward re-integrating into normal life. This might involve a return to school, a return to friends and social events, as well as a return to the difficult challenges of navigating the transition from childhood into adulthood. The effects of long term treatment and ongoing illness requires a holistic management approach that aims previous identity before cancer.
For some - this may be setting goals around developing the fitness and strength to play sports, or developing the immunity and fatigue resistance to watch a game of sports with friends. For others - it may involve developing the balance and flexibility required to wear high heels to a school formal.
All of these goals can be achieved with the correct guidance on an appropriate exercise prescription, the key thing is that all aspects of goal setting and treatment are individualised .
For a general guide on Exercise for Children check Exercise & Sport’s Science Australia’s latest eBook, “Exercise for Kids”.
Clinical Exercise Physiologists are qualified to understand the complexities around working with children living with cancer and other conditions resulting in disability. They will work with doctors and other allied health professionals to ensure your child’s safety, wellbeing and optimum treatment outcomes. They also use their skills and knowledge of physiology and pathology to prescribe effective exercise and movement based interventions that are individualised to your/your child’s specific needs.
If you’d like more information on any of the information above or would like a better understanding of how movement can be medicine for you, keep an eye out for more content like this or get in touch for a personalised plan of action today.