After Cancer Treatment
Understanding Developmental And Physical Impairments After Cancer Treatment
Pediatric Cancer Survival Rates:
As advancements in childhood cancer treatments have improved, the 5-year survival rate is now greater than 80%, with an estimated 495,739 pediatric cancer survivors living in the United States as per the most recent census from 2020. However, survivorship comes with its own set of challenges. Educating oneself on the potential side effects of cancer treatment and having a conversation with your care team, now is the best time to start a long-term medical management plan.
Types Of Cancer Treatments:
Cancer treatments can vary depending on the type, the stage, and the location of the cancer. Treatment can include chemotherapy, radiation, immunotherapy, and surgery, consisting of a series or combination of treatments. Stem cell transplants also treat certain types of blood cell cancers. Acute therapies aim to kill the cancer cells or reduce the tumor size. Long-term cancer therapies, otherwise known as maintenance treatments, are aimed at keeping the cancer contained or in remission. Both types of treatment can present with immediate and long-term side effects.
Developmental Delays And Gross Motor Coordination:
If a child receives a cancer diagnosis in the early developmental stages of life, treatment may affect a child’s ability to achieve gross motor developmental milestones on time. Cancer treatment can affect a child’s mobility and coordination development. Mobility and coordination are influenced by the range of motion in a joint and the ability to have full sensation to know where a limb is in space. Radiation or surgical treatments can cause a loss of range of motion in one or more joints. Radiation affects skin integrity by causing it to contract and scar down, which limits the surrounding joint’s range of motion. Restricted movement at a joint can alter the way a child moves, and coordination can become impaired. Address a loss in range of motion early to avoid potential impacts of altered fine and gross motor coordination issues.
Neurological Issues:
Pain resulting from treatment is also a concern, as it may limit a child’s ability to function fully. Neuropathy is nerve pain accompanying numbness and tingling, affecting the hands and feet. Nerve pain and decreased sensation impact fine motor coordination and lower extremity balance. A child experiencing neuropathy may struggle with simple tasks such as gripping a utensil to eat or holding a pencil to write. Neuropathy in the legs and feet affects gross motor movements due to decreased sensation and pain. Impairments may occur with activities such as walking on uneven surfaces, climbing stairs, negotiating a step or curb, and the ability to run. Neuropathy is often a short-term side effect. However, if it persists, a child may struggle to complete simple tasks or avoid them altogether.
Musculoskeletal Issues:
Achieving peak bone mass throughout adolescence and early adulthood determines the risk for osteoporosis and osteoporotic fractures later in life. Pediatric cancer survivors are at risk for developing low bone density. Certain types of cancers, such as sarcomas, cancers of the bone, or leukemias, which are cancers of the blood, directly influence the bone itself. Cancer treatments can delay the onset of puberty, which affects hormones that regulate bone growth. Additionally, decreased physical activity during and post-treatment can contribute to poor bone stimulation, resulting in weak and fragile bones. Poor nutritional intake during and after treatment may lead to nutritional deficiencies. Without the proper building blocks, bone growth suffers.
Exercise Intolerance:
Exercise plays a direct role in regulating metabolism, body composition, muscle development, and cardiovascular health. A common side effect that comes with cancer treatment is fatigue. Prolonged fatigue can result in decreased activity levels, poor endurance, generalized deconditioning, and reduced aerobic capacity. A decline in overall activity levels can result in decreased muscle strength and development. Cancer survivors may suffer from exercise intolerance and struggle to regain prior levels of function or activity levels as compared to their peers and siblings.
Late Effect Disease Risks:
Pediatric cancer survivors are at a higher risk for developing obesity, cardiovascular disease, and diabetes. All-cause mortality rates are higher for survivors later in life. Exercising throughout one’s lifetime is a key predictor of health outcomes. Multiple factors contribute to an individual’s capacity to tolerate exercise. Lifestyle, medications, lung and heart health, and muscle development all play a role in an individual’s ability to perform exercise.
Navigating A Cancer Diagnosis With Empowerment:
Navigating a cancer with empowerment begins at the time of diagnosis. Consult with a child’s medical management team to become educated on potential acute and long-term side effects. During a course of care, doctors may recommend restricted activity levels or place precautions on the level and amount of activity a child may participate in. Once a child is cleared to return to prior activity levels without restrictions by their physician, care should be given to slowly reintroduce activities in short durations to monitor their response and fatigue levels.
Address Physical Impairments Early:
Addressing any physical impairments, such as loss of motion, balance, or coordination issues, immediately as they arise will help decrease or avoid long-term negative impacts on gross motor development. Monitor a child’s timeline for achieving developmental milestones to identify if a delay has occurred. Observe a child during daily activity or play to assess the quality of their movement. Do they struggle with balance, coordination, or moving freely? Does the child tire easily? If a child is struggling with a physical impairment such as loss of range of motion, decreased balance or coordination, or reduced activity tolerance and cannot regain functional levels, consider requesting a referral to a pediatric rehabilitation specialist. Pediatric occupational and physical therapists specialize in the evaluation and treatment of developmental delays and physical impairments.
Additional Resources:
Navigating a cancer diagnosis can be overwhelming. The Sassy Carmen Foundation is here to help. l Sassy Carmen is a 501(c)3 Nonprofit Organization that supports children and families battling pediatric cancer. Sassy Carmen is dedicated to reducing the daily stressors of a pediatric cancer diagnosis so children and their families can live their best lives now.
References
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