6221 Exercise as a therapeutic intervention to improve QoL and reduce CRF in childhood cancer

Objectives To investigate the feasibility of an exercise intervention to improve quality of life (QoL) and cancer-related fatigue (CRF) in paediatric patients undergoing active treatment for any cancer type. Children experience impairment in QoL and fatigue, both during and after cancer treatment. Patients have difficulty regaining baseline physical function and remain at increased risk of preventable late effects and co-morbidities long after treatment is complete.5 Methods In this systematic review we searched 7 databases/registers (see figure 1- PRISMA flowchart summarising search strategy) for RCT's and cohort studies evaluating exercise interventions in paediatric cancer patients undertaken within the last 10 years. Attempts were made to source data from ongoing studies where appropriate. Studies included ages 3–25, with any cancer type currently receiving active treatment. Data was collated through database searching, full text search and data extraction. Analysis was performed using the rob2 Cochrane bias review tool. Results were calculated by pooling standard deviations of the primary end point from within the intervention group (not including long-term follow up due to confounding detraining effect) using data from studies that employed the PedsQL Multi-dimensional Fatigue scale and PedsQL QoL Inventory respectively. Results Three of six eligible papers (N=105) measuring CRF as an outcome1 2 5 displayed a significant p-value for reduction of total fatigue score (0.001, 0.01, 0.026). All other papers displayed a lower CRF score in the intervention group with a mean reduction in score of -5.7 (±8.82 pooled standard deviation), although none reached significance. One of five eligible papers (N=99) measuring QoL as an outcome 3 reported a significant improvement in QoL score (0.014). Non-significant favourable outcomes were reported in all remaining studies, with a mean reduction of 1.7 (pooled standard deviation ±45.9). Decline was noted across both groups in line with the nature of disease and treatment, but trend of decline was larger in the control group. Conclusion Physical activity is a feasible and safe means of improving both CRF and QoL in children undergoing treatment for cancer. Fatigue is a major side effect of disease and treatment, increasing risks of inactivity. This has physical consequences of reduced bone mineral density and muscle mass, in addition to impairments in cognitive and social functioning.4 Various durations and disciplines of exercise improved scores for both QoL and CRF, with several trials reporting statistically significant benefits in both parameters. Further research, including randomised controlled trials, is needed to make evidence-based recommendations for targeted therapeutic exercise programmes to benefit this vulnerable population. References Jung, Michael, et al. Physiotherapy Quarterly, 2021. Masoud, Afnan Essam, et al. Annals of Medicine, 2023. Munsie, Claire, et al. Supportive Care in Cancer, 2022. Steur, Lindsay, et al. Expert Review of Quality of Life in Cancer Care, 2016. Stössel, Sandra, et al. Frontiers in Paediatrics, 2020.