Nicolas von der Weid

Introduction Childhood cancer survivors (CCS) are at risk of experiencing lower quality‐of‐life, fatigue, and depression. Few randomized controlled trials have studied the effect of physical activity (PA) on these in adult long‐term CCS. This study investigated the effect of a 1‐year individualized PA intervention on health‐related quality‐of‐life (HRQOL), fatigue, and distress symptoms in adult CCS. Methods The SURfit trial randomized 151 CCS ≥16 years old, <16 at diagnosis and ≥5 years since diagnosis, identified through the Swiss Childhood Cancer Registry. Intervention participants received personalized PA counselling to increase intense PA by ≥2.5 h/week for 1 year. Controls maintained usual PA levels. The authors assessed physical‐ and mental‐HRQOL, fatigue, and distress symptoms at baseline, 3, 6, and 12 months. T‐scores were calculated using representative normative populations (mean = 50, standard deviation = 10). Generalized linear mixed‐effects models with intention‐to‐treat (ITT, primary), and three per‐protocol allocations were used. Results At 12 months, ITT (–3.56 larger decrease, 95% confidence interval –5.69 to –1.43, p = .001) and two per‐protocol analyses found significantly lower fatigue. Physical‐HRQOL improved significantly in two per‐protocol analyses at 12 months. No other effects were found. Conclusion SURfit showed that increased intense PA over 1 year improved fatigue in adult CCS. Survivors should be recommended PA to reduce the burden of late‐effects.

Objective Childhood cancer survivors are at risk for pulmonary morbidity due to exposure to lung‐toxic treatments, including specific chemotherapeutics, radiotherapy, and surgery. Longitudinal data on lung function and its change over time are scarce. We investigated lung function trajectories in survivors over time and the association with lung‐toxic treatments. Methods This retrospective, multicenter cohort study included Swiss survivors diagnosed between 1990 and 2013 and exposed to lung‐toxic chemotherapeutics or thoracic radiotherapy. Pulmonary function tests (PFTs), including forced expiration volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity, and diffusion capacity of the lung for carbon monoxide, were obtained from hospital charts. We calculated z‐scores and percentage predicted, described lung function over time, and determined risk factors for change in FEV1 and FVC using multivariable linear regression. Results We included 790 PFTs from 183 survivors, with a median age of 12 years at diagnosis and 5.5 years of follow‐up. Most common diagnosis was lymphoma (55%). Half (49%) of survivors had at least one abnormal pulmonary function parameter, mainly restrictive (22%). Trajectories of FEV1 and FVC started at z‐scores of −1.5 at diagnosis and remained low throughout follow‐up. Survivors treated with thoracic surgery started particularly low, with an FEV1 of −1.08 z‐scores (−2.02 to −0.15) and an FVC of −1.42 z‐scores (−2.27 to −0.57) compared to those without surgery. Conclusion Reduced pulmonary function was frequent but mainly of mild to moderate severity. Nevertheless, more research and long‐term surveillance of this vulnerable population is needed.