Five year survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) are nearing 90%, making examination of their long-term disease and treatment related outcomes a substantial public health concern. Childhood ALL survivors are at increased risk for early mortality, second malignancies, obesity and heart disease, often unavoidable because of either the effects of the cancer or the treatment required for cure. Long-term outcomes are also influenced by lifestyle choices, and may be exacerbated in ALL survivors whose physical disabilities prevent participation in regular physical activity. The primary goal of this application is to provide comprehensive and objective information on impairments of musculoskeletal health, sensory function, and fitness among a large group of childhood ALL survivors, and to define high risk groups by assessing treatment factors that contribute to impaired function. In addition, an evaluation of the impact of these impairments on participation in regular physical activity will allow for the design of interventions that take into account prevalent functional loss, and improve opportunities for participation in regular physical activity among childhood ALL survivors whose health choices are compromised by long-term disability. We propose to conduct a study that includes a direct, objective evaluation of musculoskeletal function, sensory capacity, fitness and physical activity patterns among adults who were treated for childhood ALL at St. Jude Children's Research Hospital between 1980 and 1998. Among 899 ALL survivors, all of whom are eligible for an institutionally funded clinical study of medical late effects, we propose to recruit 364 to participate in our evaluations. We also propose to recruit 364 individuals for a comparison group, frequency matching on race/ethnicity, age and gender.
Individuals who interact with and treat adult survivors of childhood ALL will benefit from information about the important consequences of disease and associated treatment agents so that they can recognize potential predictors of limited physical performance. This will allow for the design of interventions to ameliorate physical activity limitations, and targeted interventions for those individuals who are at greatest risk for developing subsequent restrictions in their abilities to participate in activities that promote a healthy lifestyle.