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Association of Exercise With Mortality in Adult Survivors of Childhood Cancer.

Publication ,  Journal Article
Scott, JM; Li, N; Liu, Q; Yasui, Y; Leisenring, W; Nathan, PC; Gibson, T; Armenian, SH; Nilsen, TS; Oeffinger, KC; Ness, KK; Adams, SC ...
Published in: JAMA Oncol
October 1, 2018

IMPORTANCE: Adult survivors of childhood cancer are at excess risk for mortality compared with the general population. Whether exercise attenuates this risk is not known. OBJECTIVE: To examine the association between vigorous exercise and change in exercise with mortality in adult survivors of childhood cancer. DESIGN, SETTING, AND PARTICIPANTS: Multicenter cohort analysis among 15 450 adult cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970 and 1999 enrolled in the Childhood Cancer Survivor Study, with follow-up through December 31, 2013. EXPOSURES: Self-reported vigorous exercise in metabolic equivalent task (MET) hours per week. The association between vigorous exercise and change in vigorous exercise and cause-specific mortality was assessed using multivariable piecewise exponential regression analysis to estimate rate ratios. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality. Secondary end points were cause-specific mortality (recurrence/progression of primary malignant neoplasm and health-related mortality). Outcomes were assessed via the National Death Index. RESULTS: The 15 450 survivors had a median age at interview of 25.9 years (interquartile range [IQR], 9.5 years) and were 52.8% male. During a median follow-up of 9.6 years (IQR, 15.5 years), 1063 deaths (811 health-related, 120 recurrence/progression of primary cancer, 132 external/unknown causes) were documented. At 15 years, the cumulative incidence of all-cause mortality was 11.7% (95% CI, 10.6%-12.8%) for those who exercised 0 MET-h/wk, 8.6% (95% CI, 7.4%-9.7%) for 3 to 6 MET-h/wk, 7.4% (95% CI, 6.2%-8.6%) for 9 to 12 MET-h/wk, and 8.0% (95% CI, 6.5%-9.5%) for 15 to 21 MET-h/wk (P < .001). There was a significant inverse association across quartiles of exercise and all-cause mortality after adjusting for chronic health conditions and treatment exposures (P = .02 for trend). Among a subset of 5689 survivors, increased exercise (mean [SD], 7.9 [4.4] MET-h/wk) over an 8-year period was associated with a 40% reduction in all-cause mortality rate compared with maintenance of low exercise (rate ratio, 0.60; 95% CI, 0.44-0.82; P = .001). CONCLUSIONS AND RELEVANCE: Vigorous exercise in early adulthood and increased exercise over 8 years was associated with lower risk of mortality in adult survivors of childhood cancer.

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Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

October 1, 2018

Volume

4

Issue

10

Start / End Page

1352 / 1358

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Regression Analysis
  • Neoplasms
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Scott, J. M., Li, N., Liu, Q., Yasui, Y., Leisenring, W., Nathan, P. C., … Jones, L. W. (2018). Association of Exercise With Mortality in Adult Survivors of Childhood Cancer. JAMA Oncol, 4(10), 1352–1358. https://doi.org/10.1001/jamaoncol.2018.2254
Scott, Jessica M., Nan Li, Qi Liu, Yutaka Yasui, Wendy Leisenring, Paul C. Nathan, Todd Gibson, et al. “Association of Exercise With Mortality in Adult Survivors of Childhood Cancer.JAMA Oncol 4, no. 10 (October 1, 2018): 1352–58. https://doi.org/10.1001/jamaoncol.2018.2254.
Scott JM, Li N, Liu Q, Yasui Y, Leisenring W, Nathan PC, et al. Association of Exercise With Mortality in Adult Survivors of Childhood Cancer. JAMA Oncol. 2018 Oct 1;4(10):1352–8.
Scott, Jessica M., et al. “Association of Exercise With Mortality in Adult Survivors of Childhood Cancer.JAMA Oncol, vol. 4, no. 10, Oct. 2018, pp. 1352–58. Pubmed, doi:10.1001/jamaoncol.2018.2254.
Scott JM, Li N, Liu Q, Yasui Y, Leisenring W, Nathan PC, Gibson T, Armenian SH, Nilsen TS, Oeffinger KC, Ness KK, Adams SC, Robison LL, Armstrong GT, Jones LW. Association of Exercise With Mortality in Adult Survivors of Childhood Cancer. JAMA Oncol. 2018 Oct 1;4(10):1352–1358.

Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

October 1, 2018

Volume

4

Issue

10

Start / End Page

1352 / 1358

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Regression Analysis
  • Neoplasms
  • Male
  • Humans
  • Female