Skip to main content

Advertisement

SpringerLink
Log in

Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Introduction

The use of rehabilitation services to address musculoskeletal, neurological and cardiovascular late effects among childhood cancer survivors could improve physical function and health-related quality-of-life (HRQL). We describe physical therapy (PT) and chiropractic utilization among childhood cancer survivors and their association with HRQL.

Methods

The sample included 5+ year survivors from the Childhood Cancer Survivor Study (N = 9,289). Questions addressing use of PT or chiropractic services and HRQL (Medical Outcomes Survey Short Form (SF-36)) were evaluated. Multivariable regression models compared PT and/or chiropractic utilization between survivors and siblings, and by diagnosis, treatment and demographic characteristics; associations between chronic disease, PT/chiropractic use, and HRQL were similarly evaluated.

Results

Survivors were not more likely to use PT (OR 1.0; 95% CI 0.8–1.2) or chiropractic (OR 0.8; 95% CI 0.7–1.0) services than siblings. More survivors reported using chiropractic (12.4%) than PT (9.2%) services. Older age and having health insurance were associated with utilization of either PT or chiropractic services. Grade 3-4 chronic conditions and a CNS tumor or sarcoma history were associated with PT but not with chiropractic service utilization. Survivors with musculoskeletal (OR 1.8; 95% CI 1.1–2.9), neurological (OR 3.4; 95% CI 1.6–6.9), or cardiovascular (OR 3.3; 95% CI 1.6–6.9) chronic conditions who used PT/chiropractic services were more likely to report poor physical health than survivors who did not use services.

Conclusions

The reported prevalence of PT/chiropractic among survivors is consistent with that reported by siblings. Severity of late effects is associated with service use and with reporting poor physical health.

Implications for Cancer Survivors

Long-term childhood cancer survivors do not appear to utilize rehabilitation services to optimize physical function and support increased HRQL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al., editors. SEER cancer statistics review, 1975–2004. Bethesda: National Cancer Institute; 2007.

    Google Scholar 

  2. Crofton PM, Ahmed SF, Wade JC, Elmlinger MW, Ranke MB, Kelnar CJ, et al. Bone turnover and growth during and after continuing chemotherapy in children with acute lymphoblastic leukemia. Pediatr Res. 2000;48(4):490–6.

    Article  CAS  PubMed  Google Scholar 

  3. Hartman A, van den Bos C, Stijnen T, Pieters R. Decrease in peripheral muscle strength and ankle dorsiflexion as long-term side effects of treatment for childhood cancer. Pediatr Blood Cancer. 2008;50(4):833–7.

    Article  PubMed  Google Scholar 

  4. Hewitt M, Weiner S, Simone J. Childhood survivorship: Improving care and quality of life: The National Academy of Sciences; 2003.

  5. Kaste SC, Rai SN, Fleming K, McCammon EA, Tylavsky FA, Danish RK, et al. Changes in bone mineral density in survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2006;46(1):77–87.

    Article  PubMed  Google Scholar 

  6. Hovi L, Era P, Rautonen J, Siimes MA. Impaired muscle strength in female adolescents and young adults surviving leukemia in childhood. Cancer. 1993;72:276–81.

    Article  CAS  PubMed  Google Scholar 

  7. Lehtinen SS, Huuskonen UE, Harila-Saari AH, Tolonen U, Vainionpaa LK, Lanning BM. Motor nervous system impairment persists in long-term survivors of childhood acute lymphoblastic leukemia. Cancer. 2003;94:2466–73.

    Article  Google Scholar 

  8. Packer RJ, Gurney JG, Punyko JA, Donaldson SS, Inskip PD, Stovall M, et al. Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: childhood Cancer Survivor Study. J Clin Oncol. 2003;21:3255–61.

    Article  PubMed  Google Scholar 

  9. Camp-Sorrell D. Surviving the cancer, surviving the treatment: acute cardiac and pulmonary toxicity. Oncol Nurs Forum. 1999;26:983–90.

    CAS  PubMed  Google Scholar 

  10. Grenier M, Lipshultz S. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol. 1998;25:72–85.

    CAS  PubMed  Google Scholar 

  11. Lipshultz S, Colan S, Gelber R, Perez-Atayde A, Sallan S, Sanders S. Late cardiac effects of Doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med. 1991;324(12):808–15.

    Article  CAS  PubMed  Google Scholar 

  12. American Physical Therapy Association. Guide to physical therapy practice. Phys Ther. 2001;81:9–746.

    Google Scholar 

  13. Nagi SZ. An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc. 1976;54:439–67.

    Article  CAS  PubMed  Google Scholar 

  14. World Health Organization. International classification of function, disability, and health (ICF). Geneva: WHO; 2002. In; 2002.

    Google Scholar 

  15. Chartered Society of Physiotherapy. Neurology, Parkinson’s disease, multiple sclerosis and severe traumatic brain injury. Physiother Effectiveness Bull. 2001;3:1–11.

    Google Scholar 

  16. Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, et al. Physical activity and exercise recommendations for stroke survivors. Circulation. 2004;109:2031–41.

    Article  PubMed  Google Scholar 

  17. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and heart failure. A statement from the American Association Committee on Exercise, Rehabilitation, and Prevention. Circulation. 2003;107:1210–25.

    Article  PubMed  Google Scholar 

  18. Woolf AD, Zeidler H, Haglund U, Carr AJ, Chaussade S, Cucinotta D, et al. Musculoskeletal pain in Europe: It’s impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann Rheum Dis. 2004;63:342–7.

    Article  CAS  PubMed  Google Scholar 

  19. Evans RC, Rosner AL. Alternatives in cancer pain treatment: the application of chiropractice care. Semin Oncol Nurs. 2005;21:184–9.

    Article  PubMed  Google Scholar 

  20. Dagenais S, Haldeman S. Chiropractic. Prim Care. 2002;29(2):419–37.

    PubMed  Google Scholar 

  21. Mertens AC, Sencer S, Myers CD, Recklitis C, Kadan-Lottick N, Whitton J, et al. Complementary and alternative therapy use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2008;50(1):90–7.

    Article  PubMed  Google Scholar 

  22. Robison LL, Armstrong GT, Boice JD, Chow EJ, Davies SM, Donaldson SS, et al. The Childhood Cancer Survivor Study: A National Cancer Institute-Supported Resource for Outcome and Intervention Research. J Clin Oncol 2009.

  23. Robison LL, Mertens AC, Boice JD, Breslow NE, Donaldson SS, Green DM, et al. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol. 2002;38(4):229–39.

    Article  PubMed  Google Scholar 

  24. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.

    Article  PubMed  Google Scholar 

  25. McHorney CA, Kosinski M, Ware Jr JE. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care. 1994;32(6):551–67.

    Article  CAS  PubMed  Google Scholar 

  26. McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31(3):247–63.

    Article  CAS  PubMed  Google Scholar 

  27. Zeltzer LK, Lu Q, Leisenring W, Tsao JC, Recklitis C, Armstrong G, et al. Psychosocial outcomes and health-related quality of life in adult childhood cancer survivors: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2008;17(2):435–46.

    Article  PubMed  Google Scholar 

  28. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.

    Article  CAS  PubMed  Google Scholar 

  29. Liang K, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

    Article  Google Scholar 

  30. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30.

    Article  CAS  PubMed  Google Scholar 

  31. Allison PD. Logistic regression using the SAS system. Cary: SAS; 1999.

    Google Scholar 

  32. Kleinbaum DG, Kupper LL, Muller KE, Nizam A. Applied regression analysis and other multivariable methods. Pacific Grove: Duxbury; 2007.

    Google Scholar 

  33. Littell RC, Stroup WW, Freund RJ. SAS for linear models. Cary: SAS; 2002.

    Google Scholar 

  34. SAS Institute Inc. SAS/STAT 9.1 user’s guide. Cary: SAS; 2004.

    Google Scholar 

  35. Ware JE, Kosinski M, Gandek B. SF-36 health survey: manual & interpretation guide. Lincoln: QualityMetric; 2000.

    Google Scholar 

  36. Cox CL, Oeffinger KC, Montgomery M, Hudson MM, Leisenring W, Whitton J, et al. Determinants of mammography screening participation in adult childhood cancer survivors: results from the childhood cancer survivor study. Oncol Nurs Forum. 2009;36(3):335–44.

    Article  PubMed  Google Scholar 

  37. Freburger JK, Holmes GM, Carey TS. Physicians' referral to physical therapy: A comparison of primary care and orthopedic physicians' management of musculoskeletal conditions. In: Annual Research Meeting of the Academy for Health Services Research and Health Policy. Washington, D.C.; 2002.

  38. Cheville A, Khemka V, O'Mahony S. The role of cancer rehabilitation in the maintenance of functional integrity and quality of life. In: Blank AE, Selwyn A, O’Mahony S, editors. Choices in palliative care: issues in health care delivery. New York: Springer; 2007. p. 62–83.

    Google Scholar 

  39. Bureau of Labor Statistics U.S. Department of Labor. Occupational Outlook Handbook, 2008-09 Edition, Physical Therapists. In; 2009.

  40. Carter SK, Rizzo JA. Use of outpatient physical therapy services by people with musculoskeletal conditions. Phys Ther. 2007;87(5):497–512.

    Article  PubMed  Google Scholar 

  41. Freburger JK, Carey TS, Holmes GM. Management of back and neck pain: who seeks care from physical therapists? Phys Ther. 2005;85(9):872–86.

    PubMed  Google Scholar 

  42. Freburger JK, Holmes GM. Physical therapy use by community-based older people. Phys Ther. 2005;85(1):19–33.

    PubMed  Google Scholar 

  43. Children's Oncology Group. The Children's Oncology Group Long-Term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, Version 3. In; 2008.

  44. Bureau of Labor Statistics U.S. Department of Labor. Occupational Outlook Handbook, 2008-09 Edition, Chiropractors. In; 2009.

  45. Thaker S, Pathman D. Use of Chiropractic Services in the Rural South. In: AcademyHealth Annual Meeting; 2004; San Diego, CA; 2004.

  46. Graham RE, Ahn AC, Davis RB, O'Connor BB, Eisenberg DM, Phillips RS. Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey. J Natl Med Assoc. 2005;97(4):535–45.

    PubMed  Google Scholar 

  47. Dunlop DD, Manheim LM, Song J, Chang RW. Gender and ethnic/racial disparities in health care utilization among older adults. J Gerontol B Psychol Sci Soc Sci. 2002;57(4):S221–33.

    PubMed  Google Scholar 

  48. Dunlop DD, Song J, Manheim LM, Chang RW. Racial disparities in joint replacement use among older adults. Med Care. 2003;41(2):288–98.

    Article  PubMed  Google Scholar 

  49. Mikuls TR, Mudano AS, Pulley L, Saag KG. The association of race/ethnicity with the receipt of traditional and alternative arthritis-specific health care. Med Care. 2003;41(11):1233–9.

    Article  PubMed  Google Scholar 

  50. Chiropractic Economics. Challenges and progress of black chiropractors [Electronic Version]. http://www.chiroeco.com/article/2004/issue10/10events6.php (2004). Accessed 15 Apr 2010

  51. Ness KK, Mertens AC, Hudson MM, Wall MM, Leisenring WM, Oeffinger KC, et al. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann Intern Med. 2005;143(9):639–47.

    PubMed  Google Scholar 

  52. Mansky P, Arai A, Stratton P, Bernstein D, Long L, Reynolds J, et al. Treatment late effects in long-term survivors of pediatric sarcoma. Pediatr Blood Cancer. 2007;48(2):192–9.

    Article  PubMed  Google Scholar 

  53. Muhic A, Hovgaard D, Mork Petersen M, Daugaard S, Hojlund Bech B, Roed H, et al. Local control and survival in patients with soft tissue sarcomas treated with limb sparing surgery in combination with interstitial brachytherapy and external radiation. Radiother Oncol. 2008;88(3):382–7.

    Article  PubMed  Google Scholar 

  54. Paulino AC. Late effects of radiotherapy for pediatric extremity sarcomas. Int J Radiat Oncol Biol Phys. 2004;60(1):265–74.

    Article  PubMed  Google Scholar 

  55. Gerber L, Vargo M, Smith R. Rehabilitation for patients with cancer diagnoses. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 6th ed. Philadelphia: Lippencott-Raven; 2005. p. 2719–46.

    Google Scholar 

  56. Coulter ID, Hurwitz EL, Adams AH, Genovese BJ, Hays R, Shekelle PG. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine. 2002;27(3):291–6. discussion 297-8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA

    Michele Montgomery

  2. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sujuan Huang, Cheryl L. Cox, Gregory T. Armstrong, Leslie L. Robison & Kirsten K. Ness

  3. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Melissa M. Hudson

  4. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Wendy M. Leisenring

  5. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kevin C. Oeffinger

  6. Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jill Ginsberg

Authors
  1. Michele Montgomery
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sujuan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheryl L. Cox
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wendy M. Leisenring
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin C. Oeffinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Melissa M. Hudson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jill Ginsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gregory T. Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leslie L. Robison
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kirsten K. Ness
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Montgomery.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Montgomery, M., Huang, S., Cox, C.L. et al. Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life. J Cancer Surviv 5, 73–81 (2011). https://doi.org/10.1007/s11764-010-0151-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-010-0151-9

Keywords

Search

Navigation