Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
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.
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.
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.
- 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.
- 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. CrossRef
- 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. CrossRef
- Hewitt M, Weiner S, Simone J. Childhood survivorship: Improving care and quality of life: The National Academy of Sciences; 2003.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Camp-Sorrell D. Surviving the cancer, surviving the treatment: acute cardiac and pulmonary toxicity. Oncol Nurs Forum. 1999;26:983–90.
- Grenier M, Lipshultz S. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol. 1998;25:72–85.
- 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. CrossRef
- American Physical Therapy Association. Guide to physical therapy practice. Phys Ther. 2001;81:9–746.
- Nagi SZ. An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc. 1976;54:439–67. CrossRef
- World Health Organization. International classification of function, disability, and health (ICF). Geneva: WHO; 2002. In; 2002.
- Chartered Society of Physiotherapy. Neurology, Parkinson’s disease, multiple sclerosis and severe traumatic brain injury. Physiother Effectiveness Bull. 2001;3:1–11.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Evans RC, Rosner AL. Alternatives in cancer pain treatment: the application of chiropractice care. Semin Oncol Nurs. 2005;21:184–9. CrossRef
- Dagenais S, Haldeman S. Chiropractic. Prim Care. 2002;29(2):419–37.
- 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. CrossRef
- 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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Liang K, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22. CrossRef
- Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30. CrossRef
- Allison PD. Logistic regression using the SAS system. Cary: SAS; 1999.
- Kleinbaum DG, Kupper LL, Muller KE, Nizam A. Applied regression analysis and other multivariable methods. Pacific Grove: Duxbury; 2007.
- Littell RC, Stroup WW, Freund RJ. SAS for linear models. Cary: SAS; 2002.
- SAS Institute Inc. SAS/STAT 9.1 user’s guide. Cary: SAS; 2004.
- Ware JE, Kosinski M, Gandek B. SF-36 health survey: manual & interpretation guide. Lincoln: QualityMetric; 2000.
- 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. CrossRef
- 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.
- 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.
- Bureau of Labor Statistics U.S. Department of Labor. Occupational Outlook Handbook, 2008-09 Edition, Physical Therapists. In; 2009.
- Carter SK, Rizzo JA. Use of outpatient physical therapy services by people with musculoskeletal conditions. Phys Ther. 2007;87(5):497–512. CrossRef
- 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.
- Freburger JK, Holmes GM. Physical therapy use by community-based older people. Phys Ther. 2005;85(1):19–33.
- 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.
- Bureau of Labor Statistics U.S. Department of Labor. Occupational Outlook Handbook, 2008-09 Edition, Chiropractors. In; 2009.
- Thaker S, Pathman D. Use of Chiropractic Services in the Rural South. In: AcademyHealth Annual Meeting; 2004; San Diego, CA; 2004.
- 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.
- 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.
- Dunlop DD, Song J, Manheim LM, Chang RW. Racial disparities in joint replacement use among older adults. Med Care. 2003;41(2):288–98. CrossRef
- 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. CrossRef
- Chiropractic Economics. Challenges and progress of black chiropractors [Electronic Version]. http://www.chiroeco.com/article/2004/issue10/10events6.php (2004). Accessed 15 Apr 2010
- 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.
- 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. CrossRef
- 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. CrossRef
- Paulino AC. Late effects of radiotherapy for pediatric extremity sarcomas. Int J Radiat Oncol Biol Phys. 2004;60(1):265–74. CrossRef
- 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.
- 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. CrossRef
- Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life
Journal of Cancer Survivorship
Volume 5, Issue 1 , pp 73-81
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Physical therapy
- Childhood cancer survivor
- Health related quality of life
- Industry Sectors
- Author Affiliations
- 1. Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
- 2. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- 4. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- 5. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- 3. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- 6. Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA