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Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations

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Abstract

Purpose

The study aims were to determine the prevalence of balance impairments in adult survivors of pediatric central nervous system (CNS) tumors, and to identify predictors of and limitations associated with balance impairments.

Methods

Participants were adult survivors (N = 329) of pediatric CNS tumors. Balance was considered impaired among those with composite scores < 70 on the sensory organization test. Potential predictors of impaired balance were evaluated with generalized linear regression. Multivariable logistic regression was used to evaluate associations between balance impairment and function.

Results

Balance impairment was observed in 48% of survivors, and associated with infratentorial tumor location (OR = 4.0, 95% CI, 2.0–7.6), shunt placement (OR = 3.5, 95% CI, 1.8–6.7), increased body fat percentage (OR = 1.1, 95% CI, 1.0–1.1), hearing loss (OR = 11.1, 95% CI, 5.6–22.2), flexibility limitations (OR = 2.0, 95% CI, 1.0–3.9), peripheral neuropathy (OR = 2.4, 95% CI, 1.2–4.5), and cognitive deficits (OR = 2.2, 95% CI, 1.1–4.7). In adjusted models, impaired balance was associated with limitations in overall physical performance (OR = 3.6, 95% CI, 2.0–6.3), mobility (OR = 2.6, 95% CI, 1.5–4.4), diminished walking endurance (OR = 2.9, 95% CI, 1.7–5.0), and non-independent living (OR = 2.0, 95% CI, 1.0–4.3).

Conclusions

Nearly half of adult survivors of pediatric CNS tumors have impaired balance, which is associated with mobility and physical performance limitations. Interventions to address the complex needs of this population should be prioritized.

Implications for Cancer Survivors

Survivors with identified risk factors should be closely evaluated for presence of balance impairment. Interventions tailored to improve balance also can positively affect function and mobility in survivors.

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References

  1. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and ageing. 2006;35(suppl_2):ii7-ii11.

  2. de CdSC S, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study. Brazilian journal of physical therapy. 2018;22(1):70–6.

    Article  Google Scholar 

  3. Peterson ML, Christou E, Rosengren KS. Children achieve adult-like sensory integration during stance at 12-years-old. Gait & posture. 2006;23(4):455–63.

    Article  Google Scholar 

  4. Abrahamova D, Hlavačka F. Age-related changes of human balance during quiet stance. Physiological Research. 2008;57(6).

  5. Ding D, Allman BL, Salvi R. Ototoxic characteristics of platinum antitumor drugs. Anat Rec Adv Integr Anat Evol Biol. 2012;295(11):1851–67.

    Article  CAS  Google Scholar 

  6. Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. Mechanisms of chemotherapy-induced peripheral neuropathy. Int J Mol Sci. 2019;20(6):1451.

    Article  Google Scholar 

  7. Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro-oncology. 2012;14(suppl_4):iv45–54.

    CAS  PubMed  PubMed Central  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. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2003;21(17):3255–61. https://doi.org/10.1200/jco.2003.01.202.

  9. Ness KK, Morris EB, Nolan VG, Howell CR, Gilchrist LS, Stovall M, et al. Physical performance limitations among adult survivors of childhood brain tumors. Cancer. 2010;116(12):3034–44. https://doi.org/10.1002/cncr.25051.

  10. Turner CD, Rey-Casserly C, Liptak CC, Chordas C. Late effects of therapy for pediatric brain tumor survivors. J Child Neurol. 2009;24(11):1455–63.

    Article  Google Scholar 

  11. Sontgerath R, Eckert K. Impairments of lower extremity muscle strength and balance in childhood cancer patients and survivors: a systematic review. Pediatr Hematol Oncol. 2015;32(8):585–612. https://doi.org/10.3109/08880018.2015.1079756.

    Article  CAS  PubMed  Google Scholar 

  12. Turner M, Gagnon D, Lagace M, Gagnon I. Effect of treatment for paediatric cancers on balance: what do we know? A review of the evidence. European journal of cancer care. 2013;22(1):3–11. https://doi.org/10.1111/ecc.12019.

    Article  CAS  PubMed  Google Scholar 

  13. Hudson MM, Ness KK, Nolan VG, Armstrong GT, Green DM, Morris EB, et al. Prospective medical assessment of adults surviving childhood cancer: study design, cohort characteristics, and feasibility of the St. Jude Lifetime cohort study. Pediatr Blood Cancer. 2011;56(5):825–36.

  14. Hudson MM, Ehrhardt MJ, Bhakta N, Baassiri M, Eissa H, Chemaitilly W, et al. Approach for classification and severity grading of long-term and late-onset health events among childhood cancer survivors in the St. Jude Lifetime cohort. Cancer Epidemiol Biomark Prev. 2017;26(5):666–74. https://doi.org/10.1158/1055-9965.epi-16-0812.

  15. Nashner LM, Peters JF. Dynamic posturography in the diagnosis and management of dizziness and balance disorders. Neurol Clin. 1990.

  16. Pedalini MEB, Cruz OLM, Bittar RSM, Lorenzi MC, Grasel SS. Sensory organization test in elderly patients with and without vestibular dysfunction. Acta Otolaryngol. 2009;129(9):962–5.

    Article  Google Scholar 

  17. Landers MR, Backlund A, Davenport J, Fortune J, Schuerman S, Altenburger P. Postural instability in idiopathic Parkinson’s disease: discriminating fallers from nonfallers based on standardized clinical measures. J Neurol Phys Ther. 2008;32(2):56–61.

    Article  Google Scholar 

  18. Ness KK, Hudson MM, Pui CH, Green DM, Krull KR, Huang TT, et al. Neuromuscular impairments in adult survivors of childhood acute lymphoblastic leukemia: associations with physical performance and chemotherapy doses. Cancer. 2012;118(3):828–38. https://doi.org/10.1002/cncr.26337.

  19. Jacobson GP, Newman CW. Kartush JM. Thomson Demar Learning: Handbook of balance function testing; 1997.

    Google Scholar 

  20. Wampler MA, Miaskowski C, Hamel K, Byl N, Rugo H, Topp KS. The modified total neuropathy score: a clinically feasible and valid measure of taxane-induced peripheral neuropathy in women with breast cancer. J Support Oncol. 2006;4(8):W9–W16.

    Google Scholar 

  21. Varedi M, Lu L, Howell CR, Partin RE, Hudson MM, Pui C-H, et al. Peripheral neuropathy, sensory processing, and balance in survivors of acute lymphoblastic leukemia. J Clin Oncol. 2018;36(22):2315–22. https://doi.org/10.1200/jco.2017.76.7871.

  22. Lavoie Smith EM, Li L, Chiang C, Thomas K, Hutchinson RJ, Wells EM, et al. Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia. Journal of the peripheral nervous system : JPNS. 2015;20(1):37–46. https://doi.org/10.1111/jns.12114.

  23. Harbo T, Brincks J, Andersen H. Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. Eur J Appl Physiol. 2012;112(1):267–75. https://doi.org/10.1007/s00421-011-1975-3.

    Article  PubMed  Google Scholar 

  24. Shephard RJ, Berridge M, Montelpare W. On the generality of the “sit and reach” test: an analysis of flexibility data for an aging population. Res Q Exerc Sport. 1990;61(4):326–30. https://doi.org/10.1080/02701367.1990.10607495.

    Article  CAS  PubMed  Google Scholar 

  25. Boone DC, Azen SP, Lin CM, Spence C, Baron C, Lee L. Reliability of goniometric measurements. Phys Ther. 1978;58(11):1355–60.

    Article  CAS  Google Scholar 

  26. McCrimmon AW, Smith AD. Review of the Wechsler Abbreviated Scale of Intelligence (WASI-II). Los Angeles: Sage Publications; 2013.

    Google Scholar 

  27. Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients. The physical performance test. J Am Geriatr Soc. 1990;38(10):1105–12.

    Article  CAS  Google Scholar 

  28. Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther. 2006;29(2):64–8.

    Article  Google Scholar 

  29. Enright PL. The six-minute walk test. Respir Care. 2003;48(8):783–5.

    PubMed  Google Scholar 

  30. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158(5):1384–7.

    Article  CAS  Google Scholar 

  31. Ware JE Jr. SF-36 health survey update. Spine. 2000;25(24):3130–9.

    Article  Google Scholar 

  32. Friedman J. Regularization paths for generalized linear models via coordinate descent. J Stat Softw. 2010;33(1):1–22.

    Article  Google Scholar 

  33. Syczewska M, Dembowska-Baginska B, Perek-Polnik M, Perek D. Functional status of children after treatment for a malignant tumour of the CNS: a preliminary report. Gait Posture. 2006;23(2):206–10. https://doi.org/10.1016/j.gaitpost.2005.02.001.

    Article  PubMed  Google Scholar 

  34. Piscione PJ, Bouffet E, Mabbott DJ, Shams I, Kulkarni AV. Physical functioning in pediatric survivors of childhood posterior fossa brain tumors. Neuro-oncology. 2013;16(1):147–55.

    Article  Google Scholar 

  35. Wilke M, Dechent P, Bähr M. Sarcoidosis manifestion centered on the thalamic pulvinar leading to persistent astasia. Movement disorders clinical practice. 2017;4(6):898–900.

    Article  Google Scholar 

  36. Rüb U, Del Turco D, Del Tredici K, De Vos R, Brunt E, Reifenberger G, et al. Thalamic involvement in a spinocerebellar ataxia type 2 (SCA2) and a spinocerebellar ataxia type 3 (SCA3) patient, and its clinical relevance. Brain. 2003;126(10):2257–72.

    Article  Google Scholar 

  37. Ferro JM, Bravo-Marques J, Castro-Caldas A, Antunes L. Crossed optic ataxia: possible role of the dorsal splenium. J Neurol Neurosurg Psychiatry. 1983;46(6):533–9.

    Article  CAS  Google Scholar 

  38. Pisella L, Sergio L, Blangero A, Torchin H, Vighetto A, Rossetti Y. Optic ataxia and the function of the dorsal stream: contributions to perception and action. Neuropsychologia. 2009;47(14):3033–44.

    Article  Google Scholar 

  39. Eickhoff SB, Weiss PH, Amunts K, Fink GR, Zilles K. Identifying human parieto-insular vestibular cortex using fMRI and cytoarchitectonic mapping. Hum Brain Mapp. 2006;27(7):611–21.

    Article  Google Scholar 

  40. Nikaido Y, Akisue T, Urakami H, Kajimoto Y, Kuroda K, Kawami Y, et al. Postural control before and after cerebrospinal fluid shunt surgery in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg. 2018;172:46–50. https://doi.org/10.1016/j.clineuro.2018.06.032.

  41. Satzer D, Guillaume DJ. Hearing loss in hydrocephalus: a review, with focus on mechanisms. Neurosurg Rev. 2016;39(1):13–24; discussion 5. https://doi.org/10.1007/s10143-015-0650-2.

    Article  PubMed  Google Scholar 

  42. Zerf M. Body composition versus body fat percentage as predictors of posture/balance control mobility and stability among football players under 21 years. Physical education of students. 2017;21(2):96–102.

    Article  Google Scholar 

  43. Alonso AC, Mochizuki L, Silva Luna NM, Ayama S, Canonica AC, Greve JM. Relation between the sensory and anthropometric variables in the quiet standing postural control: is the inverted pendulum important for the static balance control? Biomed Res Int. 2015;2015:1–5.

    Article  CAS  Google Scholar 

  44. Mainenti MRM, Rodrigues ÉC, JFd O, AdS F, Dias CM, ALdS S. Adiposity and postural balance control: correlations between bioelectrical impedance and stabilometric signals in elderly Brazilian women. Clinics. 2011;66(9):1513–8.

    PubMed  PubMed Central  Google Scholar 

  45. Schoch B, Konczak J, Dimitrova A, Gizewski ER, Wieland R, Timmann D. Impact of surgery and adjuvant therapy on balance function in children and adolescents with cerebellar tumors. Neuropediatrics. 2006;37(6):350–8. https://doi.org/10.1055/s-2007-964904.

    Article  CAS  PubMed  Google Scholar 

  46. Konczak J, Schoch B, Dimitrova A, Gizewski E, Timmann D. Functional recovery of children and adolescents after cerebellar tumour resection. Brain. 2005;128(6):1428–41. https://doi.org/10.1093/brain/awh385.

    Article  PubMed  Google Scholar 

  47. Omoti AE, Omoti CE. Ocular toxicity of systemic anticancer chemotherapy. J Pharm Pract. 2006;4(2):55.

    Google Scholar 

  48. Cao Y, Summerfield C, Park H, Giordano BL, Kayser C. Causal inference in the multisensory brain. Neuron. 2019;102(5):1076–1087. e8.

  49. Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol. 2002;88(3):1097–118. https://doi.org/10.1152/jn.2002.88.3.1097.

    Article  CAS  PubMed  Google Scholar 

  50. Syczewska M, Dembowska-Baginska B, Perek-Polnik M, Kalinowska M, Perek D. Postural sway in children and young adults, survivors of CNS tumours. Advances in medical sciences. 2008;53(2):256–62. https://doi.org/10.2478/v10039-008-0031-y.

    Article  CAS  PubMed  Google Scholar 

  51. Brinkman TM, Li Z, Neglia JP, Gajjar A, Klosky JL, Allgood R, et al. Restricted access to the environment and quality of life in adult survivors of childhood brain tumors. J Neuro-Oncol. 2013;111(2):195–203. https://doi.org/10.1007/s11060-012-1001-6.

  52. Brinkman TM, Ness KK, Li Z, Huang I-C, Krull KR, Gajjar A et al. Attainment of functional and social independence in adult survivors of pediatric CNS tumors: a report from the St Jude Lifetime cohort study. Journal of Clinical Oncology.0(0):JCO.2018.77.9454. doi:https://doi.org/10.1200/jco.2018.77.9454.

  53. Duregon F, Vendramin B, Bullo V, Gobbo S, Cugusi L, Di Blasio A, et al. Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Crit Rev Oncol Hematol. 2018;121:90–100.

    Article  Google Scholar 

  54. McCrary JM, Goldstein D, Sandler CX, Barry BK, Marthick M, Timmins HC, et al. Exercise-based rehabilitation for cancer survivors with chemotherapy-induced peripheral neuropathy. Support Care Cancer. 2019;27(10):3849–57.

    Article  Google Scholar 

  55. Reynolds CR, Suzuki LA. Bias in psychological assessment: an empirical review and recommendations. In: Handbook of psychology. second ed; 2012.

  56. Ness KK, Krull KR, Jones KE, Mulrooney DA, Armstrong GT, Green DM, et al. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: a report from the St Jude Lifetime cohort study. J Clin Oncol. 2013;31(36):4496–503. https://doi.org/10.1200/jco.2013.52.2268.

  57. Ness KK, Armstrong GT, Kundu M, Wilson CL, Tchkonia T, Kirkland JL. Frailty in childhood cancer survivors. Cancer. 2015;121(10):1540–7. https://doi.org/10.1002/cncr.29211.

    Article  PubMed  Google Scholar 

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Funding

Support was provided by the National Cancer Institute Grants No. CA195547 (M.H.) and CA21765 (C. Roberts), and the American Lebanese Syrian Associated Charities.

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Authors and Affiliations

  1. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Mitra Varedi, Lu Lu, Nicholas S. Phillips, Robyn E. Partin, Tara M. Brinkman, Gregory T. Armstrong, Leslie L. Robison & Kirsten K. Ness

  2. School of Health Studies, The University of Memphis, Memphis, TN, USA

    Emma Chase & Douglas Powell

  3. Division of Neurology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Raja B. Khan

  4. Department of Physical Therapy, Stony Brook University, Stony Brook, NY, USA

    Raymond F. McKenna

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

    Melissa M. Hudson

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  1. Mitra Varedi
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  2. Lu Lu
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Contributions

L.R., M.H., T.B., G.A., R.K., and K.N. were the principal investigators of the RCTs for which the data were originally collected and were involved in data collection. In addition, R.P. was involved in data collection. All authors were involved in the conceptualization of this study. M.V., L.L., and K.N. performed the statistical analysis. M.V., N.P., E.C., R.M., D.P., and K.N. wrote the first draft of the manuscript. All authors were involved in the revision of the manuscript and have read and approved the final version.

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Correspondence to Mitra Varedi.

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Varedi, M., Lu, L., Phillips, N.S. et al. Balance impairment in survivors of pediatric brain cancers: risk factors and associated physical limitations. J Cancer Surviv 15, 311–324 (2021). https://doi.org/10.1007/s11764-020-00932-5

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