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Author Notes:

Kirsten Ness, PhD, Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, Telephone - 901.595.5157, Facsimile - 901.595.5845, kiri.ness@stjude.org.

Conception and design: C.L. Wilson, W.M. Leisenring, K.C. Oeffinger, M.M. Hudson, G.T. Armstrong, K.R. Krull, L.L. Robison, K.K. Ness; Development of methodology: C.L. Wilson, W.M. Leisenring, K.C. Oeffinger, L.L. Robison, K.K. Ness; Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): K. Wasilewski-Masker, M. Stovall, G.T. Armstrong, L.L. Robison; Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): C.L. Wilson, K. Stratton, W.M. Leisenring, K.C. Oeffinger, M.M. Hudson, K.R. Krull, K.K. Ness; Writing, review, and/or revision of the manuscript: C.L. Wilson, K. Stratton, W.M. Leisenring, K.C. Oeffinger, P.C. Nathan, K. Wasilewski-Masker, M.M. Hudson, S.M. Castellino, M. Stovall, G.T. Armstrong, T.M. Brinkman, K.R. Krull, L.L. Robison, K.K. Ness; Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): M. Stovall, K.K. Ness; Study supervision: G.T. Armstrong, K.K. Ness; Other (provided radiation dosimetry related to therapy of patients): M. Stovall.

The authors have no financial interests to disclose.


Research Funding:

This project was funded by grant number U24CA055727 (L. L. Robison, Principal Investigator) from the National Cancer Institute.

Additional funding provided by St Jude Children’s Research Hospital Cancer Center Support Grant (number 5P30CA021765-33) and American Lebanese Syrian Associated Charities (ALSAC).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Public, Environmental & Occupational Health

Decline in Physical Activity Level in the Childhood Cancer Survivor Study Cohort

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Journal Title:

Cancer Epidemiology, Biomarkers and Prevention


Volume 23, Number 8


, Pages 1619-1627

Type of Work:

Article | Post-print: After Peer Review


Background: We aimed to identify demographic and health-related predictors of declining physical activity levels over a four-year period among participants in the Childhood Cancer Survivor Study. Methods: Analyses included 7,287 ≥5-year childhood cancer survivors and 2,107 siblings who completed multiple follow-up questionnaires. Participants were classified as active if they met the Centers for Disease Control and Prevention guidelines for physical activity. Generalized linear models were used to compare participants whose physical activity levels declined from active to inactive over the study to those who remained active. In addition, selected chronic conditions (CTCAE v4.03 Grade 3 and 4) were evaluated as risk factors in an analysis limited to survivors only. Results: The median age at last follow-up among survivors and siblings was 36 (range, 21-58) and 38 (range, 21-62) years, respectively. The rate of decline did not accelerate over time among survivors when compared with siblings. Factors that predicted declining activity included body mass index >30 kg/m<sup>2</sup> [RR = 1.32; 95% confidence interval (CI), 1.19-1.46, P < 0.01], not completing high school (RR = 1.31; 95% CI, 1.08-1.60, P < 0.01), and female sex (RR = 1.33; 95% CI, 1.22-1.44, P < 0.01). Declining physical activity levels were associated with the presence of chronic musculoskeletal conditions (P = 0.034), but not with the presence of cardiac (P = 0.10), respiratory (P = 0.92), or neurologic conditions (P = 0.21). Conclusions: Interventions designed to maximize physical activity should target female, obese, and less educated survivors. Survivors with chronic musculoskeletal conditions should be monitored, counseled, and/or referred for physical therapy. Impact: Clinicians should be aware of low activity levels among subpopulations of childhood cancer survivors, which may heighten their risk for chronic illness.

Copyright information:

© 2014 American Association for Cancer Research.

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