Children with cancer, including those diagnosed with acute lymphoblastic leukaemia and those who need to undergo a stem cell transplant, often experience adverse effects from their illness and treatments. These include loss of muscle strength, pain (including bone pain), difficulty walking or an inability to walk, fatigue and loss of appetite. PhD candidate Emma den Hartog assessed the physical functioning of children with cancer at the Princess Máxima Centre. She defended her thesis on 25 March.
In recent years, the five-year survival rate following a childhood cancer diagnosis has risen to 84%. That is a significant improvement. More children with cancer are surviving, thanks to the excellent care provided at the Princess Máxima Center. However, they often face adverse effects from their illness and treatments. If a child’s physical functioning declines and, for example, they can no longer walk, this has a major impact on their independence and their ability to participate in daily activities such as going to school, playing outside, and playing sports. These activities are important for a good quality of life. That is why it is important to be able to identify a decline in physical functioning at an early stage. This is necessary to initiate interventions to improve their physical functioning, but how?
Emma: “Physical therapists observe that physical functioning declines in children with cancer. At the Princess Máxima Center, under the guidance of Emma Verwaaijen, Professor Wim Tissing, and Professor Hanneke van Santen from the Princess Máxima Center and UMC Utrecht, I had the opportunity to conduct scientific research on this topic, so that we can gain a better understanding of how physical functioning changes in children with cancer and learn more about how we can improve their physical functioning. “How do these problems develop over the course of treatment? Which children are at the highest risk of reduced physical functioning? How can we identify problems in this area earlier?”
How the condition progresses vary from child to child. “The study shows that 15 percent of children with acute lymphoblastic leukaemia are unable to walk at the time of diagnosis. And another 28 percent lose the ability to walk during the early stages of treatment. “That is a very difficult experience for both parents and the children themselves. Losing the ability to walk can lead to insecurity and social isolation,” says Emma. The risk was higher for certain groups: “What stood out was younger children, children who lost weight, and children who were hospitalized for a long time during the first month of treatment are at increased risk,” says Emma. “But all the children who participated in the study eventually regained their ability to walk. These insights help us properly inform parents and children and guide them on what they might face. Together with the physical therapists, we created a video for parents with explanations and tips on physical activity for children with cancer. The insights from the study can already be used to inform and support children and their parents.”
Emma also investigated the physical performance of children who had to undergo a stem cell transplant. A stem cell transplant (SCT) is an intensive process that can be accompanied by complications, which can impair children’s physical functioning. This form of therapy is used not only to treat cancer, but also other diseases treated at the WKZ. “At the Princess Máxima Centre, we investigated the physical performance of children 100 days after the transplant,” says Emma. “We found that 100 days after the SCT, children had reduced muscle strength and muscle mass and performed physical tests more slowly than healthy peers. Children who were fitter before the transplant also performed better afterwards. This correlation remained consistent, regardless of age, the amount of medication or the duration of hospital stays.”
These insights help in developing an intervention to improve the physical performance of these children, both before and after an intensive treatment regimen. A smartwatch could potentially play a role in this, but that requires further research.
All these insights combined help us offer children with cancer a more personalized approach to minimize the negative effects of their illness and treatment and improve their physical functioning. This can contribute to improving the quality of life for children with cancer.”
