A Longitudinal Assessment of Frailty in Young Adult Survivors of Childhood Cancer

Advances in cancer therapies have led to increasing numbers of adult survivors of pediatric
malignancy. Unfortunately, treatment of childhood cancer continues to require agents designed
to destroy malignant cell lines, and normal tissue is not always spared. While early
treatment- related organ specific toxicities are not always apparent, many childhood cancer
survivors report symptoms that interfere with daily life, including exercise induced
shortness of breath, fatigue and reduced capacity to participate in physical activity. These
symptoms may be a hallmark of premature aging, or frailty. Frailty is a phenotype most
commonly described in older adults; it indicates persons who are highly vulnerable to adverse
health outcomes. Frailty may help explain why nearly two thirds of childhood cancer survivors
have at least one severe chronic health condition 30 years from diagnosis, why childhood
cancer survivors are more likely than peers to be hospitalized for non-obstetrical reasons,
and why they have mortality rates more than eight times higher than age-and-gender matched
members of the general population.

Frailty is a valuable construct because it can be distinguished from disability and
co-morbidity, and is designed to capture pre-clinical states of physiologic vulnerability
that identify individuals most at risk for adverse health outcomes. These investigators have
recently presented data indicating that impaired fitness is present in survivors of childhood
acute lymphoblastic leukemia, brain tumor and Hodgkin lymphoma. This is relevant because
frailty, characterized by a cluster of five measurements of physical fitness, is predictive
of chronic disease onset, frequent hospitalization, and eventually mortality in both the
elderly and in persons with chronic conditions. Using a frailty phenotype as an early
predictor of later chronic disease onset will allow identification of childhood and
adolescent cancer survivors at greatest risk for adverse health. An early indicator of those
at risk for adverse health will allow researchers to test, and clinicians to provide,
specific interventions designed to remediate functional loss, and prevent or delay onset of
chronic health conditions. The investigators goals include characterizing physical frailty
over a five year time span in a population of young adult survivors of childhood cancer, as
well as assessing the association between frailty and the increase in the number and severity
of chronic health conditions.