Energy cost of walking in obese survivors of acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort.

Purpose: Adult survivors of childhood acute lymphoblastic leukemia (ALL) have impaired adaptive physical function and poor health-related quality of life (HRQoL). Obesity may contribute to these impairments by increasing the physiological cost of walking. Due to treatment exposures during ALL therapy, survivors' cost of walking may be more impacted by obesity than the general population. Therefore, we examined associations between obesity, persistent motor neuropathy, and energy cost of walking; and examined associations between energy cost of walking, adaptive physical function, and HRQoL, in adult survivors of childhood ALL vs. community controls. Methods: Obesity was measured via body mass index (BMI) and body fat percentage. The physiological cost index (PCI) was calculated from the six-minute walk test. Adaptive physical functioning was measured using two tests: the timed up and go (TUG) test and the physical performance test. Persistent motor neuropathy was measured using the modified total neuropathy score; HRQoL was measured using the Short-Form-36 questionnaire. The associations between obesity and PCI were evaluated using multivariable linear regressions in adult survivors of childhood ALL (n = 1,166) and community controls (n = 491). Then, the associations between PCI, adaptive physical functioning and peripheral neuropathy were examined using multivariable linear regressions. Finally, to determine the association between obesity, and neuropathy on PCI, while accounting for potential lifestyle and treatment confounders, a three model, sequential linear regression was used. Results: Obese individuals (BMI > 40 kg/m2 and excess body fat percentage [males: >25%; females: >33%]) had higher PCI compared to those with normal BMI and body fat percentage (0.56 ± 0.01 vs. 0.49 ± 0.009 beats/meter p < .01; and 0.51 ± 0.007 vs. 0.48 ± .0006 beats/meter p < .01, respectively). Treatment exposures did not attenuate this association. Increased PCI was associated with longer TUG time in survivors, but not community controls (6.14 ± 0.02 s vs. 5.19 ± 0.03 s, p < .01). Survivors with PCI impairment >95th percentile of community controls had lower HRQoL compared to un-impaired ALL survivors: 46.9 ± 0.56 vs. 50.4 ± 1.08, respectively (p < .01). Conclusion: Obesity was associated with increased PCI. Survivors with high PCI had disproportionately worse adaptive physical function and HRQoL compared to controls. Survivors with increased energy costs of walking may benefit from weight loss interventions.

Bone and [18F]fluorodeoxyglucose positron-emission tomography/computed tomography scanning for the assessment of osseous involvement in Hodgkin lymphoma in children and young adults.

To compare FDG PET/CT and bone scans for the management of young patients with Hodgkin lymphoma (HL). Eighteen patients, aged 7-24 years, with HL received bone and PET scans within 2 weeks--11 at diagnosis and 7 at known or suspected relapse (37 scan pairs). In six patients (nine scan pairs) both studies were positive. In four patients (five scan pairs), PET showed involvement not evident on bone scan. In four patients (four scan pairs), one of the studies was equivocal and the other negative. In one patient, bone scan showed abnormal uptake in a benign lesion. In nine patients (19 scan pairs), both studies were negative. All osseous metastases identified on bone scan were present on PET. Many additional sites of bony involvement were identified on PET. The bone scan may be safely eliminated.

Physical performance limitations in the Childhood Cancer Survivor Study cohort.

Physical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatment-based risk factors include radiation and treatment with a combination of alkylating agents and anthracyclines. Musculoskeletal, neurologic, cardiac, pulmonary, sensory, and endocrine organ system dysfunction also increase the risk of developing a physical performance limitation. In summary, monitoring of physical performance limitations in an aging cohort of childhood cancer survivors is important and will help determine the impact of physical performance limitations on morbidity, mortality, and caregiver burden. In addition, in developing restorative and preventive interventions for childhood cancer survivors, we must take into account the special needs of survivors with physical disability to optimize their health and enhance participation in daily living activities.

Image Gently(SM): a national education and communication campaign in radiology using the science of social marketing.

Communication campaigns are an accepted method for altering societal attitudes, increasing knowledge, and achieving social and behavioral change particularly within public health and the social sciences. The Image Gently(SM) campaign is a national education and awareness campaign in radiology designed to promote the need for and opportunities to decrease radiation to children when CT scans are indicated. In this article, the relatively new science of social marketing is reviewed and the theoretical basis for an effective communication campaign in radiology is discussed. Communication strategies are considered and the type of outcomes that should be measured are reviewed. This methodology has demonstrated that simple, straightforward safety messages on radiation protection targeted to medical professionals throughout the radiology community, utilizing multiple media, can affect awareness potentially leading to change in practice.

Quantitative bone mineral density assessment in malignant infantile osteopetrosis.

PURPOSE: To investigate the use of quantitative computed tomography (QCT) and dual energy absorptiometry (DXA) for assessing bone mineral density (BMD) in the evaluation of children with malignant infantile osteopetrosis (MIOP). METHODS AND PATIENTS: We retrospectively reviewed QCT- and DXA-determined BMD in six patients with infantile osteopetrosis and correlated BMD measured during the initial evaluation with patient characteristics. RESULTS: Five male and one female infant met the eligibility criteria. BMD was markedly elevated in all patients as determined by each modality, QCT or DXA. For QCT, in which age-specific normal values are known, the BMD was found to be 22.4-32.6 standard deviations above the mean. Using DXA, the estimated BMD of the lumbar spine ranged from 0.45 to 0.8 g/cm(2); children with similarly appearing bone radiographs had quite disparate BMD. While the qualitative trend of BMD among the patients was similar for both measures, the units and numerical values of BMD differed. We found no correlation between BMD results and hematopoiesis observed in the bone marrow or with visual evaluation of the radiographs. CONCLUSION: Both QCT and DXA are effective quantitative measures of BMD in children with MIOP. However, the same modality should be employed for longitudinal evaluation of a given patient. Each technique has unique advantages and disadvantages and may complement one another in the evaluation of MIOP or other bone disorders. Quantitative assessment of BMD in children with MIOP will likely serve to further characterize this disease.

Issues specific to implementing PET-CT for pediatric oncology: what we have learned along the way.

In parallel with the expansion of PET imaging to pediatric patients has been the technological development of merging state-of-the-art cross-sectional anatomic information (CT) with functional imaging (PET) into a single modality: PET-CT. Attending to the clinical, scheduling, and medical needs that are unique to imaging children and adolescents can be a challenge, particularly when instituting a single new modality. When that modality bridges two unique, previously independent methods-often previously located in two separate departmental divisions-the details and logistics required to set up a smoothly functioning process can be particularly difficult. This paper focuses on our experience in implementing PET-CT in a tertiary pediatric referral center.