Mitra Varedi1, Raymond McKenna1,2, Eric M Lamberg1,2. 1. Rehabilitation Research and Movement Performance Laboratory, Stony Brook University, New York, USA. 2. Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, New York, USA.
Abstract
BACKGROUND: Treatment for acute lymphoblastic leukemia (ALL) can affect balance via different mechanisms, including sensory and motor peripheral neuropathy, cognitive impairment, and reduced muscle strength and flexibility. To provide an overview of what is currently known about the effects of cancer treatment on balance in pediatric ALL patients and survivors, and of the predictors of poor balance, a review of the literature was conducted. METHODS: Five databases were searched for English-language original research articles on balance during or after treatment for pediatric ALL. RESULTS: From a total of nine studies, six identified significant balance problems in children with ALL during or after treatment. The percentage of patients or survivors with impaired balance varied between 27% and 69% during treatment, 7% and 65% a few years after completion of treatment, and 14% and 17% many years after the completion of treatment. Factors associated with impaired balance were higher body mass index; higher intrathecal methotrexate dose; cranial radiation; knee extensor weakness; and impaired cognition. CONCLUSION: Although heterogeneity between the studies regarding patient age; age at diagnosis; time since completion of treatment; and methods of quantifying balance make it difficult to reach a single conclusion, the evidence suggests that survivors may experience short- and/or long-term balance difficulties. While there is a need for additional studies to better understand the effects of impaired balance in survivors, clinicians treating both child and adult survivors of ALL need to be aware of these potential risks.
BACKGROUND: Treatment for acute lymphoblastic leukemia (ALL) can affect balance via different mechanisms, including sensory and motor peripheral neuropathy, cognitive impairment, and reduced muscle strength and flexibility. To provide an overview of what is currently known about the effects of cancer treatment on balance in pediatric ALL patients and survivors, and of the predictors of poor balance, a review of the literature was conducted. METHODS: Five databases were searched for English-language original research articles on balance during or after treatment for pediatric ALL. RESULTS: From a total of nine studies, six identified significant balance problems in children with ALL during or after treatment. The percentage of patients or survivors with impaired balance varied between 27% and 69% during treatment, 7% and 65% a few years after completion of treatment, and 14% and 17% many years after the completion of treatment. Factors associated with impaired balance were higher body mass index; higher intrathecal methotrexate dose; cranial radiation; knee extensor weakness; and impaired cognition. CONCLUSION: Although heterogeneity between the studies regarding patient age; age at diagnosis; time since completion of treatment; and methods of quantifying balance make it difficult to reach a single conclusion, the evidence suggests that survivors may experience short- and/or long-term balance difficulties. While there is a need for additional studies to better understand the effects of impaired balance in survivors, clinicians treating both child and adult survivors of ALL need to be aware of these potential risks.
Authors: Tejaswi Kandula; Michelle Anne Farrar; Richard J Cohn; David Mizrahi; Kate Carey; Karen Johnston; Matthew C Kiernan; Arun V Krishnan; Susanna B Park Journal: JAMA Neurol Date: 2018-08-01 Impact factor: 18.302
Authors: Kari L Bjornard; Laura S Gilchrist; Hiroto Inaba; Barthelemy Diouf; Marilyn J Hockenberry; Nina S Kadan-Lottick; Daniel C Bowers; M Eileen Dolan; Nicole J Ullrich; William E Evans; Kirsten K Ness Journal: Lancet Child Adolesc Health Date: 2018-09-01
Authors: Carolina Simioni; Giorgio Zauli; Alberto M Martelli; Marco Vitale; Simona Ultimo; Daniela Milani; Luca M Neri Journal: Oncotarget Date: 2018-03-30