CARDIOPULMONARY EXERCISE TESTING IN EVALUATION OF THE FUNCTIONAL-CAPACITY OF SURVIVORS OF CHILDHOOD-CANCER

Progress in the treatment of pediatric cancer has resulted in a growin g population of survivors of malignancy treated in childhood. These in dividuals may have evidence of multiple organ system impairment relate d to oncologic disease and its therapy. Metabolic exercise testing mea sures cardiovascular, pulmonary and musculoskeletal components of maxi mal exercise performance, quantifying functional capacity. This inform ation has been used to describe the clinical syndromes related to anth racycline exposure, radiation therapy and bone marrow transplantation. Impaired performance at exercise testing has been quantified in gener al as decreased endurance, increased symptomatology and excess cardiac arrhythmias. Specific evaluation of the cardiovascular system in surv ivors of childhood cancer demonstrates impaired aerobic capacity and i mpaired hemodynamic response to exercise, with relatively increased he art rate, decreased stroke volume and decreased maximal cardiac index. These abnormalities correlate with risk factors for cardiovascular im pairment: increased anthracycline dose, female sex, younger age at tre atment and longer time to follow-up evaluation. Changes in musculoskel etal function impact variably on exercise capacity. Metabolic exercise testing which measures the integrated function of multiple organ syst ems identifies subclinical abnormalities useful in monitoring function al capacity and guiding intervention. (C) 1998 Elsevier Science Irelan d Ltd.