Research Article
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Examination of participation limitations affecting the activity performance of children and adolescents diagnosed with childhood cancer

Year 2026, Volume: 13 Issue: 1 , 32 - 39 , 16.04.2026
https://doi.org/10.15437/jetr.1543949
https://izlik.org/JA29JG94UR

Abstract

Purpose: This descriptive study aimed to examine participation restrictions affecting activity performance in children and adolescents diagnosed with cancer.
Methods: The study included 62 children and adolescents diagnosed with cancer who had been receiving treatment for more than one year (mean age: 10.07±3.83 years) and 54 healthy children and adolescents (mean age: 9.29±3.43 years). The Pediatric Outcomes Data Collection Instrument (PODCI) was used to assess participation limitations. The PODCI consists of five main subdomains related to participation in daily living activities.The Mann-Whitney U test was used to compare participation levels between children and adolescents with cancer and their healthy counterparts, while the Kruskal-Wallis test was applied to compare participation levels among different cancer diagnoses.
Results: Of the children participating in the study, 14.5% were diagnosed with acute lymphoblastic leukemia, 21% with lymphoma, and 64.5% with brain tumors. A significant difference was found between adolescents diagnosed with cancer and healthy adolescents in all subparameters of the PVTA test (p=0.001). There were significant differences among cancer types in global function and comfort (p=0.020), upper extremity function (p=0.001), and physical function/sports (p=0.006). However, no significant differences were found in transfer and mobility (p=0.847), pain/comfort (p=0.020), or happiness and satisfaction (p=0.061).
Conclusion: Children diagnosed with cancer experience long-term participation restrictions due to their diagnosis and treatment processes. These restrictions are primarily physical but vary depending on the type of cancer. Further studies are recommended to explore participation restrictions and their underlying causes in more detail in children and adolescents with cancer.

References

  • Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36:277-285.
  • Kebudi R, Alkaya DU. Epidemiology and survival of childhood cancer in Turkey. Pediatr Blood Cancer. 2021;68.
  • Erdmann F, Frederiksen LE, Bonaventure A, et al. Childhood cancer: survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol. 2021;71:101733.
  • Franco VI, Lipshultz SE. Cardiac complications in childhood cancer survivors treated with anthracyclines. Cardiol Young. 2015;25:107-116.
  • Chen Y, Chow EJ, Oeffinger KC, et al. Traditional cardiovascular risk factors and individual prediction of cardiovascular events in childhood cancer survivors. J Natl Cancer Inst. 2020;112:256-265.
  • Armstrong GT, Liu Q, Yasui Y, et al. Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2009;101:946-958.
  • Marmol-Perez A, Gil-Cosano JJ, Ubago-Guisado E, et al. Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The iBoneFIT project. J Sport Health Sci. 2024;13:419-427.
  • Armstrong GT, Liu Q, Yasui Y, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27:2328-2338.
  • Heath JA. Monitoring after childhood cancer: an update for GPs. Aust Fam Physician. 2005;34:769-773.
  • Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572-1582.
  • Brick R, Bender C, Skidmore E. Impact of cancer and cancer-related treatments on participation restrictions. Br J Occup Ther. 2021;84:222-229.
  • World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. World Health Organization; 2007.
  • Imms C, Granlund M, Wilson PH, , et al. Participation, both a means and an end: a conceptual analysis of processes and outcomes in childhood disability. Dev Med Child Neurol. 2017;59:16-25.
  • Mehraban AH, Hasani M, Amini M. The comparison of participation in school-aged cerebral palsy children and normal peers: A preliminary study. Iran J Pediatr. 2016;26:5303.
  • Ness KK, Mertens AC, Hudson MM, et al. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann Intern Med. 2005;143:639-647.
  • Alizadeh Zarei M, Mohammadi A, Mehraban AH, et al. Participation in daily life activities among children with cancer. Middle East J Cancer. 2017;8:213-222.
  • Ness KK, Bhatia S, Baker KS, et al. Performance limitations and participation restrictions among childhood cancer survivors treated with hematopoietic stem cell transplantation: the bone marrow transplant survivor study. Arch Pediatr Adolesc Med. 2005;159:706-713.
  • Ness KK, Hudson MM, Ginsberg JP, et al. Physical performance limitations in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:2382-2389.
  • Stam H, Grootenhuis M, Last B. Social and emotional adjustment in young survivors of childhood cancer. Support Care Cancer. 2001;9:489-513.
  • Gurney JG, Krull KR, Kadan-Lottick N, et al. Social outcomes in the childhood cancer survivor study cohort. J Clin Oncol. 2009;27:2390-2395.
  • Yildiz Kabak V, Ipek F, Unal S, , et al. An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy. Eur J Pediatr. 2021;180:1081-1088.
  • Fox RS, Armstrong GE, Gaumond JS, et al. Social isolation and social connectedness among young adult cancer survivors: A systematic review. Cancer. 2023;129:2946-2965.
  • Bonneau J, Lebreton J, Taque S, et al. School performance of childhood cancer survivors: mind the teenagers! J Pediatr. 2011;158:135-141.
  • Buizer AI, de Sonneville LM, van den Heuvel-Eibrink MM, , et al. Behavioral and educational limitations after chemotherapy for childhood acute lymphoblastic leukemia or Wilms tumor. Cancer. 2006;106:2067-2075.
  • Ness KK, Leisenring WM, Huang S, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2009;115:1984-1994.
  • Barrera M, Shaw AK, Speechley KN, et al. Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer. 2005;104:1751-1760.
  • Daltroy LH, Liang MH, Fossel AH, Goldberg MJ. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthop. 1998;18:561-571.
  • Wright M, Twose D, Gorter JW. Multidimensional outcome measurement of children and youth with neuropathy following treatment of leukemia: cross-sectional descriptive report. Rehabil Oncol. 2019;37:160-166.
  • Debuse D, Brace H. Outcome measures of activity for children with cerebral palsy: a systematic review. Pediatr Phys Ther. 2011;23:221-231.
  • Dilbay NK, Günel MK, Aktan T. Pediatrik Veri Toplama Aracının (PVTA) Türkçe versiyonunun serebral palsili bireylerde geçerlik ve güvenirliği. Fizyoter Rehabil. 2013;24:118-126.
  • An KJ, Song MS, Sung KW, et al. Health-related quality of life, activities of daily living and parenting stress in children with brain tumors. Psychiatry Investig. 2011;8:250-257.
  • Kristiansen I, Frykberg GE, Höglund A, et al. Motor performance after treatment of pilocytic astrocytoma in the posterior fossa in childhood. Cancer Reports. 2022;5:1548.
  • Aiuppa L, Cartaxo T, Spicer CM, et al. Childhood Cancers and Function. In Childhood Cancer and Functional Impacts Across the Care Continuum. National Academies Press (US). 2020.
  • Rueegg CS, Gianinazzi ME, Michel G, et al. Do childhood cancer survivors with physical performance limitations reach healthy activity levels? Pediatr Blood Cancer. 2013;60:1714-1720.
  • Conklin, HM, Ness KK, Ashford JM, et al. Cognitive performance, aerobic fitness, motor proficiency, and brain function among children newly diagnosed with craniopharyngioma. Journal of the International Neuropsychological Society. 2019;25:413-425.
  • Demers C, Gélinas I, Carret AS. Activities of daily living in survivors of childhood brain tumor. Am J Occup Ther. 2016;70:7001220040p1-8.
  • Barbosa RMF, Goretti PF, Chagas PSC. Muscle strength, functional mobility, and performance in activities of daily living in children and adolescents with cancer. Eur J Pediatr. 2024;19;184:28.
  • Tonning Olsson I, Alberts NM, Li C, et al. M. Pain and functional outcomes in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort study. Cancer. 2021;127:1679-1689.
  • Götte M, Kesting SV, Winter CC., et al. Motor performance in children and adolescents with cancer at the end of acute treatment phase. Eur J Pediatr. 2015;174:791-799.
  • Braam KI, Takken T, Veening MA, et al. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016;3:CD008796.

Çocukluk çağı kanseri tanılı çocuklar ve adölesanların aktivite performansını etkileyen katılım kısıtlılıklarının incelenmesi

Year 2026, Volume: 13 Issue: 1 , 32 - 39 , 16.04.2026
https://doi.org/10.15437/jetr.1543949
https://izlik.org/JA29JG94UR

Abstract

Amaç: Bu tanımlayıcı çalışmada, kanser tanısı almış çocuk ve adölesanların aktivite performansını etkileyen katılım kısıtlılıklarının incelenmesi amaçlandı.
Yöntem: Çalışmaya kanser tanısı almış ve bir yıldan uzun süredir tedavi gören 62 (yaş ortalaması 10,07± 3,83 yıl) ve sağlıklı 54 (yaş ortalaması 9,29±3,43 yıl) çocuk ve adölesan katıldı. Aktivite performansını etkileyen katılım kısıtlılıklarının incelenmesi için Pediatrik Veri Toplama Aracı (PVTA) kullanıldı. Kanser tanısı almış ve sağlıklı çocukların ve adölesanların katılım düzeyleri arasındaki fark düzeyini karşılaştırmak için Mann-Whitney U testi kullanıldı. Kanser tanısına göre katılım düzeylerini karşılaştırmak için ise Kruskal Wallis kullanıldı.
Bulgular: Çalışmaya katılan çocukların %14,5’i akut lenfoblastik lösemi, %21’i lenfoma ve %64,5’i beyin tümörü tanısı almıştı. Kanser tanısı alan ve sağlıklı adölesanlar arasında PVTA testinin tüm alt parametreleri arasında anlamlı fark bulundu (p=0,001). Kanser türlerine göre global fonksiyon ve rahatlık (p=0,020), üst ekstremite fonksiyonu(p=0,001) ve fiziksel fonksiyon/spor parametreleri arasında anlamlı fark bulundu (p=0,006) özellikle beyin tümörü tanılı çocukların en fazla fonksiyonel sınırlılığa sahip olduğu bulundu. Transfer & mobilite(p=0,847), rahatlık /ağrısızlık (p=0,020) ve mutluluk & memnuniyet (p=0,061) parametrelerinde anlamlı fark bulunamadı.
Sonuç: Kanser tanısı alan çocuklarda tanı ve tedavi süreçlerine bağlı olarak uzun dönemde katılım kısıtlılıkları ortaya çıkmaktadır. Bu kısıtlılıklar özellikle fiziksel boyutta olmakla birlikte kanserin türüne göre değişkenlik göstermektedir. Bu süreçte çocukların ve adölesanların katılım kısıtlılıkları ve ilişkili nedenler detaylıca inceleyen ileri çalışmalar önerilmektedir.

Ethical Statement

Çalışma protokolü XXXXX Kurumsal Etik Kurulu tarafından onaylandı (E-54022451-050.05.04-43888). Bu araştırmada sadece araştırmaya katılmaya gönüllü olan katılımcılardan veri toplanmıştır. Katılımcılara araştırmanın amacı ve önemi açıklanmış ve araştırmaya katılım için onayları alınmıştır. Araştırma yürütülürken Helsinki Deklarasyonu Prensipleri’ne bağlı kalınmıştır.

Thanks

Çalışmaya katılmayı kabul eden tüm çocuklar ve ailelerine teşekkür ederiz.

References

  • Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36:277-285.
  • Kebudi R, Alkaya DU. Epidemiology and survival of childhood cancer in Turkey. Pediatr Blood Cancer. 2021;68.
  • Erdmann F, Frederiksen LE, Bonaventure A, et al. Childhood cancer: survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol. 2021;71:101733.
  • Franco VI, Lipshultz SE. Cardiac complications in childhood cancer survivors treated with anthracyclines. Cardiol Young. 2015;25:107-116.
  • Chen Y, Chow EJ, Oeffinger KC, et al. Traditional cardiovascular risk factors and individual prediction of cardiovascular events in childhood cancer survivors. J Natl Cancer Inst. 2020;112:256-265.
  • Armstrong GT, Liu Q, Yasui Y, et al. Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2009;101:946-958.
  • Marmol-Perez A, Gil-Cosano JJ, Ubago-Guisado E, et al. Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The iBoneFIT project. J Sport Health Sci. 2024;13:419-427.
  • Armstrong GT, Liu Q, Yasui Y, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27:2328-2338.
  • Heath JA. Monitoring after childhood cancer: an update for GPs. Aust Fam Physician. 2005;34:769-773.
  • Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572-1582.
  • Brick R, Bender C, Skidmore E. Impact of cancer and cancer-related treatments on participation restrictions. Br J Occup Ther. 2021;84:222-229.
  • World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. World Health Organization; 2007.
  • Imms C, Granlund M, Wilson PH, , et al. Participation, both a means and an end: a conceptual analysis of processes and outcomes in childhood disability. Dev Med Child Neurol. 2017;59:16-25.
  • Mehraban AH, Hasani M, Amini M. The comparison of participation in school-aged cerebral palsy children and normal peers: A preliminary study. Iran J Pediatr. 2016;26:5303.
  • Ness KK, Mertens AC, Hudson MM, et al. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann Intern Med. 2005;143:639-647.
  • Alizadeh Zarei M, Mohammadi A, Mehraban AH, et al. Participation in daily life activities among children with cancer. Middle East J Cancer. 2017;8:213-222.
  • Ness KK, Bhatia S, Baker KS, et al. Performance limitations and participation restrictions among childhood cancer survivors treated with hematopoietic stem cell transplantation: the bone marrow transplant survivor study. Arch Pediatr Adolesc Med. 2005;159:706-713.
  • Ness KK, Hudson MM, Ginsberg JP, et al. Physical performance limitations in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:2382-2389.
  • Stam H, Grootenhuis M, Last B. Social and emotional adjustment in young survivors of childhood cancer. Support Care Cancer. 2001;9:489-513.
  • Gurney JG, Krull KR, Kadan-Lottick N, et al. Social outcomes in the childhood cancer survivor study cohort. J Clin Oncol. 2009;27:2390-2395.
  • Yildiz Kabak V, Ipek F, Unal S, , et al. An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy. Eur J Pediatr. 2021;180:1081-1088.
  • Fox RS, Armstrong GE, Gaumond JS, et al. Social isolation and social connectedness among young adult cancer survivors: A systematic review. Cancer. 2023;129:2946-2965.
  • Bonneau J, Lebreton J, Taque S, et al. School performance of childhood cancer survivors: mind the teenagers! J Pediatr. 2011;158:135-141.
  • Buizer AI, de Sonneville LM, van den Heuvel-Eibrink MM, , et al. Behavioral and educational limitations after chemotherapy for childhood acute lymphoblastic leukemia or Wilms tumor. Cancer. 2006;106:2067-2075.
  • Ness KK, Leisenring WM, Huang S, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2009;115:1984-1994.
  • Barrera M, Shaw AK, Speechley KN, et al. Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer. 2005;104:1751-1760.
  • Daltroy LH, Liang MH, Fossel AH, Goldberg MJ. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthop. 1998;18:561-571.
  • Wright M, Twose D, Gorter JW. Multidimensional outcome measurement of children and youth with neuropathy following treatment of leukemia: cross-sectional descriptive report. Rehabil Oncol. 2019;37:160-166.
  • Debuse D, Brace H. Outcome measures of activity for children with cerebral palsy: a systematic review. Pediatr Phys Ther. 2011;23:221-231.
  • Dilbay NK, Günel MK, Aktan T. Pediatrik Veri Toplama Aracının (PVTA) Türkçe versiyonunun serebral palsili bireylerde geçerlik ve güvenirliği. Fizyoter Rehabil. 2013;24:118-126.
  • An KJ, Song MS, Sung KW, et al. Health-related quality of life, activities of daily living and parenting stress in children with brain tumors. Psychiatry Investig. 2011;8:250-257.
  • Kristiansen I, Frykberg GE, Höglund A, et al. Motor performance after treatment of pilocytic astrocytoma in the posterior fossa in childhood. Cancer Reports. 2022;5:1548.
  • Aiuppa L, Cartaxo T, Spicer CM, et al. Childhood Cancers and Function. In Childhood Cancer and Functional Impacts Across the Care Continuum. National Academies Press (US). 2020.
  • Rueegg CS, Gianinazzi ME, Michel G, et al. Do childhood cancer survivors with physical performance limitations reach healthy activity levels? Pediatr Blood Cancer. 2013;60:1714-1720.
  • Conklin, HM, Ness KK, Ashford JM, et al. Cognitive performance, aerobic fitness, motor proficiency, and brain function among children newly diagnosed with craniopharyngioma. Journal of the International Neuropsychological Society. 2019;25:413-425.
  • Demers C, Gélinas I, Carret AS. Activities of daily living in survivors of childhood brain tumor. Am J Occup Ther. 2016;70:7001220040p1-8.
  • Barbosa RMF, Goretti PF, Chagas PSC. Muscle strength, functional mobility, and performance in activities of daily living in children and adolescents with cancer. Eur J Pediatr. 2024;19;184:28.
  • Tonning Olsson I, Alberts NM, Li C, et al. M. Pain and functional outcomes in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort study. Cancer. 2021;127:1679-1689.
  • Götte M, Kesting SV, Winter CC., et al. Motor performance in children and adolescents with cancer at the end of acute treatment phase. Eur J Pediatr. 2015;174:791-799.
  • Braam KI, Takken T, Veening MA, et al. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016;3:CD008796.
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Physiotherapy, Palliative Care
Journal Section Research Article
Authors

Güleser Güney Yılmaz 0000-0003-1781-9381

Müberra Tanrıverdi 0000-0002-7770-9718

Sedef Şahin 0000-0002-6483-072X

Fatma Cakir 0000-0001-9581-8128

Submission Date September 5, 2024
Acceptance Date February 25, 2025
Publication Date April 16, 2026
DOI https://doi.org/10.15437/jetr.1543949
IZ https://izlik.org/JA29JG94UR
Published in Issue Year 2026 Volume: 13 Issue: 1

Cite

Vancouver 1.Güleser Güney Yılmaz, Müberra Tanrıverdi, Sedef Şahin, Fatma Cakir. Çocukluk çağı kanseri tanılı çocuklar ve adölesanların aktivite performansını etkileyen katılım kısıtlılıklarının incelenmesi. Journal of Exercise Therapy and Rehabilitation. 2026 Apr. 1;13(1):32-9. doi:10.15437/jetr.1543949