Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life

J Cancer Surviv. 2011 Mar;5(1):73-81. doi: 10.1007/s11764-010-0151-9. Epub 2010 Oct 5.


Introduction: The use of rehabilitation services to address musculoskeletal, neurological and cardiovascular late effects among childhood cancer survivors could improve physical function and health-related quality-of-life (HRQL). We describe physical therapy (PT) and chiropractic utilization among childhood cancer survivors and their association with HRQL.

Methods: The sample included 5+ year survivors from the Childhood Cancer Survivor Study (N = 9,289). Questions addressing use of PT or chiropractic services and HRQL (Medical Outcomes Survey Short Form (SF-36)) were evaluated. Multivariable regression models compared PT and/or chiropractic utilization between survivors and siblings, and by diagnosis, treatment and demographic characteristics; associations between chronic disease, PT/chiropractic use, and HRQL were similarly evaluated.

Results: Survivors were not more likely to use PT (OR 1.0; 95% CI 0.8-1.2) or chiropractic (OR 0.8; 95% CI 0.7-1.0) services than siblings. More survivors reported using chiropractic (12.4%) than PT (9.2%) services. Older age and having health insurance were associated with utilization of either PT or chiropractic services. Grade 3-4 chronic conditions and a CNS tumor or sarcoma history were associated with PT but not with chiropractic service utilization. Survivors with musculoskeletal (OR 1.8; 95% CI 1.1-2.9), neurological (OR 3.4; 95% CI 1.6-6.9), or cardiovascular (OR 3.3; 95% CI 1.6-6.9) chronic conditions who used PT/chiropractic services were more likely to report poor physical health than survivors who did not use services.

Conclusions: The reported prevalence of PT/chiropractic among survivors is consistent with that reported by siblings. Severity of late effects is associated with service use and with reporting poor physical health.

Implications for cancer survivors: Long-term childhood cancer survivors do not appear to utilize rehabilitation services to optimize physical function and support increased HRQL.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Age of Onset
  • Child
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Manipulation, Chiropractic / statistics & numerical data*
  • Neoplasms / complications*
  • Neoplasms / epidemiology
  • Neoplasms / rehabilitation
  • Neoplasms / therapy*
  • Physical Therapy Modalities / statistics & numerical data*
  • Quality of Life* / psychology
  • Surveys and Questionnaires
  • Survivors
  • Treatment Outcome
  • Young Adult