Motor Performance After Treatment for Pediatric Bone Tumors Sabine V. Kesting, PhD,* Miriam Go ¨tte, PhD,* Corinna C. Seidel, PhD,w Dieter Rosenbaum, PhD,w and Joachim Boos, MD* Background: Reduced motor performance can negatively affect physical activity and social partake after childhood cancer. Espe- cially in bone tumor patients, who are at risk of physical limitations due to surgical interventions, motor performance has not yet been sufficiently investigated. Therefore, this study aimed at assessing motor performance in pediatric bone tumor patients. Procedure: Motor performance was measured within 2 years posttreatment using the MOON (test for MOtor performance in pediatric ONcology) test. This instrument enables quantitative data collection even in physically impaired patients for comparison with age-matched and sex-matched reference values. Results: Twenty-one patients (13 male) ages 15.2 ± 2.1 years (median: 15 y, 10 to 19 y) and 9.4 ± 7.4 months posttreatment (median: 6 mo, 2 to 24 mo) were tested. Motor performance was slightly reduced in muscular endurance of the legs; significantly reduced in speed, flexibility, eye-hand coordination, and muscular explosive strength (P < 0.001), whereas patients’ hand grip strength and static balance were superior to the reference values. Follow-up duration, body mass index, and tumor localization apparently affected motor performance. Conclusions: These findings show serious reductions in motor per- formance within 2 years after bone tumor treatment and highlight the need for interventions to improve motor performance. The results should be used to advise and support patients to engage in suitable physical and sports activities. Key Words: pediatric bone tumor, motor performance, motor ability, childhood cancer, physical activity (J Pediatr Hematol Oncol 2015;37:509–514) B ecause of optimized therapy strategies, survival rates of patients with pediatric bone tumors have improved over the last decades. 1 Thus, quality of survival and long-term disease-related and therapy-related consequences of bone tumor treatment have gained importance. These long-term outcomes can have negative effects on physical activity 2,3 and could also constrain motor performance. Age-appro- priate motor skills are essential for a healthy development in childhood and contribute to the participation in physical activity as well as in social life. 4,5 Although motor per- formance and physical functioning have been described in mixed samples of patients after treatment for cancer 6–11 and mainly patients and survivors of leukemia, 12–18 little is known about motor performance of patients treated for pediatric bone tumors. Besides general treatment regimes with chemotherapy, young patients with bone tumors experience additional severe surgery (ie, tumor resection, endoprosthetic replacement, or amputation). 19 For exam- ple, in contrast to children and adolescents treated for leukemia, who can achieve healthy reference levels of motor performance, 8,18 these surgical interventions can result in lifelong implications, physical impairments, and functional limitations. Patients with bone tumors have to cope with these consequences as several studies reported for long-term survivors (>5y after treatment). 2,10,20–24 Furthermore, patients after the treatment of bone tumors are at high risk of developing chronic health conditions in adulthood. 25,26 Functional outcomes are usually assessed using self- reported measures (eg, Toronto Extremity Salvage Score or Musculoskeletal Tumor Society Score), 27 but are rarely tested objectively. Correlations between Musculoskeletal Tumor Society Score and objective measures could not be confirmed for adolescents. 28 Despite these findings, motor performance in the early phase of pediatric oncological aftercare has not yet been investigated sufficiently, although this is an important phase of orientation, reintegration, and return to normal life after cancer therapy. Therefore, this study aimed at objectively assessing motor performance in patients after therapy of pediatric bone tumors within the first 2 years after cessation of treatment in comparison to reference values of healthy children and adolescents. Collecting further information about motor performance in this special group of patients is necessary to provide suitable interventions for these ado- lescents and support them to safely engage in daily, sports and leisure-time physical activity. MATERIALS AND METHODS Patients and Study Design A cross-sectional single-center study was conducted during the patients’ regular check-ups between May 2012 and December 2013 in the outpatient clinic of the local department of Pediatric Hematology and Oncology. Patients were eligible when meeting the following inclusion criteria: 6 to 19 year olds, treatment of a pediatric bone tumor (all localizations), pediatric oncological aftercare, and follow-up duration up to 24 months. Exclusion criteria were mental disability and inability to understand the German language. According to the inclusion criteria, 41 patients were initially found eligible. Clinical data (ie, Received for publication August 19, 2014; accepted June 18, 2015. From the *Department of Pediatric Hematology and Oncology, Uni- versity Hospital Mu¨nster; and wMovement Analysis Laboratory, Institute for Experimental Musculoskeletal Medicine, University Hospital Mu¨nster, Muenster, Germany. Supported by the nonprofit organization: Horizont Kinderkrebshilfe Weseke e.V. The authors declare no conflict of interest. Reprints: Sabine V. Kesting, PhD, Department of Pediatric Hemat- ology and Oncology, University Hospital Mu¨nster, Albert- Schweitzer-Campus 1, A1, Muenster 48149, Germany (e-mail: sabine.kesting@ukmuenster.de). Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved. ORIGINAL ARTICLE J Pediatr Hematol Oncol  Volume 37, Number 7, October 2015 www.jpho-online.com | 509 Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.