Children undergoing cancer treatment face a hidden but critical challenge: the unexpected and often overlooked loss of skeletal muscle during a crucial period of physical development. New findings from the Exercise Medicine Research Institute at Edith Cowan University (ECU) shed light on how this muscular deterioration occurs at a time when young patients should normally be gaining significant muscle mass. This phenomenon not only undermines their immediate treatment tolerance but also compromises long-term health outcomes, signaling an urgent need to rethink supportive care strategies during pediatric oncology treatment.
The research, led by ECU PhD candidate Anna Maria Markarian, reveals that both the malignancy and the aggressive interventions employed in its treatment synergistically induce a catabolic state that erodes muscle tissue. Unlike adults, children typically experience rapid muscle accretion, especially during pubertal years when gains can reach between three to five kilograms annually. Interruptions in this anabolic process caused by cancer treatments can lead to a net loss of muscle, with far-reaching consequences for physical resilience and recovery capacity.
Muscle functions as the body’s primary metabolic reserve—a critical energy depot and protein bank that supports organ function during physiologic stress. When this reserve diminishes, the patient’s ability to endure intensive chemotherapy weakens, increasing susceptibility to treatment-related toxicities. Markarian emphasizes that muscle loss is not merely a side effect; it fundamentally alters pharmacodynamics, potentially causing standard chemotherapy doses to become disproportionately toxic or ineffective due to altered metabolic capacity.
Concurrently, the study highlights a paradoxical increase in fat mass in many of these children during treatment, intensifying metabolic dysregulation. This simultaneous reduction in lean tissue and accumulation of adipose tissue creates a detrimental shift in body composition. Clinicians traditionally use weight as the principal metric for dosing chemotherapy, but without differentiating between lean mass and fat, this practice risks misestimating the patient’s true metabolic processing abilities. The implications include heightened risks for cardiometabolic complications such as insulin resistance, hyperglycemia, and long-term cardiovascular disease.
These body composition dynamics underscore the complexity of pediatric oncology care. Unlike simple weight measurement, precise assessment of muscle and fat compartments can inform more nuanced clinical decisions, tailoring treatment intensity to the child’s metabolic reserves. As Markarian explains, two children may display identical body weights, yet their actual physiological resilience and chemotherapy tolerance can differ sharply depending on tissue composition.
The ramifications extend well beyond immediate treatment windows. Pediatric cancer survivors who experience muscle deficits during therapy may endure lifelong consequences related to impaired musculoskeletal development. This stunted muscle growth during formative years correlates with increased vulnerability to chronic metabolic illnesses in adulthood, including type 2 diabetes and heart disease. Therefore, preserving muscle mass during cancer treatment is not only a matter of improving chemotherapy tolerance but also one of safeguarding the survivor’s long-term health trajectory.
In response to these findings, encouraging physical activity that is appropriate for the child’s age and treatment stage emerges as a crucial intervention. Although the physical and psychological toll of cancer treatment poses significant barriers to exercise, maintaining movement is essential to mitigating muscle loss and supporting metabolic health. Physical activity stimulates anabolic pathways, counters fat accumulation, and enhances cardiovascular function, creating a buffer against the known adverse effects of cancer therapy.
The systematic review and meta-analysis published in the European Journal of Pediatrics provide a comprehensive synthesis of longitudinal studies tracking skeletal muscle changes throughout pediatric cancer treatment. This robust aggregation of data lends significant weight to the argument that targeted supportive care focusing on muscle preservation should be integrated into standard oncology practice. The evidence calls for multidisciplinary approaches, incorporating exercise physiologists, nutritionists, and pediatric oncologists to craft individualized rehabilitation protocols.
Additionally, this research challenges existing paradigms in chemotherapy dosing that predominantly rely on body surface area or total body weight. Refining dosing algorithms with considerations of lean body mass could optimize therapeutic efficacy while limiting toxicity. The integration of advanced imaging and bioelectrical impedance measures into routine clinical assessments may enable timely detection of unfavorable body composition shifts and prompt early interventions.
The insights delivered by this study represent a critical step in addressing the nuanced challenges faced by children with cancer. They establish muscle loss as a modifiable risk factor with profound clinical implications, highlighting the importance of holistic patient management beyond tumor eradication alone. As pediatric oncology moves toward personalized medicine, integrating metabolic health and muscle preservation into treatment plans promises to enhance both survival rates and quality of life.
In summary, the emerging evidence unequivocally positions skeletal muscle as a vital determinant of treatment success and long-term health in pediatric cancer patients. Recognizing muscle loss not as an inevitable consequence but rather a preventable complication opens new avenues for improving supportive care. Ultimately, this approach holds the potential to not only increase chemotherapy tolerance and reduce complications but also empower young survivors to enjoy healthier futures.
Subject of Research: People
Article Title: Longitudinal changes in skeletal muscle in children undergoing cancer treatment: a systematic review and meta-analysis
News Publication Date: 31-Jul-2025
Web References:
https://link.springer.com/article/10.1007/s00431-025-06349-5
References:
Markarian, A.M., et al. (2025). Longitudinal changes in skeletal muscle in children undergoing cancer treatment: a systematic review and meta-analysis. European Journal of Pediatrics. DOI: 10.1007/s00431-025-06349-5
Keywords: Cancer, Physical exercise, Cancer patients, Pediatrics
