Author Identifier
Date of Award
2026
Keywords
Childhood cancer, musculoskeletal health, exercise intervention
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Medical and Health Sciences
First Supervisor
Robert Newton
Second Supervisor
Dennis Taaffe
Third Supervisor
Daniel Galvao
Fourth Supervisor
Carolyn McIntyre
Fifth Supervisor
Jodie Cochrane-Wilkie
Abstract
Background: Advances in paediatric oncology have substantially improved survival rates for childhood cancer, resulting in a rapidly growing population of survivors. Despite these improvements, childhood cancer survivors remain at increased risk of developing frailty and accelerated ageing phenotypes. Musculoskeletal health underpins physical function, independence, and broader metabolic well-being across the lifespan. Because cancer and its treatments often occur during critical periods of growth, they can disrupt the normal development of bone, muscle, and physical function, highlighting the need for systematic investigation of musculoskeletal health trajectories in childhood cancer patients and survivors.
Purpose: The overarching aim of this thesis was to characterise musculoskeletal health in childhood cancer patients and survivors, to advance approaches to musculoskeletal assessment in paediatric populations, and to evaluate the feasibility and potential benefits of a developmentally informed exercise intervention for childhood cancer survivors.
Methods: This thesis is organised into three interconnected parts. Part 1 presents systematic reviews and meta-analyses of bone mineral density and skeletal muscle outcomes during and after treatment for childhood cancer. Part 2 focuses on advancing musculoskeletal assessment using peripheral quantitative computed tomography and dual-energy X-ray absorptiometry. Part 3 evaluates a targeted exercise intervention in early off-treatment childhood cancer survivors, integrating both quantitative and qualitative methods to assess feasibility, acceptability, and potential benefits.
Results: Systematic reviews and meta-analyses revealed clinically relevant deficits in bone mineral density and skeletal muscle during treatment, which persisted into survivorship. Musculoskeletal measures were sensitive to imaging protocols and analytical choices, highlighting the need for improved standardisation and careful longitudinal monitoring in paediatric populations. The exercise intervention was feasible and well accepted, with indications of improvements in physical and psychosocial outcomes, as well as increased confidence and motivation to engage in physical activity among participants.
Conclusions: This thesis provides a comprehensive evaluation of musculoskeletal health in childhood cancer survivors by integrating evidence synthesis, methodological inquiry, and applied intervention research. Findings highlight the importance of robust, standardised approaches to musculoskeletal assessment and monitoring, as well as the potential benefits of early, targeted exercise interventions in this population.
Access Note
Access to this thesis is embargoed until 13th June 2031
Recommended Citation
Markarian, A. (2026). Musculoskeletal health in childhood cancer survivors: Assessment and intervention strategies. Edith Cowan University. https://doi.org/10.25958/vm6w-jj17