Purpose Exercise-induced symptoms (EIS) are common in children and understudied in childhood cancer survivors (CCS). We assessed the prevalence of EIS in CCS and identified associated risk factors. Methods We included CCS aged 6-21 years who were diagnosed with cancer ≥ 1 year before study entry, were treated with systemic anticancer treatment, chest surgery, radiotherapy, or hematopoietic stem cell transplantation, completed cancer treatment, and received pediatric oncology follow-up care. Participants completed a questionnaire on respiratory symptoms and lifestyle. To explore risk factors of EIS, we used multivariable logistic regression and calculated population attributable fractions (PAFs). Results Of 196 participants (median age 14 years [IQR 10-17]), 46 (24%) reported EIS, including dyspnea (14%), cough (12%), and wheeze (7%). EIS were more common among females (OR 2.5, 95% CI 1.1-5.9), older survivors (OR 1.2 per year, 95% CI 1.1-1.3,), and those with obesity (OR 4.7, 95% CI 1.1-19.6), asthma (OR 10.1, 95% CI 3.3-31.2), and physical inactivity (OR 2.9, 95% CI 1.3-6.6). Chest-directed radiotherapy tended also to increase the risk (OR 2.4, 95% CI 0.6-9.2). Twenty percent of EIS were attributable to asthma, 18% to physical inactivity, and 7% to obesity, with a combined PAF of 44%. Conclusions EIS affect one in four CCS and are primarily associated with risk factors common in the general population rather than cancer treatments. Implications For Cancer Survivors Clinical investigation and management of common causes of EIS, particularly asthma, physical inactivity, and obesity, could reduce symptom burden and support long-term health in CCS.
