"The need for preventive measures, extended aftercare and psychosocial rehabilitation is clearly demonstrated in these patients," says Dr Krister K Boman, one of the researchers involved in the study. "Our findings show how CNS cancer affects not only health and function, but also fundamental aspects of identity linked to the body and physical performance."

The study is based on a follow-up of some 700 adult patients who survived CNS tumours as children, whose health, disabilities, body-image, and self-esteem in relation to sport and physical activities were measured by self-rating and a standardised multidimensional method.

Body image and self-esteem in sports/physical activity was found to be linked in various ways with study participants' current health and functional status. Persistent speech and vision impairments, pain, and emotional 'late effects' (adverse side effects of illness and therapy that appear after treatment), were all associated with a negative body/self-image.

The relationship between late effects and patients' self-image was also shown to be gender-related. Women, who generally suffered from more serious health complications, had a more negative body and self-image in sports/physical activity.

"We don't yet have a full understanding of the causes of these gender differences, but knowledge of the importance of the health-related late effects and the gender-related differences is an important step forwards," says Dr Boman. "It means that, in future, we will be able to organise preventive healthcare measures and extended remedial interventions for patients with heightened risk for disturbances in self-identity."

According to the researchers, the results confirm the need for an advanced clinical follow-up plan that includes adulthood, focusing on both the physical and psychological late effects of childhood CNS tumours.

The study was funded by research grants from the Swedish Childhood Cancer Foundation and Karolinska Institutet.