Survivors of childhood cancer and their guardians

Poor adherence to dietary guidelines among adult survivors of childhood acute lymphoblastic leukemia

Recent studies indicate that survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk of obesity and cardiovascular disease, conditions that healthy dietary patterns may help ameliorate or prevent. To evaluate the usual dietary intake of adult survivors of childhood ALL, food frequency questionnaire data were collected from 72 participants, and compared with the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention recommendations, the Dietary Approaches to Stop Hypertension (DASH) diet, and the 2005 United States Department of Agriculture (USDA) Food Guide. Mean daily energy intake was consistent with estimated requirements; however, mean body mass index was 27.1 kg/m2 (overweight). Dietary index scores averaged fewer than half the possible number of points on all 3 scales, indicating poor adherence to recommended guidelines. No study participant reported complete adherence to any set of guidelines. Although half the participants met minimal daily goals for 5 servings of fruits and vegetables (WCRF/AICR recommendations) and Collapse

Key Words Collapse

MESH Headings

• Adult
• Body Mass Index
• Cardiovascular Diseases/prevention & control
• Child
• Diet/standards
• Energy Intake
• Feeding Behavior
• Female
• Guideline Adherence
• Health Status
• Humans
• Male
• Nutrition Policy
• Patient Compliance
• Precursor Cell Lymphoblastic Leukemia-Lymphoma/diet therapy
• Surveys and Questionnaires
• Survivors

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Grants

• M01 RR000400 NCRR NIH HHS
• U24 CA055727 NCI NIH HHS
• M01-RR00400 NCRR NIH HHS
• K23 CA085503 NCI NIH HHS
• R21 CA106778 NCI NIH HHS
• R21-CA106778 NCI NIH HHS
• K23-CA85503 NCI NIH HHS
• U24-CA55727 NCI NIH HHS
• R21 CA106778-02 NCI NIH HHS

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Affiliation(s)

Kim Robien Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second St, 300 WBOB, Minneapolis, MN 55454, USA.
Kirsten K Ness
Lisa M Klesges
K Scott Baker
James G Gurney

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Smoking and binge drinking among Canadian survivors of childhood and adolescent cancers: a comparative, population-based study

BACKGROUND

Objectives of this study were to describe the prevalence of smoking and binge drinking among survivors of childhood and adolescent cancer compared to controls who had never had cancer, and to identify factors associated with these behaviors.

PROCEDURE

Data came from a national, multi-centre, population-based study of survivors of childhood and adolescent cancer (n = 1,263) aged 16 to 37 years and an age and gender matched control group (n = 1,422). Logistic regression analyses were performed to determine the likelihood and predictors of current smoking and binge drinking.

RESULTS

Survivors were less likely to be current smokers (OR(adj) = 0.65, 95% CI = 0.54-0.77) and binge drinkers (OR(adj) = 0.66, 95% CI = 0.55-0.78) than the controls. Still, a substantial proportion of survivors reported smoking (23%) and binge drinking (25%). Survivors' smoking and binge drinking did not vary substantially by the clinical factors assessed. Survivors who received therapy associated with cardiac and/or pulmonary toxicity were as likely to smoke as non-exposed survivors. For both the survivors and controls current smoking and binge drinking were associated with lower education and higher reported stress. Binge drinking was also associated with being male and life dissatisfaction in both groups.

CONCLUSIONS

This study indicates a need to reduce smoking and binge drinking among survivors of childhood and adolescent cancer and to design interventions addressing the underlying reasons for adopting unhealthy behaviors despite their risk for late effects. We identified factors related to smoking and binge drinking among survivors: being male, lower educational attainment, life dissatisfaction and high stress, which should help inform intervention development.

Promoting a healthy lifestyle among cancer survivors

With improving longevity, the late-occurring adverse effects of cancer and its treatment are becoming increasingly apparent. As in other clinical populations, healthy lifestyle behaviors encompassing weight management, a healthy diet, regular exercise, and smoking cessation have the potential to reduce morbidity and mortality significantly in cancer survivors. This article addresses the strength of evidence for recommendations in areas of weight management, diet, exercise, and smoking cessation; and the current evidence examining the efficacy of various intervention approaches to promote health behavior changes among adult cancer survivors.

Education and health promotion in adolescent and young adult cancer survivors

The increasing numbers of long-term adolescent and young adult cancer survivors and their well-established risk of cancer-related morbidity strongly support the need for effective health promotion programs that motivate and sustain positive lifestyle changes. To date, the priority of these initiatives has been relatively low as only a handful of studies have been organized that prospectively evaluate lifestyle interventions and health education curricula with these aims. To effectively integrate lifestyle interventions into pediatric oncology care, prioritization and funding of health promotion research efforts must be comparable to that of disease control in frontline cancer trials.

A community-based physical activity program for adolescents with cancer (project TREK): program feasibility and preliminary findings

INTRODUCTION

As the number of pediatric survivors continues to grow, a greater emphasis is being placed on identifying long-term health risk/protecting behaviors. The primary purpose of this pilot study was to examine the feasibility of a theoretically-based physical activity (PA) intervention in adolescents with cancer.

METHODS

A group PA intervention was administered to participants over 16 weeks. Program attendance/adherence, total PA, physical fitness, and quality of life (QOL) were assessed at 5 different intervals over the 1-year study duration.

RESULTS

Over a period of 6 weeks, 11 adolescents responded to recruitment efforts. Ten ultimately enrolled and completed the 1-year study. Overall, the program was well received with attendance over the 16-week intervention averaging 81.5%. Although improvements in total PA, physical fitness, and QOL were noted across the intervention, follow-up data revealed that participants failed to maintain their postintervention PA levels at both the 3 and 12-month follow-up assessments.

CONCLUSIONS

Adolescents with a history of cancer are undoubtedly susceptible to the same maladaptive health habits as are their healthy peers. Innovative interventions aimed at improving their adherence to positive behavioral interventions, such as PA are warranted. Although not without limitations, this study provides preliminary data in support of a university-sponsored PA intervention.

Psychosocial functioning in parents of adult survivors of childhood cancer

BACKGROUND

Although significant progress has been made in identifying long-term sequelae for adult survivors of childhood cancer, comparatively little attention has been paid to the functioning of their parents. In a previous study, we observed that a majority of adult survivors are accompanied to clinic visits by at least 1 parent, suggesting ongoing concern for their children's health. In the current study, we explore psychologic stressors that characterize this population and might account for this finding.

PROCEDURE

Responses to measures of psychosocial functioning (ie, Brief Symptom Inventory, Impact on Family Scale, Impact of Events Scale, Parent Experience of Child Illness Scale) were compared between 27 parents of adult survivors (mean age=25.6 y) of pediatric cancer and 28 parents of current pediatric cancer patients (mean age=10.2 y) on, or within 1 year of, active treatment.

RESULTS

Compared with parents of pediatric cancer patients on treatment, parents of adult survivors demonstrated few significant differences in overall psychologic functioning, posttraumatic stress symptoms, and adjustment to the disease experience. Indeed, the 2 groups differed only in their report of objective and family burden (eg, financial cost, time off from work, less time with family members), and in their levels of anger associated with the illness experience.

CONCLUSIONS

Results suggest that parents who continue to accompany their adult child to clinic may remain psychologically vulnerable many years after the end of treatment, and that the impact of having a child with a life-threatening illness may not diminish even years into the child's survivorship.

Complementary and alternative therapies in pediatric oncology

Evidence on the science of complementary and alternative medicine (CAM) in children with cancer is slowly evolving. Most parents of children with cancer want their children to receive state-of-the-art therapy, which generally includes chemotherapy, radiation, and surgery. Increasingly, they also want the concomitant use of CAM therapies to help effect a cure or to alleviate symptoms. The ideal model of integrative pediatric oncology offers safe and effective CAM therapies in a pediatric hospital or medical center setting which participates in the clinical trials network of a pediatric oncology cooperative group setting.

Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia

BACKGROUND

Chronicity of muscle weakness from cancer and its treatment may be problematic, particularly in those treated for cancer during childhood. We compared body composition, muscle strength, and mobility between 75 adult survivors of childhood acute lymphoblastic leukemia (ALL) and expected values based on population normative data.

METHODS

Subjects were young adults treated for childhood ALL between 1970 and 1986, selected randomly from participants in an ongoing study of cancer survivors. DeXA scans were performed to evaluate body composition, and myometry used to measure strength. Mobility was evaluated with the Timed Up and Go (TUG) and 2-min walk (TMW). One sample t-tests compared ALL survivors to population norms.

RESULTS

Males had 4.5% and females had 2.3% more body fat than expected (expected males 21.5%, females 36.0%). Males were 76.7 Newtons and females were 58.6 Newtons weaker in quadriceps strength than expected (expected males 569.87 N, females 464.67 N). Males walked 100.88 m and females walked 85.38 m less on the TMW (expected values: males 304.23 m, females 276.26 m), and took longer to complete the TUG (males 5.82 vs. 2.84 sec, females 5.88 vs. 3.00 sec) than expected. Treatment with cranial radiation and current growth hormone (GH) deficiency were associated with lower body weakness among females.

CONCLUSIONS

Young adult survivors of childhood ALL have strength and mobility deficits. Decreased strength may reduce ability to participate in physical activity, perpetuating fitness deficits in survivors of childhood ALL.

Correlates of physical activity in young adult survivors of childhood cancers

PURPOSE/OBJECTIVES

To examine correlates of participation in regular physical activities among young adult survivors of childhood cancers.

DESIGN

Descriptive, correlational.

SETTING

Web-based survey.

SAMPLE

117 well-educated, predominately Caucasian survivors of various types of childhood cancers (-X age = 24 years).

METHODS

Participants completed four rating scales, a stages of change measure, and background questions. Logistic regression and graphical methods were used to examine relationships among physical activity correlates and physical activity.

MAIN RESEARCH VARIABLES

Physical activity stages of change, autonomous motivation, physical activity pros and cons, self-efficacy, and self-reported worries.

FINDINGS

More than 80% of participants reported that they were physically active. Survivors who were autonomously motivated and who perceived fewer cons to being physically active were more likely to report being active than survivors with lower autonomous motivation scores and higher physical activity cons scores. Worries about the present and future moderated the effect of physical activity cons on physical activity. The estimated probabilities of reporting being active for women and men changed as the collective contribution of autonomous motivation, physical activity cons, and worries varied from low to high values.

CONCLUSIONS

Engaging in physical activity willingly and without a sense of pressure (autonomous motivation), perceiving fewer cons to physical activity participation (cognitive appraisal), and worrying about the present and future (affective response) were important correlates of self-reported physical activity beyond the influence of gender.

IMPLICATIONS FOR NURSING

Interventions that promote autonomous motivation, decrease physical activity cons, and address present and future worries may increase physical activity in young adult cancer survivors and may have a greater impact on women than men.

Health behaviors in cancer survivors

PURPOSE/OBJECTIVES

To describe health behaviors of cancer survivors by cancer diagnosis and to compare them to people without a personal or family cancer history.

DESIGN

Cross-sectional secondary data analysis.

SETTING

A national, list-assisted telephone survey using random-digit dialing of U.S. adults about use of cancer-related information and cancer beliefs.

SAMPLE

619 cancer survivors and 2,141 participants without a history of cancer from the original 6,369 Health Information National Trends Survey (HINTS) respondents.

METHODS

Using the National Cancer Institute's 2003 HINTS, further analyses were conducted.

MAIN RESEARCH VARIABLES

Cancer history, current smoking, fruit and vegetable consumption, physical activity, and body mass index (BMI).

FINDINGS

When controlling for demographic variables, no differences were found in self-reported health behaviors between survivors and those without cancer: 22.5% of survivors and 18.4% of those without cancer were current smokers, 18% of survivors and 14.9% of those without cancer consumed at least five fruits or vegetables per day, 45.3% of survivors and 53% of those without cancer were physically active at least weekly, and 58% of survivors and 54.9% of those without cancer were overweight or obese (i.e., BMI > 25). Only 7.4% of survivors and 6.4% of participants without cancer reported positively on all three health behaviors and had a healthy or normal weight.

CONCLUSIONS

Survivors did not have different health behaviors when compared to participants without a history of cancer. Neither group met the American Cancer Society or Healthy People 2010 objectives for these behaviors. Adoption of healthy lifestyle behaviors should be addressed in cancer survivors.

IMPLICATIONS FOR NURSING

Cancer survivors need to be assessed for current smoking, dietary habits, physical activity, and weight. Information and resources should be made available, if needed, to promote the adoption of healthy lifestyle behaviors.

Main Outcomes of the FRESH START Trial: A Sequentially Tailored, Diet and Exercise Mailed Print Intervention Among Breast and Prostate Cancer Survivors

Purpose

Cancer survivors are at increased risk for cardiovascular disease, diabetes, osteoporosis, and second primary tumors. Healthful lifestyle practices may improve the health and well-being of survivors. The FRESH START trial tested the efficacy of sequentially tailored versus standardized mailed materials on improving cancer survivors’ diet and exercise behaviors.

Methods

Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America. Participants were randomly assigned either to a 10-month program of tailored mailed print materials promoting fruit and vegetable (F&V) consumption, reducing total/saturated fat intake, and/or increasing exercise or to a 10-month program of nontailored mailed materials on diet and exercise available in the public domain. Telephone surveys conducted at baseline and 1 year assessed body mass index (BMI), dietary consumption, physical activity, and other psychosocial/behavioral indices. Clinical assessments were conducted on a 23% subsample; information was used to validate self-reports.

Results

Five hundred nineteen participants completed the 1-year follow-up (4.4% attrition; sample characteristics: 57 ± 10.8 years old, 83% white, 56% female, 64% overweight/obese, and 0% underweight). Although both arms significantly improved their lifestyle behaviors (P < .05), significantly greater gains occurred in the FRESH START intervention versus the control arm (practice of two or more goal behaviors: +34% v +18%, P < .0001; exercise minutes per week: +59.3 v +39.2 minutes, P = .02; F&V per day: +1.1 v +0.6 servings, P = .01; total fat: −4.4% v –2.1%, P < .0001; saturated fat: −1.3% v –0.3%, P < .0001; and BMI: −0.3 v +0.1 kg/m2, respectively, P = .004).

Conclusion

Mailed material interventions, especially those that are tailored, are effective in promoting healthful lifestyle changes among cancer survivors. Further study is needed to determine sustainability, cost to benefit, and generalizability to other cancer populations.

Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance

More than 12,000 newly diagnosed cases of cancer occur each year in the United States among children ages 20 years or younger, and the current 5-year survival rate is near 80%. An estimated 228,000 among adults 47 years or younger and currently living in the United States had a diagnosis of cancer during childhood or adolescence. Here, we review long-term adverse effects of childhood cancer and its treatment with an emphasis on physical performance and health. We also briefly review existing guidelines that may be used to develop appropriate exercise and diet interventions for childhood cancer survivors. We suggest that there is a need for development of evidence-based, risk-based guidelines and interventions for health promotion among long-term childhood cancer survivors, particularly for those whose physical activity limitations interfere with chances for optimizing their bodies' potential in today's society.

Diet, exercise, and complementary therapies after primary treatment for cancer

Every year, more than 10 million people are diagnosed with cancer worldwide. In view of the substantial improvements in early detection and treatment, even more patients can expect to be alive 5 years after diagnosis. With improvements in longevity, the late-occurring adverse effects of cancer and its treatment are becoming increasingly apparent. Healthy lifestyle behaviours that encompass regular exercise, weight control, healthy nutrition, and some complementary practices--eg, support groups, imagery--have the potential to greatly reduce cancer-treatment-associated morbidity and mortality in cancer survivors and can enhance quality of life. Here, we aim to review the strength of evidence for recommendations for exercise, weight management, nutritional practices, and related complementary therapies; assess the perceived needs of cancer survivors for health information and how they can access this information; and discuss the resources available to oncology care providers and patients about healthy lifestyle behaviours. Overall, this review provides important information to oncology care providers who counsel their patients on preventive lifestyle practices to maximise health and longevity after a diagnosis of cancer.

Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Tobacco Use in Adult Long-term Survivors of Retinoblastoma

A significant risk of lung cancer was identified among hereditary, but not nonhereditary, retinoblastoma (Rb) patients. Tobacco use was investigated to determine whether differences in smoking prevalence might explain the lung cancer excess and to characterize smoking patterns in adult survivors of Rb. Subjects were 441 hereditary and 395 nonhereditary 1-year survivors of Rb, age >or=18 years, who responded to a telephone survey about current health behavior, including tobacco use. Response rates were 76% for hereditary and 73% for nonhereditary survivors. We compared patterns and predictors of current tobacco use among hereditary and nonhereditary survivors with other childhood cancer survivor studies and the U.S. population. Hereditary Rb survivors currently smoke cigarettes significantly less frequently than nonhereditary survivors (16. 8% versus 24.3%), although among current smokers, age at smoking initiation (17 years old) and average cigarettes (1.5 packs) smoked daily are similar. Predictors of current and ever cigarette smoking include nonhereditary Rb, older age, being female, less education, and use of other tobacco products. Rb survivors smoke cigarettes significantly less than the U.S. population (rate ratio, 0.63; 95% confidence interval, 0.5-0.8 for males; rate ratio, 0.75; 95% confidence interval, 0.6-0.9 for females), but Rb survivors have comparable smoking rates with other childhood cancer survivors. Smoking did not account for the increased risk of lung cancer among hereditary Rb patients, and this may point to an enhanced sensitivity to the carcinogenic effects of tobacco. Adult survivors of Rb should be encouraged to stop smoking.