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Self-reported physical activity behaviors of childhood cancer survivors: comparison to a general adolescent population in Korea. Support Care Cancer 2023; 31:164. [PMID: 36781555 DOI: 10.1007/s00520-023-07612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Adequate physical activity (PA) can significantly contribute to the prevention of undesirable health outcomes in childhood cancer survivors (CCS). This study aimed to identify the patterns of PA and related factors in Korean CCS. METHODS Study subjects were 184 adolescents selected from an ongoing cohort study of Korean CCS and 1,840 sex- and school grade-matched controls randomly selected from the participants of the 2019 Korea Youth Risk Behavior Web-based Survey. Information on PA and sedentary behaviors was collected by self-administered questionnaire. We estimated body mass index (BMI)-adjusted odds ratio (OR) and 95% confidence interval (CI) for the advisable healthy behaviors of CCS compared with healthy controls using conditional logistic regression analysis. In addition, the associations of advisable healthy behaviors of CCS with sociodemographic and clinical factors were estimated using multiple logistic regression analysis. RESULTS CCS were less likely to be physically active than controls, but this finding was evident only in males. The ORs (95% CIs) for regular exercise, moderate intensity PA, vigorous intensity PA, and walking were 0.42 (0.27-0.65), 0.39 (0.24-0.63), 0.53 (0.33-0.84), and 0.64 (0.42-0.98), respectively, in male CCS compared with same-sex controls. Compared with same-sex controls, male CCS were 4.60 times and female survivors were 15.19 times more likely to sleep longer than 8 h a day. Among CCS, males were 2.92 times and 3.07 times more likely to perform moderate intensity PA and muscle-strengthening exercise, respectively, than female. Higher BMI (OR: 1.16), highest family income (OR: 3.98), and a caregiver who performed regular exercise (OR: 2.08) were positively associated with vigorous intensity PA of CCS. With increasing time after treatment completion, the probability of engaging in sedentary activity for less than 6 h per day decreased (OR = 0.89, 95% CI 0.79-1.00). CONCLUSION Korean adolescent CCS were physically inactive compared with control adolescents. Several sociodemographic factors such as sex, family income, caregiver PA, and obesity level were associated with PA behaviors of CCS. IMPLICATIONS Strategic effort would be needed to increase physical activity of childhood cancer survivors in adolescent period with consideration of various sociodemographic factors found in this study.
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Hullmann SE, Biederman E, Monahan PO, Champion VL, Pradhan KR. Psychometric Testing of Attitudes Toward Physical Activity Scale for Adolescent and Young Adult Survivors of Pediatric Cancer. J Adolesc Young Adult Oncol 2022; 11:470-477. [PMID: 34882014 PMCID: PMC9595610 DOI: 10.1089/jayao.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors of pediatric cancer experience chronic health problems following treatment, many of which could be prevented through healthy lifestyle choices. This report describes the development of the AYA Cancer Survivor Attitude (AYA-CSA) Scale, an attitudinal scale that is associated with physical activity in AYA survivors of pediatric cancer. Methods: AYA survivors (n = 100) completed a survey to evaluate their attitudes toward engagement in physical activity. Internal consistency was calculated using Cronbach's alpha. Construct validity was assessed by exploratory factor analysis, correlation with physical activity intention and physical activity behavior, and prediction of physical activity, after adjusting for past physical activity, survivor age, gender, and family income. Results: Data demonstrated a single 6-item scale with excellent internal consistency (α = 0.82). Construct validity was supported by significant correlations with physical activity intention (r = 0.553, p < 0.001) and physical activity behavior (r = 0.489, p < 0.001). After controlling for past physical activity and demographic covariates, survivor age, attitude toward physical activity, and intention were significant predictors of physical activity, and the overall model (F(6, 77) = 7.722, p < 0.001) predicted 39.5% of the variability in physical activity. Conclusion: The AYA-CSA scale demonstrates good reliability and construct validity, most important of which was the ability to predict actual physical activity in AYA survivors of pediatric cancer. This reliable and valid measure is an important tool in the design of behavioral interventions to improve physical activity engagement in AYA survivors.
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Affiliation(s)
- Stephanie E. Hullmann
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Erika Biederman
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Patrick O. Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Vyhlídal T, Dygrýn J, Pelclová J, Chmelík F. Movement behaviours in paediatric cancer survivors during recovery and school weeks. Front Oncol 2022; 12:971805. [PMID: 36172140 PMCID: PMC9510990 DOI: 10.3389/fonc.2022.971805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Paediatric cancer survivors (PCS) are a high-risk population, who can suffer from late effects of their treatment, such as metabolic syndrome, cardiovascular conditions, secondary tumours. Optimal movement behaviours (e.g., limited sedentary behaviour [SB] and sufficient physical activity [PA]) can reduce the side effects or avoid late effects of their treatment. The aims of this study were to analyse movement behaviours and meeting the recommendation of 60 minutes of moderate-to-vigorous physical activity (MVPA) a day in Czech PCS, and to compare their movement behaviours during recovery and school weeks in relation to gender, age, and cancer type. Methods Twenty-six PCS aged 7-15 years in remission stage took part in the cross-sectional study. Movement behaviours were measured with Actigraph wGT3X+ accelerometers worn 24 hour/day for 20 consecutive days covering recovery week (13 days at recovery camp) and school week (7 days). Based on cancer types, the PCS were categorized into haematological malignancy or solid tumours group. Results In the PCS, movement behaviours differed between recovery and school weeks. During recovery week, the PCS showed less SB (451.8 vs. 552.3 min/day, p < 0.001) and spent more time on light PA (350.3 vs. 255.1 min/day, p < 0.001), moderate PA (73.2 vs. 37.4 min/day, p < 0.001), and vigorous PA (10.3 vs. 4.0 min/day p < 0.001) than during school week. The PA recommendation was met by 77% (n = 20) PCS during recovery week, but only by 15% (n = 4) individuals during school week. Conclusions The PCS recorded higher levels of PA and lower levels of SB during recovery week than during school week. If provided with appropriate conditions, PCS in the remission stage are able to reach the PA level recommended for the healthy population. Recovery week can be a suitable platform for gaining experience that PCS are able to meet the recommended PA level and could be an integral part of reconditioning and resocialization programmes for PCS after the completion of their treatment.
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Knowles R, Kemp E, Miller M, Davison K, Koczwara B. Physical activity interventions in older people with cancer: A review of systematic reviews. Eur J Cancer Care (Engl) 2022; 31:e13637. [PMID: 35730689 DOI: 10.1111/ecc.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Whilst there has been a wealth of research on benefits of physical activity (PA) in people with cancer, with three published reviews of reviews, no review of reviews has focused on older adults (65 years or older) who may have unique biological characteristics and barriers. We summarised PA effectiveness from reviews where majority of study participants were 65 years or older. METHODS Six databases were searched for systematic reviews of randomised controlled studies (RCTs)/quasi-RCTs examining any type of PA in reviews where majority of study participants were aged 65 years or older. Two reviewers conducted the search and analysis according to PRISMA and JBI guidelines. RESULTS Fifteen reviews involving 76 different primary studies (5404 participants) were included. The majority (3827; 71%) had prostate cancer. PA was associated with benefits across multiple physical outcomes (muscle mass, functional performance, strength), improved fatigue and health service outcomes. In contrast to younger adults, there was no improvement in anxiety and mixed findings for quality of life and depression. CONCLUSION PA is associated with multiple benefits in older adults with cancer, with some differences compared to younger individuals which may reflect biological or behavioural determinants. Future research should focus on mechanisms underlying PA effectiveness and underrepresented populations.
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Affiliation(s)
- Reegan Knowles
- Survivorship and Psycho-Oncology, Flinders Cancer Research, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Emma Kemp
- Survivorship and Psycho-Oncology, Flinders Cancer Research, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michelle Miller
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kade Davison
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Bogda Koczwara
- Survivorship and Psycho-Oncology, Flinders Cancer Research, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Risk of diabetes and the impact on preexisting diabetes in lymphoma patients treated with steroid-containing immunochemotherapy. Blood Adv 2022; 6:4427-4435. [PMID: 35679481 DOI: 10.1182/bloodadvances.2021006859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/29/2022] [Indexed: 01/08/2023] Open
Abstract
First-line treatments for lymphomas often include high doses of prednisolone, but the risks of new-onset diabetes mellitus (DM) or worsening of pre-existing DM following treatment with cyclic high dose corticosteroids is unknown. This cohort study matched non-Hodgkin lymphoma (NHL) patients treated with steroid-containing immunochemotherapy, i.e. R-CHOP(-like) and R-CVP, between 2002 and 2015 to individuals from the Danish population to investigate the risks of new-onset DM. For patients with pre-existing DM, the risks of insulin dependency and anthracycline-associated cardiovascular diseases (CVD) were assessed. In total, 5,672 NHL patients and 28,360 matched comparators were included. Time-varying incidence rate ratios (IRRs) showed increased risk of DM in the first year after treatment compared to matched comparators with the highest IRR being 2.7. The absolute risks were higher among patients in the first two years, but the difference was clinically insignificant. NHL patients with pre-existing DM had increased risks of insulin prescriptions with 0.5-, 5-, and 10-year cumulative risk differences of insulin treatment of 15.3, 11.8, and 6.0 percentage units as compared to the DM comparators. In a landmark analysis at one year, DM patients with lymphoma had decreased risks of insulin dependency compared to comparators. Time-varying IRRs showed a higher CVD risk for NHL patients with DM as compared to comparators in the first year after treatment. NHL patients treated with steroid-containing immunochemotherapy regimens have a clinically insignificant increased risk of DM in the first year following treatment, and patients with pre-existing DM have a temporary increased risk of insulin prescriptions and CVD.
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Iijima M, Stall M, Wang L, Panetta JC, Triplett BM, Pui CH, Ribeiro RC, Rubnitz JE, Pounds SB, Inaba H. Changes in body mass index, weight, and height in children with acute myeloid leukemia and the associations with outcome. Blood Adv 2022; 6:2824-2834. [PMID: 35196375 PMCID: PMC9092412 DOI: 10.1182/bloodadvances.2021006090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Little is known about body composition changes in patients with acute myeloid leukemia (AML) during and after treatment or their associations with outcomes. Z-scores for body mass index (BMI), weight, and height at diagnosis, their longitudinal changes from diagnosis to 5 years off therapy, and their associations with adverse effects and outcomes were evaluated in 227 pediatric patients with AML enrolled in the AML02 and AML08 trials at St. Jude Children's Research Hospital between 2002-2017. The median Z-scores for baseline weight, height, and BMI were 0.193, 0.209, and 0.170, respectively, and those for weight and height decreased significantly during therapy to -0.038 and -0.163, respectively, at off-therapy (P < .001 for both). At 5 years off therapy, the Z-scores for weight and BMI had increased significantly to 0.492 (P = .003) and 0.911 (P < .001), respectively, whereas the height Z-score remained significantly lower at -0.066 (P < .001) compared with baseline. The height Z-score of transplant recipients decreased further from -0.211 at transplant to -0.617 12 months later (P < .001). Baseline BMI category and Z-score were not associated with outcomes, but higher weight Z-scores were associated with lower incidences of refractory or relapsed disease (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.67-0.99) and higher incidences of death in remission (HR, 1.31; 95% CI, 1.01-1.70). Furthermore, weight Z-score decrease during induction therapy was associated with gastrointestinal, hepatic, and infection toxicities during subsequent therapy and with death in remission (HR, 2.66; 95% CI, 1.11-6.45). Multidisciplinary monitoring for weight changes and short stature is required from diagnosis to the off-therapy period.
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Affiliation(s)
- Mayuko Iijima
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Melanie Stall
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Brandon M. Triplett
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeffrey E. Rubnitz
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Stanley B. Pounds
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
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The impact of CNS-directed treatment on quality of life in childhood cancer survivors. Qual Life Res 2022; 31:817-829. [PMID: 34455525 PMCID: PMC8882709 DOI: 10.1007/s11136-021-02984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators. METHODS Families of children with cancer (ages 5-17) were recruited at diagnosis or relapse (N = 336). Survivors completed the PedsQL at 3 (n = 96) and 5 years (n = 108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses. RESULTS Parent-report of the child's total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p = 0.04). In terms of time since last treatment, mother and child both reported the child's QoL improved over time (p = 0.0002 and p = 0.0006, respectively). Based on parent-report, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL. CONCLUSIONS Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.
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Physical activity levels, exercise preferences, and exercise barriers in Korean children and adolescents after cancer treatment. Support Care Cancer 2021; 30:1787-1796. [PMID: 34599665 DOI: 10.1007/s00520-021-06588-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the current study was to explore physical activity (PA) levels, exercise preferences, and perceived barriers to PA in childhood cancer survivors. METHODS This cross-sectional study surveyed 120 childhood cancer survivors aged 8-18 years from the pediatric oncology center in South Korea between March and August 2017. The modified Exercise & Quality of Life questionnaire, Korea Youth Risk Behavior Web-based Survey, and Godin Leisure-Time Questionnaire were used to assess PA levels, preferences, and exercise barriers. RESULTS Among 120 participants (72 boys, 48 girls) whose average age at the time of the survey was 14.57 ± 3.00 years and the average age at diagnosis was 8.22 years, the three most common diagnoses were acute leukemia (43.3%), brain tumor (13.3%), and malignant lymphoma (10.8%). Only 16 participants (5%) met the PA recommendations for children (at least 60 min of moderate PA per day). The most preferred sporting activities included soccer, basketball, strengthening exercises, badminton, dance, and taekwondo. They generally had positive attitudes toward exercise, and more than 63% of participants intended to exercise the following month. The five most prevalent perceived barriers to exercise were lack of time, poor health, reluctance to sweat, lack of exercise skills, and no exercise partners. CONCLUSIONS While most childhood cancer survivors did not meet the PA recommendation, most of them agreed that exercise was beneficial, and they intended to participate in the exercise. Exercise and PA programs should be tailored to the personal health and preferences of childhood cancer survivors.
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Aktolan T, Acar-Tek N. Prevalence of Obesity/Abdominal Obesity and Related Factors in Pediatric ALL Survivors. J Am Coll Nutr 2021; 41:50-56. [PMID: 34264161 DOI: 10.1080/07315724.2020.1846635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Obesity has been increasingly recognized in pediatric acute lymphoblastic leukemia (ALL) survivors. The aim of the current study was to determine the prevelance and related factors of obesity/abdominal obesity and evaluate the association between nutrition and overweight/obesity after cancer treatment in pediatric ALL survivors. METHOD An observational retrospective cohort study was performed among 67 volunteers (aged 5-15). Participants completed 3 consecutive days (2 weekdays and 1 weekend day) recording food consumption and physical activity simultaneously. Weight, height, and waist circumference measurements were performed in remission period, and retrospective data were obtained from patient records. We examined data at three periods: diagnosis, end of treatment, and remission. Subjects were classified into four groups according to body mass index for age z score (BAZ): underweight, normal weight, overweight, and obese. Abdominal obesity was defined waist-to-height ratio ≥ 0.5. RESULTS Prevalence of overweight, obesity, and abdominal obesity were 25.3%, 23.9%, 38.8%, respectively in remission. BAZ at diagnosis and at treatment completion, dietary energy intake, and physical activity were associated with an increased risk of being overweight/obese in remission (p < .05). Gender, age at diagnosis, cranial radiotherapy, and treatment risk category were not significant (p > .05). CONCLUSIONS As in obesity, abdominal obesity was found an important problem in pediatric ALL survivors. Therefore, nutritional targets are needed to prevent obesity. Survivors should be closely monitored in terms of nutritional status during and after treatment and informed about and supported for healthy lifestyle (balanced and adequate nutrition, increase in physical activity).
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Affiliation(s)
- Teslime Aktolan
- Nutrition and Diet Policlinic, Akyurt Devlet Hastanesi, Akyurt, Ankara, Turkey
| | - Nilüfer Acar-Tek
- Faculty of Health Science, Department of Nutrition and Dietetic, Gazi University, Emek, Ankara, Turkey
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Cohen J, Goddard E, Brierley ME, Bramley L, Beck E. Poor Diet Quality in Children with Cancer During Treatment. J Pediatr Oncol Nurs 2021; 38:313-321. [PMID: 33960867 DOI: 10.1177/10434542211011050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: With improved long-term health outcomes and survivorship, the long-term nutritional management of childhood cancer survivors, from diagnosis to long-term follow-up, has become a priority. The aim of this study was to examine the diet quality of children receiving treatment for cancer. Methods: Participants were parents of children with cancer who were receiving active treatment and not receiving supplementary nutrition. A 24-h dietary recall assessed food and nutrient intake. Serves of food group intakes and classification of core and discretionary items were made according to the Australian Dietary Guidelines and compared with age and sex recommendations. Results: Sixty-four parents participated (75% female). Most children were not consuming adequate intake of vegetables (94% of patients), fruit (77%), and milk/alternatives (75%). Of the vegetables that were consumed, half were classified as discretionary foods (e.g., chips/fries). Nearly half (49%) of children exceeded recommendations for total sugar intake and 65% of patients had an excessive sodium intake. Discussion: Children receiving cancer treatment are consuming diets of reasonable quantity, but poor quality. Information provided during treatment should focus on educating parents on a healthy diet for their child, the importance of establishing healthy eating habits for life, and strategies to overcome barriers to intake during treatment.
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Affiliation(s)
- Jennifer Cohen
- School of Women's and Children's Health, 7800UNSW Sydney, Sydney, NSW, Australia.,Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, Australia
| | - Emma Goddard
- School of Medicine, 8691University of Wollongong & Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Mary-Ellen Brierley
- School of Women's and Children's Health, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Lynsey Bramley
- Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, Australia
| | - Eleanor Beck
- School of Medicine, 8691University of Wollongong & Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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Huang YJ, Lee SL, Wu LM. Health-Promoting Lifestyle and Its Predictors in Adolescent Survivors of Childhood Cancer. J Pediatr Oncol Nurs 2021; 38:233-241. [PMID: 33595358 DOI: 10.1177/1043454221992322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cancer survivors are at increased risk of long-term adverse effects related to the disease or treatment. Thus, it is important for cancer survivors to adopt a health-promoting lifestyle (HPL). This study aims to: (1) describe health behavior self-efficacy (HBSE) and HPL of adolescent survivors of childhood cancer, (2) examine the relationships between HBSE, HPL, and various demographic factors, and (3) identify determinants of HPL among adolescent survivors of childhood cancer. Method: A descriptive cross-sectional study was conducted with adolescent survivors of childhood cancer, ranged in age from 11 to 19 years (n = 82). Participants were recruited from pediatric oncology follow-up clinics at two medical centers in southern Taiwan. Data for each participant were collected from questionnaires assessing HBSE and HPL. Results: Only 61% of the adolescent survivors were considered as normal weight. The exercise was the lowest scoring HBSE subscale. Factors associated with better HPL included: education level, HBSE, well-being, and a healthy diet. Specifically, survivors diagnosed with cancer during adolescence exhibited significantly greater self-efficacy with stress management (F = 3.20, p = .04) compared with those diagnosed at pre-school ages. HBSE scores for well-being and a healthy diet were significant predictors of HPL, accounting for 43.8% of the total variance observed. Discussion: Our findings suggest that the age of diagnosis of childhood cancer significantly modulates the frequency of health-promoting behaviors of adolescent survivors. Thus, interventions designed to enhance adolescents' well-being and the management of a healthy diet may enhance HPL in survivors of childhood cancer.
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Affiliation(s)
- Yi-Jung Huang
- Kaohsiung Municipal Sinsing Senior High School, Kaohsiung City, Taiwan (R.O.C.)
| | - Shu-Li Lee
- School of Nursing, 38023Kaohsiung Medical University, Kaohsiung City, Taiwan (R.O.C.)
| | - Li-Min Wu
- School of Nursing, 38023Kaohsiung Medical University, Kaohsiung City, Taiwan (R.O.C.).,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan (R.O.C.)
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Darabos K, Barakat LP, Schapira M, Hill-Kayser C, Schwartz LA. Association of Demographic and Cancer-Specific Factors on Health Behavior Recommendations Specific to Cancer Prevention and Control Among Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2020; 10:619-628. [PMID: 33211609 DOI: 10.1089/jayao.2020.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for long-term health problems that are exacerbated by not meeting health behavior recommendations (e.g., exercise). To identify AYA at risk for not meeting health behavior recommendations, we explored demographic (e.g., age) and cancer-specific (e.g., intensity of treatment) factors associated with not meeting specific health behavior recommendations that have implications for cancer prevention and control. Methods: Regression (linear/binary) was used to examine demographic and cancer-specific associates regarding fruit/vegetable intake, binge drinking, sleep duration, sunscreen use, tobacco use, and physical activity among 307 AYA (Mage = 20.33, range = 15-34) across three combined studies, treated at a pediatric cancer center. Health behavior measures were adapted from The Health Behaviors Survey and the Youth Risk Behavior Surveillance System questionnaire. Results: AYA in general did not meet health behavior recommendations. Compared with AYA with public insurance, AYA with private insurance (β = -0.19, p < 0.01) were more likely to meet multiple health behavior recommendations. AYA at greatest risk for not meeting specific health behaviors were more likely to be diagnosed in middle childhood (11.35years) compared with early childhood (8.38years), be closer to diagnosis (8.77years vs. 11.76years) and closer to treatment completion (6.97years vs. 9.91years), and have a solid tumor (32.7%) compared with a brain tumor (10.6%). Conclusion: Not meeting health behavior recommendations is common among AYA survivors of childhood cancer. Early education in the context of survivorship care is critical to provide teachable moments to AYA; such interventions might impact future long-term health and reduce risk for secondary cancers.
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Affiliation(s)
- Katie Darabos
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn Schapira
- Department of Medicine, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zheng J, Zhou X, Cai R, Yu R, Tang D, Liu K. Dietary behaviours, physical activity and quality of life among childhood cancer survivors in Mainland China: A cross-sectional study. Eur J Cancer Care (Engl) 2020; 30:e13342. [PMID: 33191582 DOI: 10.1111/ecc.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the dietary behaviours, physical activity (PA) and quality of life (QoL) of childhood cancer survivors (CCS) in Mainland China and explore the relationships between these behaviours and QoL. METHODS This cross-sectional study recruited 181 CCS from three Grade-A tertiary hospitals in Guangzhou. Survivors completed questionnaires assessing their dietary behaviours, PA and QoL. RESULTS Only 2.2%, 7.7% and 2.2% of CCS reported frequent soft drinks, sugar and fast food intake, which were lower compared to CCS in Western studies. Most survivors (72.9%) failed to drink milk daily, and many (54.7%) were picky eating. Sixty percent of CCS reported less moderate-to-vigorous physical activity (MVPA) time than 60 min/day recommended by WHO. Picky eating was significantly associated with lower overall (p < 0.001), physical (p < 0.001) and psychosocial (p < 0.001) QoL. MVPA was significantly positively associated with overall (p < 0.05) and psychosocial (p < 0.01) QoL. CONCLUSIONS Chinese CCS engaged better dietary behaviours of less soft drinks, sugar and fast food consumption, but many were picky eaters and did not meet milk intake and PA recommendations. Early behavioural interventions aimed at increasing the dietary diversity and MVPA level of this population should be taken to improve their QoL.
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Affiliation(s)
- Junyi Zheng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xuezhen Zhou
- Nursing Department, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Ruiqing Cai
- Pediatric Oncology Department, Sun Yat-sen Cancer Center, Guangzhou, China
| | - Runting Yu
- Pediatric Hematology Department, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Dongyan Tang
- Pediatric Hematology Department, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Ke Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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14
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Bérard S, Morel S, Teasdale E, Shivappa N, Hebert JR, Laverdière C, Sinnett D, Levy E, Marcil V. Diet Quality Is Associated with Cardiometabolic Outcomes in Survivors of Childhood Leukemia. Nutrients 2020; 12:nu12072137. [PMID: 32708379 PMCID: PMC7400871 DOI: 10.3390/nu12072137] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
There is little information about how diet influences the health of childhood acute lymphoblastic leukemia (cALL) survivors. This study explores the associations between diet quality indices, cardiometabolic health indicators and inflammatory biomarkers among cALL survivors. Participants were part of the PETALE study (n = 241, median age: 21.7 years). Adherence to 6 dietary scores and caloric intake from ultra-processed foods were calculated. Multivariate logistirac regressions, Student t-tests and Mann-Whitney tests were performed. We found that 88% of adults and 46% of children adhered poorly to the Mediterranean diet, 36.9% had poor adherence to the World Health Organisation (WHO) recommendations and 76.3% had a diet to be improved according to the HEI-2015 score. On average, ultra-processed foods accounted for 51% of total energy intake. Low HDL-C was associated with a more inflammatory diet (E-DIITM score) and higher intake of ultra-processed foods. A greater E-DII score was associated with elevated insulin resistance (HOMA-IR), and consumption of ultra-processed foods was correlated with high triglycerides. Circulating levels of TNF-α, adiponectin and IL-6 were influenced by diet quality indices, while CRP and leptin were not. In conclusion, survivors of cALL have poor adherence to dietary recommendations, adversely affecting their cardiometabolic health.
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Affiliation(s)
- Sophie Bérard
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Sophia Morel
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Emma Teasdale
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - James R. Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada; (C.L.); (D.S.)
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada; (C.L.); (D.S.)
| | - Emile Levy
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Valérie Marcil
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-514-345-4931 (ext. 3272)
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15
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Cohen J, Collins L, Gregerson L, Chandra J, Cohn RJ. Nutritional concerns of survivors of childhood cancer: A "First World" perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28193. [PMID: 31994836 DOI: 10.1002/pbc.28193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.
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Affiliation(s)
- Jennifer Cohen
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laura Gregerson
- Department of Nutrition, Exercises and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joya Chandra
- Departments of Pediatrics Research, Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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16
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Cross A, Howlett N, Sheffield D. Social ecological interventions to increase physical activity in children and young people living with and beyond cancer: a systematic review. Psychol Health 2020; 35:1477-1496. [PMID: 32468857 DOI: 10.1080/08870446.2020.1759601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To identify the behaviour change techniques and intervention components associated with the promotion of physical activity (PA) for children and young people living with and beyond cancer. Design and main outcome measures: A systematic review and narrative synthesis was conducted on the evidence on PA interventions for children and young people (up to 30 years of age) living with and beyond cancer using a social ecological framework. Results: Out of 12 studies, 8 were shown to change PA. Intervention components included (1) behavioural (Instruction on how to perform the behaviour, credible source, behavioural demonstration and rehearsal), (2) cognitive-emotional (targeting attitude, perceived behavioural control, intentions, resilience and achievement) (3) socio-cultural (family and peer support for PA), (4) environmental (providing access to resources, environmental restructuring, safety), (5) demographic (child, adolescent, young adult or mixed) and (6) medical (tailored exercise depending on age and cancer stage). Conclusions: Interventions designed to increase physical activity participation and adherence during and beyond cancer treatment for young people should integrate psychosocial (behavioural, cognitive-emotional, social), environmental and medical intervention components. Our conceptual model can be used to inform the development of interventions and guides future research objectives and priorities.
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Affiliation(s)
- Ainslea Cross
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - Neil Howlett
- Department of Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, UK
| | - David Sheffield
- Human Sciences Research Centre, University of Derby, Derby, UK
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17
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Fuemmeler BF, Holzwarth E, Sheng Y, Do EK, Miller CA, Blatt J, Rosoff PM, Østbye T. Mila Blooms: A Mobile Phone Application and Behavioral Intervention for Promoting Physical Activity and a Healthy Diet Among Adolescent Survivors of Childhood Cancer. Games Health J 2020; 9:279-289. [PMID: 32391734 DOI: 10.1089/g4h.2019.0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objectives: Smartphone applications ("apps") can be used to promote health behavior change and expand the reach of behavioral interventions. To date, only a few existing apps have been developed for health promotion among adolescent survivors of childhood cancer. To address this gap, we developed an app-based intervention, using game design characteristics, theory-based behavioral strategies, and assistance from a health coach to motivate health behavior change for adolescent survivors of childhood cancer. This article describes the development and initial feasibility evaluation of the intervention. Methods: Using a theoretical framework and an extensive formative process, we developed an app-based game ("Mila Blooms") that promotes healthy eating and physical activity among adolescent survivors of childhood cancer. A single-arm 8-week intervention, using this app-based game, with assistance from a health coach, was conducted among a sample of pediatric cancer survivors (n = 15) to evaluate its initial feasibility for promoting health behavior change. Results: Results from the feasibility evaluation were encouraging. The majority of enrolled participants were retained throughout the 8-week intervention (93.8%). Participant satisfaction feedback indicated positive experiences, related to ease of use and enjoyment of the app. Although there was little evidence for behavior change attributable to the app in this first stage of development, there was a solid demonstration of the viability and appeal of the game features, and there were no adverse side effects. Conclusions: Results provide insights into how gamification can be used to promote health behaviors through an app-based intervention. Mila Blooms holds promise for promoting health behavior change. Lessons learned from our experiences could be useful for the future development and implementation of app-based adolescent health interventions.
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Affiliation(s)
- Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | | | - Yaou Sheng
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth K Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Carrie A Miller
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Julie Blatt
- Department of Pediatric Hematology Oncology Program, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Philip M Rosoff
- Department of Pediatrics and Medicine, Duke University, Durham, North Carolina
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
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18
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Farhadfar N, Kelly DL, Mead L, Nair S, Colee J, Irizarry Gatell V, Murthy HS, Brown RA, Hiemenz JW, Hsu JW, May WS, Wingard JR, Dahl WJ. Dietary Intake and Diet Quality of Hematopoietic Stem Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:1154-1159. [PMID: 32105830 DOI: 10.1016/j.bbmt.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) survivors are burdened by a high prevalence and early onset of chronic diseases. Healthy dietary patterns have been associated with lower risks of chronic health conditions in the general population. HCT survivors are susceptible to multiple complications that may result in chronic illness. Unfortunately, no study to date has comprehensively documented the adherence of HCT survivors to the Dietary Guidelines for Americans (DGA), which are designed specifically to provide guidance for making healthy food choices. The primary aim of this study was to evaluate diet quality and nutrient intake adequacy of HCT survivors. A secondary aim was to assess these survivors' willingness to take part in a future dietary intervention. The dietary intake of adults who had undergone autologous or allogeneic HCT for a hematologic disease and were at least 1 year post-transplantation was assessed using the Block 2014 food frequency questionnaire, and diet quality was estimated using the Healthy Eating Index 2015. Nutrient intake adequacies of the group were estimated by the estimated average requirement cutpoint method. Survivors' (n = 90) HEI-2015 scores averaged 61.6 ± 1.1. Adherence to a good-quality diet was reported by only 10% of survivors. Intakes of vitamins A, C, and D, as well as magnesium and calcium, suggested inadequacy. Fiber intake at 8.9 g per 1000 kcal/day fell below the recommended adequate intake. "Change in taste" was associated with lower quality of diet (P = .02). HCT survivors within 2 years post-transplantation were more receptive than survivors beyond 2 years to participating in a dietary intervention (95% versus 65%; P = .0013). Adult HCT survivors reported less-than-optimal adherence to the 2015-2020 DGA and had numerous shortfall nutrient intakes; however, their willingness to participate in a dietary intervention was relatively high. These findings reinforce the need to incorporate nutrition into HCT survivor care.
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Affiliation(s)
- Nosha Farhadfar
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida.
| | - Debra L Kelly
- College of Nursing, University of Florida, Gainesville, Florida
| | - Lacey Mead
- Institute of Food Science and Human Nutrition, University of Florida, Gainesville, Florida
| | - Shalini Nair
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - James Colee
- Department of Statistics, University of Florida, Gainesville, Florida
| | - Vivian Irizarry Gatell
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - Hemant S Murthy
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - Randy A Brown
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - John W Hiemenz
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - Jack W Hsu
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - William S May
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - John R Wingard
- Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida
| | - Wendy J Dahl
- Institute of Food Science and Human Nutrition, University of Florida, Gainesville, Florida
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19
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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20
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Touyz LM, Cohen J, Cohn RJ, Garnett SP, Anazodo A, Gohil P, Grech AM, Ng A, Wakefield CE. Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective. Pediatr Blood Cancer 2019; 66:e27922. [PMID: 31309668 DOI: 10.1002/pbc.27922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maintaining a healthy lifestyle can protect adolescent survivors of pediatric cancer against chronic diseases such as obesity and cardiovascular disease. In this study, we examined the attitudes of adolescent survivors of pediatric cancer and their parents toward improving lifestyle behaviors after cancer treatment, including their preferences for intervention delivery and perceived barriers and benefits to healthy eating and exercise. METHODS We recruited adolescent survivors of childhood cancer aged 11-19 years and their parents, from two hospitals. Participants completed a questionnaire via mail or at routine oncology clinic visits. RESULTS Thirty-three adolescents (response rate 39%, mean age 15, 61% male) and 32 parents (representing 30 parent-child dyads) participated. Parents were significantly more interested in having their child participate in a lifestyle intervention than adolescents (41% of adolescents and 72% of parents, P = .012). Both groups preferred that the survivor receive lifestyle support face to face rather than online. Adolescents preferred to involve their friends (39% of adolescents and 19% of parents) whereas parents preferred to involve the family in a lifestyle intervention (15% of adolescents and 47% of parents, P = .006). Adolescents and their parents perceived a dislike of the taste of fruits and vegetables, fatigue, lack of motivation, and fear of injury as barriers to change. They perceived that keeping healthy and having more energy were benefits to participation. Participants indicated that interventions that provide face-to-face personal training and dietary education at a local gym would be well accepted. CONCLUSIONS Adolescents who have had cancer in childhood have a preference for face-to-face contact with health professionals to overcome the barriers to participation in a lifestyle intervention.
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Affiliation(s)
- Lauren M Touyz
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Paayal Gohil
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Allison M Grech
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Anthea Ng
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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21
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Mizrahi D, Fardell JE, Wakefield CE, Simar D, Maguire AM, Hubbard G, Cohn RJ. How physically active do Australian and New Zealander childhood cancer survivors perceive themselves? A report from the ANZCHOG survivorship study. Complement Ther Med 2019; 44:196-203. [PMID: 31126556 DOI: 10.1016/j.ctim.2019.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Childhood cancer survivors are at risk of treatment late-effects. Physical activity represents a necessary complementary therapy and modifiable risk-factor across all ages for many cardio-metabolic late-effects. This study assessed perceived physical activity in Australian and New Zealander childhood cancer survivors. METHODS We recruited parents of survivors aged <16 years, and adult survivors of childhood cancer aged ≥16 years, ≥5 years since diagnosis, with age-matched controls for comparison. We compared perceived moderate-vigorous physical activity between survivors and controls, using regression to identify associations with physical activity. RESULTS We recruited 914 participants (570 childhood cancer survivors and 344 age-matched controls). Parents of survivors perceived more moderate-vigorous physical activity than child controls (248 ± 218, 95% Confidence Interval (CI) = 218-280 vs 185 ± 214 min/week, 95% CI = 144-225, p = 0.036), with no perceived difference between adult survivors and controls (125 ± 152, 95% CI = 108-140 vs 160 ± 201 min/week, 95% CI = 132-187, p = 0.477). Twenty-seven percent of child survivors (vs. 14.5% controls) and 30% of adult survivors (vs. 39.4% controls) met recommendations. Adult survivors who received radiotherapy (OR = 0.585, 95% CI = 0.343-0.995, p = 0.048) or not completed university (OR = 1.808, 95% CI = 1.071-3.053, p = 0.027) were less likely to meet recommendations. CONCLUSIONS Over two-thirds of Australian and New Zealander childhood cancer survivors across all ages are perceived to not meet physical activity recommendations. Adult survivors who had radiotherapy or did not complete university appeared at-risk for low physical activity. PRACTICAL IMPLICATIONS Physical activity is important for everyone, but critical among childhood cancer survivors due to increased late cardio-metabolic risks. Monitoring survivors' perceived but also objectively measured physical activity as complementary to routine care is warranted, to provide education and motivate survivors to take control of their health.
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Affiliation(s)
- David Mizrahi
- School of Medical Sciences, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.
| | - Joanna E Fardell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia
| | - David Simar
- School of Medical Sciences, UNSW Medicine, UNSW Sydney, Australia
| | - Ann M Maguire
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Gill Hubbard
- Department of Nursing, Centre for Health Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | - Richard J Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia
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22
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Fisher RS, Rausch JR, Ferrante AC, Prussien KV, Olshefski RS, Vannatta KA, Compas BE, Gerhardt CA. Trajectories of health behaviors across early childhood cancer survivorship. Psychooncology 2018; 28:68-75. [PMID: 30402997 DOI: 10.1002/pon.4911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The majority of childhood cancer survivors develop at least one late effect subsequent to treatment (eg, cardiovascular disease and obesity). Consistent engagement in recommended health behaviors may mitigate some of these conditions. Researchers have identified early survivorship as a teachable moment, yet few studies have examined positive health behaviors during this period. METHODS Families of children with cancer (ages 5-17) were initially recruited following a diagnosis or relapse of cancer. Three years post diagnosis, survivors (n = 82, Mage = 13.3, SD = 3.7) and their mothers (n = 103, Mage = 41.1, SD = 7.6) completed a questionnaire assessing exercise, dietary, and sleep patterns among survivors. A follow-up assessment was conducted 2 years later. Mixed models tested change in health behavior over time. RESULTS At 3- and 5-year post diagnosis, mother and self-report indicated that few survivors engaged in appropriate levels of low-intensity exercise, fruit/vegetable intake, and dairy consumption. However, most survivors engaged in recommended levels of high intensity exercise, fast food restriction, and sleep. Health behaviors remained stable over time, except for mother report of sleep duration, which decreased (b = -0.6, P < 0.001). Brain tumor diagnosis predicted a larger decrease in self-report of sleep duration compared with other diagnoses (P = 0.04). Income predicted fast food intake such that higher income was associated with decreased intake over time, whereas lower income was associated with increased intake (P = 0.04). CONCLUSIONS During early survivorship, several health behaviors fell short of expectations for exercise and diet and did not improve upon reaching 5-year post diagnosis. Providers should evaluate survivors' health behaviors, including sleep, early and often, intervening when necessary.
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Affiliation(s)
- Rachel S Fisher
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Amanda C Ferrante
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Randal S Olshefski
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn A Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
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23
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Diorio C, Lin M, Ginn E, Ladas EJ. Psychosocial determinants of physical activity and dietary behaviors in adolescents and young adults with cancer and survivors. Pediatr Blood Cancer 2018; 65:e27243. [PMID: 29797639 DOI: 10.1002/pbc.27243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Survivors of childhood cancer are at increased risk of lifestyle influenced health issues. We sought to understand the association between stages of change (SOC) and psychosocial variables related to modifiable health behaviors: physical activity (PA), dietary fat intake, and intake of fruits and vegetables among adolescents and young adults at different phases of cancer therapy. METHODS We conducted an exploratory cross-sectional survey of adolescents and young adults currently being treated for cancer or who are survivors of childhood cancer. We evaluated SOC and several psychosocial variables using the previously validated Patient-Centered Assessment and Counseling for Exercise (PACE+): Physical Activity and Diet Surveys for Adolescents tool. Current dietary behaviors were evaluated with 24 hr diet recall. RESULTS One hundred and eighteen patients participated in the survey. SOC did not vary by phase of treatment. Ethnicity and body mass index were strongly associated with SOC for PA, but not for dietary behaviors. There was a significant association between SOC and self-efficacy, knowledge of strategies, and family or friend support for PA, dietary fat, and fruits and vegetables. Higher self-efficacy and family support were significant variables impacting SOC and participants' reported intake of fruits and vegetables servings. CONCLUSION We demonstrate that SOC for the investigated behaviors did not change based on phase of treatment, supporting the initiation of lifestyle interventions early on in treatment. We identify several psychosocial variables that may act as important targets for future lifestyle interventions aimed to improve dietary and exercise behaviors in adolescents and young adults with cancer and survivors.
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Affiliation(s)
- Caroline Diorio
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Meiko Lin
- Teachers College, Columbia University
| | - Elizabeth Ginn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York.,Institute of Human Nutrition, Columbia University Medical Center, New York
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Touyz L, Cohen J, Wakefield C, Grech A, Garnett S, Gohil P, Cohn R. Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study. JMIR Res Protoc 2018; 7:e129. [PMID: 29769170 PMCID: PMC5976864 DOI: 10.2196/resprot.9252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot). OBJECTIVE This pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors' dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake. METHODS We aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children's diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating. RESULTS Reboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018. CONCLUSIONS Reboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas. REGISTERED REPORT IDENTIFIER RR1-10.2196/9252.
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Affiliation(s)
- Lauren Touyz
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Jennifer Cohen
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Claire Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Allison Grech
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Sarah Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Paayal Gohil
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Richard Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Chidlren's Health, University of New South Wales Sydney, Sydney, Australia
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25
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Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, Ladhani S, Socha A, Shinuda J, Jaber S, Burrow S, Singh SK, Banfield L, de Souza RJ, Thabane L, Samaan MC. Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta-analysis. Clin Obes 2018; 8:55-67. [PMID: 29024558 DOI: 10.1111/cob.12224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/22/2022]
Abstract
Survivors of childhood brain tumours (SCBT) have increased cardiometabolic risks, but the determinants of these risks are unclear. This systematic review aims to compare the prevalence of overweight and obesity as well as adiposity measures between SCBT and non-cancer controls. The PubMed, EMBASE, MEDLINE, CINAHL and the Cochrane Library databases were searched. The primary outcomes were the prevalence of overweight and obesity based on body mass index. The secondary outcomes were adiposity measures including percent fat mass, waist-to-hip and waist-to-height ratios. Forty-one studies were included in the meta-analysis. The prevalence of overweight and obesity combined was similar between overall SCBT, SCBT excluding craniopharyngioma and non-cancer controls (42.6%, 95% CI 30.1-55.1 vs. 31.7%, 95% CI 20.4-43.0 vs. 40.4%, 95% CI 34.0-46.8). We also found that SCBT have higher percent fat mass (mean difference 4.1%, 95% CI 2.0-6.1), waist-to-hip ratio (mean difference 0.07, 95% CI 0.02-0.13) and waist-to-height ratio (mean difference 0.06, 95% CI 0.01-0.10) than non-cancer controls. We conclude that SCBT have similar overweight and obesity distribution but higher adiposity than non-cancer controls. More studies were needed to explore the determinants of adiposity and its contribution to cardiometabolic outcomes in SCBT.
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Affiliation(s)
- K-W Wang
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
| | - A Fleming
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Canada
| | - S R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
| | - S Ladhani
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - A Socha
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - J Shinuda
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Jaber
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Canada
| | - S K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Canada
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Canada
| | - L Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - R J de Souza
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - L Thabane
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - M C Samaan
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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26
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Physical activity barriers, preferences, and beliefs in childhood cancer patients. Support Care Cancer 2018; 26:2177-2184. [DOI: 10.1007/s00520-017-4041-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022]
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27
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Health-related quality of life of survivors of childhood acute lymphoblastic leukemia: a systematic review. Qual Life Res 2018; 27:1431-1443. [DOI: 10.1007/s11136-018-1788-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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28
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Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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29
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Low adherence to dietary recommendations in adult childhood cancer survivors. Clin Nutr 2017; 36:1266-1274. [DOI: 10.1016/j.clnu.2016.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/05/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022]
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30
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Devine KA, Mertens AC, Whitton JA, Wilson CL, Ness KK, Gilleland Marchak J, Leisenring W, Oeffinger KC, Robison LL, Armstrong GT, Krull KR. Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS). Psychooncology 2017; 27:613-619. [PMID: 28805953 DOI: 10.1002/pon.4528] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/21/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate concurrent and longitudinal associations between psychosocial functioning and physical activity in adolescent and young adult survivors of early childhood cancer. METHODS Adolescent survivors of early childhood cancer (diagnosed before age four) participating in the Childhood Cancer Survivor Study completed the Coping Health and Illness Profile-Adolescent Edition (CHIP-AE; n = 303; mean age at survey: 17.6 years). A subset of these survivors (n = 248) completed a follow-up survey an average of 6.0 years later (range: 4-10). Logistic regression identified associations between psychosocial functioning in adolescence and physical activity levels in adolescence and young adulthood. RESULTS Survivors reported low physical activity as adolescents (46.1% scored below CHIP-AE cut-point) and young adults (40.8% below Centers for Disease Control guidelines). Poor physical activity during adolescence was associated with female sex (OR = 2.06, 95% CI, 1.18-3.68), parents with less than a college education (OR = 1.91, 95% CI, 1.11-3.32), previous treatment with cranial radiation (OR = 3.35, 95% CI, 1.69-6.88), TV time (OR = 1.77, 95% CI, 1.00-3.14), and limitations of activity due to health or mobility restrictions (OR = 8.28, 95% CI, 2.87-30.34). Poor diet (OR = 1.84, 95% CI, 1.05-3.26) and low self-esteem (OR = 1.80, 95% CI, 0.99-3.31) during adolescence were associated with lower odds of meeting Centers for Disease Control physical activity guidelines in young adulthood. CONCLUSION These findings provide targets for future interventional studies to improve physical activity in this high-risk population.
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Affiliation(s)
- Katie A Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - John A Whitton
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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31
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Schulte F, Russell KB, Cullen P, Embry L, Fay-McClymont T, Johnston D, Rosenberg AR, Sung L. Systematic review and meta-analysis of health-related quality of life in pediatric CNS tumor survivors. Pediatr Blood Cancer 2017; 64. [PMID: 28266804 DOI: 10.1002/pbc.26442] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pediatric central nervous system (CNS) tumor survivors are at high risk for numerous late effects including decreased health-related quality of life (HRQOL). Our objective was to summarize studies describing HRQOL in pediatric CNS tumor survivors and compare HRQOL outcomes in studies that included a comparison group. PROCEDURE EMBASE, MEDLINE, and PsychINFO were used to identify relevant articles published until August, 2016. Eligible studies reported outcomes for pediatric CNS tumor survivors diagnosed before age 21, at least 5 years from diagnosis and/or 2 years off therapy and used a standardized measure of HRQOL. All data were abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS Of 1,912 unique articles identified, 74 were included in this review. Papers described 29 different HRQOL tools. Meta-analyses compared pediatric CNS tumor survivors to healthy comparisons and other pediatric cancer survivors separately. HRQOL was significantly lower for CNS (n = 797) than healthy comparisons (n = 1,397) (mean difference = -0.54, 95% confidence interval [CI] = -0.72 to -0.35, P < 0.001, I2 = 35%). HRQOL was also significantly lower for CNS (n = 244) than non-CNS survivors (n = 414) (mean difference = -0.56, 95% CI = -0.73 to -0.38, P < 0.00001, I2 = 0%). CONCLUSIONS Pediatric CNS tumor survivors experience worse HRQOL than healthy comparisons and non-CNS cancer survivors. Future HRQOL work should be longitudinal, and/or multisite studies that examine HRQOL by diagnosis and treatment modalities.
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Affiliation(s)
- Fiona Schulte
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - K Brooke Russell
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Oncology and Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Cullen
- Loretto Heights School of Nursing, Regis University, Denver, Colorado
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Taryn Fay-McClymont
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Johnston
- Department of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Abby R Rosenberg
- Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Lillian Sung
- Department of Haematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada
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32
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Wang KW, Souza RJD, Fleming A, Singh SK, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Scheinemann K, Thabane L, Samaan MC. Adiposity in childhood brain tumors: A report from the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE Study). Sci Rep 2017; 7:45078. [PMID: 28327649 PMCID: PMC5361156 DOI: 10.1038/srep45078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023] Open
Abstract
Children with brain tumors (CBT) are at high risk of cardiovascular diseases and type 2 diabetes compared to the general population. Recently, adiposity has been reported to be more informative for cardiometabolic risk stratification than body mass index (BMI) in the general population. The goal of this study is to describe the adiposity phenotype in CBT, and to establish adiposity determinants. We recruited CBT (n = 56) and non-cancer controls (n = 106). Percent body fat (%FM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured to determine total and central adiposity, respectively. Regression analyses were used to evaluate adiposity determinants. CBT had higher total and central adiposity compared to non-cancer controls despite having similar BMI measurements. Those with tumors at the supratentorial region had increased total and central adiposity, while those who received radiotherapy had increased total adiposity. In conclusion, CBT have increased total and central adiposity in the presence of similar BMI levels when compared to non-cancer controls. Adiposity, especially central adiposity, is a potential cardiometabolic risk factor present relatively early in life in CBT. Defining interventions to target adiposity may improve long-term outcomes by preventing cardiometabolic disorders in CBT.
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Affiliation(s)
- Kuan-Wen Wang
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adam Fleming
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sheila K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.,McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, University Children's Hospital, Basel, Switzerland
| | - Lehana Thabane
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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33
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Pugh G, Hough RE, Gravestock HL, Jackson SE, Fisher A. The Health Behavior Information Needs and Preferences of Teenage and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:318-326. [PMID: 28165844 DOI: 10.1089/jayao.2016.0089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study aimed to establish teenage and young adult cancer survivors (TYACS') specific interest in receiving information on physical activity, diet, smoking, and alcohol consumption and their preferences regarding the delivery, format, and timing of such health behavior information. METHODS TYACS aged 13-25 years were invited to complete a questionnaire assessing the advice they had received in the past and their preferences on when and how health behavior information should be delivered. RESULTS A total of 216 TYACS (mean age: 20 years; mean age at diagnosis: 16 years) completed the questionnaire. Approximately 40% of TYACS received no advice on physical activity and diet, and more than half (54%) received no advice on weight management. The majority (>70%) reported receiving no advice on smoking or alcohol consumption. Interest in receiving lifestyle advice was high overall (71%) but varied across behaviors, with TYACS reporting a greater level of interest in receiving advice on health protective behaviors (physical activity and diet) than health risk behaviors (smoking and alcohol consumption) (∼85% vs. ∼15%, respectively). TYACS reported seeking health behavior information from health professionals and were most interested in information delivered online or in the form of a mobile app. Similar proportions (18%-29%) felt health behavior information should first be provided before, during, immediately after, and post-treatment. CONCLUSIONS It is evident that there is a need to develop lifestyle interventions in a range of formats available to TYACS throughout the care pathway to address the health behavior information needs of young people with cancer.
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Affiliation(s)
- Gemma Pugh
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
| | - Rachael E Hough
- 2 Department of Haematology, University College London Hospital , London, United Kingdom
| | | | - Sarah E Jackson
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
| | - Abigail Fisher
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
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34
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Kopp LM, Gastelum Z, Guerrero CH, Howe CL, Hingorani P, Hingle M. Lifestyle behavior interventions delivered using technology in childhood, adolescent, and young adult cancer survivors: A systematic review. Pediatr Blood Cancer 2017; 64:13-17. [PMID: 27468131 DOI: 10.1002/pbc.26166] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/29/2016] [Accepted: 07/05/2016] [Indexed: 02/05/2023]
Abstract
Childhood, adolescent, and young adult cancer survivors demonstrate increased cardio-metabolic risk factors, which are amenable to lifestyle changes. The use of technology to impact lifestyle change expands previously limited intervention access, yet little is known about its use. We summarized lifestyle interventions for survivors delivered using technology, finding six studies, primarily targeting physical activity. Study samples were small and durations ranged from 5 to 16 weeks and outcomes modest. Participants were older, white, survivors of leukemia or brain tumors, and the majority received Web-based interventions. Study quality was moderate. Few technology-based interventions have been developed, suggesting an area of opportunity for survivors.
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Affiliation(s)
- Lisa M Kopp
- Division of Hematology/Oncology, Department of Pediatrics, BMT University of Arizona, Tucson, Arizona
| | | | - Christian H Guerrero
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, Arizona
| | - Carol L Howe
- College of Medicine, University of Arizona, Tucson, Arizona
| | - Pooja Hingorani
- Division of Hematology and Oncology, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, Arizona
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35
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Bordbar MR, Haghpanah S, Dabbaghmanesh MH, Omrani GR, Saki F. Bone mineral density in children with acute leukemia and its associated factors in Iran: a case-control study. Arch Osteoporos 2016; 11:36. [PMID: 27785744 DOI: 10.1007/s11657-016-0290-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/18/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Acute leukemia is the most common malignancy in children. We showed that low bone mass is prevalent among children with leukemia, especially in femur. Serum calcium, exercise, chemotherapy protocol, and radiotherapy are the main contributing factors. We suggest that early diagnosis and treatment of this problem could improve bone health in them. INTRODUCTION Acute leukemia is the most common malignancy in children and has been reported to be associated with low bone mass. Due to lack of sufficient data about the bone mineral density of children with leukemia in the Middle East, and inconsistencies between possible associated factors contributing to decreasing bone density in these children, we aimed to conduct a case-control study in Iran. MATERIALS AND METHODS This case-control study was conducted on 60 children with acute leukemia and 60 age- and sex-matched healthy controls. Anthropometric data, sun exposure, puberty, physical activity, and mineral biochemical parameters were assessed. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). Data analysis was done by SPSS software v. 21. RESULTS Serum calcium was higher in the control group (P = 0.012) while serum phosphorous, alkaline phosphatase, and serum 25(OH)D3 were higher in children with leukemia with P values of 0.04, 0.002, and 0.036, respectively. Sun exposure and physical activity were more in healthy controls (P values <0.001 and 0.003, respectively). Prevalence of vitamin D deficiency in case and control groups was 57.8 and 79.4 %, respectively. This prevalence was higher in healthy controls (P value = 0.007). Both lumbar and femoral neck bone mineral apparent density (BMAD) were higher in the control group (P value <0.001). Serum calcium, physical activity, and radiotherapy were the most relevant factors associated with lumbar BMAD. Femoral neck BMAD was associated with chemotherapy protocol. CONCLUSION Low bone mass for chronological age is prevalent among children with leukemia, especially in the femoral neck. Serum calcium, physical activity, chemotherapy protocol, and radiotherapy are the main contributing factors.
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Affiliation(s)
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Mooney R, Samhouri M, Holton A, Devine KA, Kirchhoff AC, Wright J, Wu YP. Adolescent and Young Adult Cancer Survivors' Perspectives on Their Internet Use for Seeking Information on Healthy Eating and Exercise. J Adolesc Young Adult Oncol 2016; 6:367-371. [PMID: 27845844 DOI: 10.1089/jayao.2016.0059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore adolescent and young adult (AYA) cancer survivors' internet use in seeking healthy lifestyle behavior (HLB) information on diet and exercise. METHODS Twenty-five AYA cancer survivors participated in focus groups or interviews. Data were analyzed using qualitative content analysis. RESULTS Most survivors (92%) sought HLB information from internet sources. Key issues included the following: (1) too much information available, (2) information not meeting survivors' unique needs, and (3) concerns about trustworthiness of information. CONCLUSION Although AYA cancer survivors use the internet to seek HLB information, internet resources could be modified to better meet the needs of AYA cancer survivors.
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Affiliation(s)
- Ryan Mooney
- 1 Department of Family and Preventive Medicine, University of Utah , Salt Lake City, Utah
| | - Mahasen Samhouri
- 1 Department of Family and Preventive Medicine, University of Utah , Salt Lake City, Utah
| | - Avery Holton
- 2 Department of Communication, University of Utah , Salt Lake City, Utah
| | - Katie A Devine
- 3 Department of Medicine, Section of Population Science, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey , New Brunswick, New Jersey
| | - Anne C Kirchhoff
- 4 Department of Pediatrics, University of Utah , Salt Lake City, Utah.,5 Cancer Control and Population Sciences, Huntsman Cancer Institute , Salt Lake City, Utah
| | - Jennifer Wright
- 4 Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Yelena P Wu
- 1 Department of Family and Preventive Medicine, University of Utah , Salt Lake City, Utah.,5 Cancer Control and Population Sciences, Huntsman Cancer Institute , Salt Lake City, Utah
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Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review. Pediatr Res 2016; 80:338-46. [PMID: 27064243 DOI: 10.1038/pr.2016.84] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/16/2016] [Indexed: 11/08/2022]
Abstract
Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.
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Deisenroth A, Söntgerath R, Schuster AJ, von Busch C, Huber G, Eckert K, Kulozik AE, Wiskemann J. Muscle strength and quality of life in patients with childhood cancer at early phase of primary treatment. Pediatr Hematol Oncol 2016; 33:393-407. [PMID: 27690707 DOI: 10.1080/08880018.2016.1219796] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer- and treatment-related side effects in patients with childhood cancer may cause limitations in motor performance affecting activities of daily living (ADLs). Data focusing on long-term effects are available, but little is known with regard to the short-term perspective. Therefore, the purpose of this study was to assess muscle strength performance and quality of life (QoL) in children and adolescents with cancer at the beginning of primary treatment. Forty children and adolescents aged 5-18 years (mean: 11.39 ± 4.08 years) with different types of childhood cancer were enrolled. On average 36 ± 20.5 days after diagnosis, strength performance in 7 muscle groups was assessed by handheld dynamometry. KINDL questionnaires were completed to evaluate QoL (children's self-report and parents' report). All parameters were compared with age- and gender-matched reference values. Patients with childhood cancer showed significantly lower strength values in all muscle groups (P < .01) compared with age- and gender-matched controls. Most affected were the lower extremities, with a -57.1% ± 10.4%, median: -59.2%, minimum: -75.4%, maximum: -41.4% percentage deviation in knee flexion from healthy peers. Children themselves and parents assessed total QoL significantly below age- and gender-matched reference values (P < .01). Correlation between elbow flexion and self-reported QoL was detected. Broader correlations were found for the parents' report. Muscle weakness and decreased QoL in children and adolescents seem to persist already at the beginning of anticancer treatment. This underlines the need of counteracting measures, such as exercise intervention programs, starting as early as possible during the treatment process. Efforts on this topic are currently being carried out by our group.
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Affiliation(s)
- Anne Deisenroth
- a Department of Pediatric Oncology, Hematology and Immunology , Heidelberg , Germany
| | - Regine Söntgerath
- b Department of Pediatric Oncology, Hematology and Hemostaseology , Leipzig University Hospital , Leipzig , Germany
| | - Anne Judith Schuster
- a Department of Pediatric Oncology, Hematology and Immunology , Heidelberg , Germany.,c Centre for Paediatric Medicine, Women's Clinic, Klinikum Stuttgart , Stuttgart , Germany
| | - Christine von Busch
- a Department of Pediatric Oncology, Hematology and Immunology , Heidelberg , Germany
| | - Gerhard Huber
- d Institute of Sports and Sport Science, Ruprecht Karls University , Heidelberg , Germany
| | - Katharina Eckert
- e Institute of Exercise and Public Health, Faculty of Sport Science, Leipzig University , Leipzig , Germany
| | - Andreas E Kulozik
- a Department of Pediatric Oncology, Hematology and Immunology , Heidelberg , Germany
| | - Joachim Wiskemann
- f Department of Medical Oncology , National Center for Tumor Diseases and Heidelberg University Hospital , Heidelberg , Germany
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Abstract
BACKGROUND Childhood cancer survivors are at a higher risk of developing health conditions such as osteoporosis, and cardiovascular disease than their peers. Health-promoting behaviour, such as consuming a healthy diet, could lessen the impact of these chronic issues, yet the prevalence rate of health-protecting behaviour amongst survivors of childhood cancer is similar to that of the general population. Targeted nutritional interventions may prevent or reduce the incidence of these chronic diseases. OBJECTIVES The primary aim of this review was to assess the efficacy of a range of nutritional interventions designed to improve the nutritional intake of childhood cancer survivors, as compared to a control group of childhood cancer survivors who did not receive the intervention. Secondary objectives were to assess metabolic and cardiovascular risk factors, measures of weight and body fat distribution, behavioural change, changes in knowledge regarding disease risk and nutritional intake, participants' views of the intervention, measures of health status and quality of life, measures of harm associated with the process or outcomes of the intervention, and cost-effectiveness of the intervention SEARCH METHODS We searched the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, Issue 3), MEDLINE/PubMed (from 1945 to April 2013), and Embase/Ovid (from 1980 to April 2013). We ran the search again in August 2015; we have not yet fully assessed these results, but we have identified one ongoing trial. We conducted additional searching of ongoing trial registers - the International Standard Randomised Controlled Trial Number register and the National Institutes of Health register (both screened in the first half of 2013) - reference lists of relevant articles and reviews, and conference proceedings of the International Society for Paediatric Oncology and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (both 2008 to 2012). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared the effects of a nutritional intervention with a control group which did not receive the intervention in this review. Participants were childhood cancer survivors of any age, diagnosed with any type of cancer when less than 18 years of age. Participating childhood cancer survivors had completed their treatment with curative intent prior to the intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected and extracted data from each identified study, using a standardised form. We assessed the validity of each identified study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE criteria to assess the quality of each trial. MAIN RESULTS Three RCTs were eligible for review. A total of 616 participants were included in the analysis. One study included participants who had been treated for acute lymphoblastic leukaemia (ALL) (275 participants). Two studies included participants who had all forms of paediatric malignancies (266 and 75 participants). All participants were less than 21 years of age at study entry. The follow-up ranged from one month to 36 months from the initial assessment. All intended outcomes were not evaluated by each included study. All studies looked at different interventions, and so we were unable to pool results. We could not rule out the presence of bias in any of the studies.There was no clear evidence of a difference in calcium intake at one month between those who received the single, half-day, group-based education that focused on bone health, and those who received standard care (mean difference (MD) 111.60, 95% confidence interval (CI) -258.97 to 482.17; P = 0.56, low quality evidence). A regression analysis, adjusting for baseline calcium intake and changes in knowledge and self-efficacy, showed a significantly greater calcium intake for the intervention as compared with the control group at the one-month follow-up (beta coefficient 4.92, 95% CI 0.33 to 9.52; P = 0.04). There was statistically significant higher, self-reported milk consumption (MD 0.43, 95% CI 0.07 to 0.79; P = 0.02, low quality evidence), number of days on calcium supplementation (MD 11.42, 95% CI 7.11 to 15.73; P < 0.00001, low quality evidence), and use of any calcium supplementation (risk ratio (RR) 3.35, 95% CI 1.86 to 6.04; P < 0.0001, low quality evidence), with those who received this single, face-to-face, group-based, health behaviour session.There was no clear evidence of a difference in bone density Z-scores measured with a dual-energy X-ray absorptiometry (DEXA) scan at 36 months follow-up (MD -0.05, 95% CI -0.26 to 0.16; P = 0.64, moderate quality evidence) between those who received calcium and vitamin D supplementation combined with nutrition education and those who received nutrition education alone. There was also no clear evidence of a difference in bone mineral density between the intervention and the control group at the 12-month (median difference -0.17, P = 0.99) and 24-month follow-up (median difference -0.04, P = 0.54).A single multi-component health behaviour change intervention, focusing on general healthy eating principles, with two telephone follow-ups brought about a 0.17 lower score on the four-point Likert scale of self-reported junk food intake compared with the control group (MD -0.17, 95% CI -0.33 to -0.01; P = 0.04, low quality evidence); this result was statistically significant. There was no clear evidence of a difference between the groups in the self-reported use of nutrition as a health protective behaviour (MD -0.05, 95% CI -0.24 to 0.14; P = 0.60, low quality evidence). AUTHORS' CONCLUSIONS Due to a paucity of studies, and the heterogeneity of the studies included in this review, we are unable to draw conclusions regarding the effectiveness of nutritional interventions for use with childhood cancer survivors. Although there is low quality evidence for the improvement in health behaviours using health behaviour change interventions, there remains no evidence as to whether this translates into an improvement in dietary intake. There was also no evidence that the studies reduced the risk of cardiovascular and metabolic disorders in childhood cancer survivors, although no evidence of effect is not the same as evidence of no effect. This review highlights the need for further well designed trials to be implemented in this population.
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Affiliation(s)
- Jennifer E Cohen
- Kids Cancer Centre, Sydney Children’s HospitalDepartment of Nutrition and DieteticsRandwick NSWAustralia
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- University of WollongongSchool of MedicineWollongongNSWAustralia
| | - Claire E Wakefield
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
| | - Richard J Cohn
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
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Dietary Protein Intake and Lean Muscle Mass in Survivors of Childhood Acute Lymphoblastic Leukemia: Report From the St. Jude Lifetime Cohort Study. Phys Ther 2016; 96:1029-38. [PMID: 26893509 PMCID: PMC4935785 DOI: 10.2522/ptj.20150507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low lean muscle mass and muscle weakness, which may contribute to inactivity and early development of chronic diseases typically seen in older adults. Although increasing protein intake, in combination with resistance training, improves lean muscle mass in other populations, it is not known whether muscular tissue among survivors of ALL, whose impairments are treatment-related, will respond similarly. OBJECTIVE The aim of this study was to evaluate associations among dietary protein intake, resistance training, and lean muscle mass in survivors of ALL and age-, sex-, and race-matched controls. DESIGN This was a cross-sectional study. METHODS Lean muscle mass was determined with dual-energy x-ray absorptiometry, dietary information with 24-hour recalls, and participation in resistance training with a questionnaire. Participants were 365 survivors of ALL (52% male; 87% white; median age=28.5 years, range=23.6-31.7) and 365 controls with no previous cancer. RESULTS Compared with controls, survivors of ALL had lower lean muscle mass (55.0 versus 57.2 kg, respectively) and lower percentage of lean muscle mass (68.6% versus 71.4%, respectively) than controls. Similar proportions of survivors (71.1%) and controls (69.7%) met recommended dietary protein intake (0.8 g/kg/d). Survivors (45.4%) were less likely to report resistance training than controls (53.8%). In adjusted models, 1-g higher protein intake per kilogram of body mass per day was associated with a 7.9% increase and resistance training ≥1×wk, with a 2.8% increase in lean muscle mass. LIMITATIONS The cross-sectional study design limits temporal evaluation of the association between protein intake and lean muscle mass. CONCLUSIONS The findings suggest that survivors of childhood ALL with low lean muscle mass may benefit from optimizing dietary protein intake in combination with resistance training. Research is needed to determine whether resistance training with protein supplementation improves lean muscle mass in survivors of childhood ALL.
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Webb J, Hall J, Hall K, Fabunmi-Alade R. Increasing the frequency of physical activity very brief advice by nurses to cancer patients. A mixed methods feasibility study of a training intervention. Public Health 2016; 139:121-133. [PMID: 27370700 DOI: 10.1016/j.puhe.2016.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the impact, acceptability, practicability and implementation of a training intervention, designed using the Behaviour Change Wheel, on the delivery of very brief advice on physical activity, by nurses to cancer patients. STUDY DESIGN A mixed methods feasibility study. METHOD A purposeful sample of nurses (n = 62) were recruited across two delivery arms, face-to-face (n = 55) and online (n = 7). Frequency of delivery of physical activity advice was collected at baseline with follow-up at 12 weeks. The 'capability, opportunity and motivation' of nurses to deliver very brief advice was measured via questionnaire. Semi-structured phone interviews (n = 14) were completed and analyzed thematically. A cost consequence analysis was undertaken. RESULTS The intervention improved the 'capability, opportunity and motivation' of nurses resulting in a change in knowledge, attitudes and beliefs towards physical activity. The intervention was both acceptable and practical. Face-to-face was the preferred mode of delivery, however there was also value in the online option. The cost of delivery per participant was £33.87 for face-to-face delivery, and £103.83 for online delivery inflated due to low recruitment numbers. A significant improvement was seen in delivery of very brief advice at 12 weeks (Z = -4.39, P ≤ 0.01). CONCLUSION The intervention is acceptable, practical and improves delivery of very brief advice on physical activity by nurses to cancer patients in the short-term. Both face-to-face and online delivery should be considered.
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Affiliation(s)
- J Webb
- Macmillan Cancer Support, Support and Wellbeing Department, 89 Albert Embankment, London, SE1 7UQ, UK.
| | - J Hall
- Brunel University, Sport, Health & Exercise Sciences, Kingston Lane, Uxbridge, Middlesex, UB8 3PH, UK
| | - K Hall
- University of Bath, Humanities & Social Sciences, Claverton Down Road, Bath, North Somerset, BA2 7AY, UK
| | - R Fabunmi-Alade
- University of Bath, Humanities & Social Sciences, Claverton Down Road, Bath, North Somerset, BA2 7AY, UK
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Pugh G, Gravestock HL, Hough RE, King WM, Wardle J, Fisher A. Health Behavior Change Interventions for Teenage and Young Adult Cancer Survivors: A Systematic Review. J Adolesc Young Adult Oncol 2016; 5:91-105. [DOI: 10.1089/jayao.2015.0042] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Gemma Pugh
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | | | - Rachael E. Hough
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Wendy M. King
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Swartz MC, Basen-Engquist KM, Markham C, Lyons EJ, Cox M, Chandra J, Ater JL, Askins MA, Scheurer ME, Lupo PJ, Hill R, Murray J, Chan W, Swank PR. Psychometric Analysis of the Three-Factor Eating Questionnaire-R18V2 in Adolescent and Young Adult-Aged Central Nervous System Tumor Survivors. J Adolesc Young Adult Oncol 2016; 5:278-85. [PMID: 27042872 DOI: 10.1089/jayao.2015.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adolescent and young adult (AYA)-aged central nervous system (CNS) tumor survivors are an understudied population that is at risk of developing adverse health outcomes, such as obesity. Long-term follow-up guidelines recommend monitoring those at risk of obesity, thus motivating the need for an eating behavior questionnaire. An abbreviated online version of the Three-Factor Eating Questionnaire (TFEQ-R18v2) has been developed, but its applicability to this population is not yet known. This study investigated the instrument's factor structure and reliability in this population. METHODS AYA-aged CNS tumor survivors (n = 114) aged 15-39 years completed the TFEQ-R18V2 questionnaire online. Confirmatory factor analysis was used to examine the fit of the three-factor structure (uncontrollable eating, cognitive restraint, and emotional eating [EE]) and reliability (internal consistency of the TFEQ-R18v2). Associations between the three factors and body mass index (BMI) were assessed by linear regression. RESULTS The theorized three-factor structure was supported in our population (RMSEA = 0.056 and CFI = 0.98) and demonstrated good reliability (α of 0.81-0.93). EE (β = 0.07, 95% CI 0.02-0.13) was positively associated with BMI, whereas the other two subscale scores were not. CONCLUSION The TFEQ-R18v2 instrument holds promise for research and clinical use among AYA-aged CNS tumor survivors. The instrument may be a useful tool for researchers to develop tailored weight management strategies. It also may be a valuable tool for clinicians to monitor survivors who are at risk of obesity and to facilitate referral. Our results also suggest that EE in this population should be further investigated as a potential target for intervention.
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Affiliation(s)
- Maria C Swartz
- 1 Division of Rehabilitation Sciences, The University of Texas Medical Branch , Galveston, Texas
| | - Karen M Basen-Engquist
- 2 Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Christine Markham
- 3 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Elizabeth J Lyons
- 1 Division of Rehabilitation Sciences, The University of Texas Medical Branch , Galveston, Texas
| | - Matthew Cox
- 2 Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Joya Chandra
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Joann L Ater
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Martha A Askins
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | | | - Philip J Lupo
- 5 Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Rachel Hill
- 6 Department of Hematology & Oncology, Cook Children's Medical Center , Fort Worth, Texas
| | - Jeffrey Murray
- 6 Department of Hematology & Oncology, Cook Children's Medical Center , Fort Worth, Texas
| | - Wenyaw Chan
- 7 Department of Biostatistics, The University of Texas Health Science Center at Houston School of Public Health , Houston, Texas
| | - Paul R Swank
- 3 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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Wright M. Physical Activity Participation and Preferences: Developmental and Oncology-Related Transitions in Adolescents Treated for Cancer. Physiother Can 2016; 67:292-9. [PMID: 26839461 DOI: 10.3138/ptc.2014-25lhc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To describe motor function and participation in, barriers to, and preferences for physical activity (PA) in adolescents during and after treatment of cancer and to discuss PA promotion in the context of developmental and cancer transitions. METHOD A cross-sectional survey study used the Transfer and Basic Mobility and Sports/Physical Functioning self-report and parent-report scales of the Pediatric Outcomes Data Collection Instrument (PODCI) and questions about PA participation and preferences to collect information from 80 adolescents and 63 parents. RESULTS PODCI scores for adolescents receiving treatment were more variable and significantly lower than those of adolescents who had been off treatment for more than 2 years. Fatigue, pain, general health, and doctor's orders were frequently identified as barriers to PA for adolescents receiving treatment. Many did not achieve recommended levels of PA. The adolescents expressed preferences for being active with friends and family, at home or in school, in the afternoon or evening, and through daily recreational and sports activities typical of teenagers. CONCLUSIONS Physical abilities and participation in and barriers to PA vary across the cancer journey. Interventions should be sensitive to variability and acknowledge individual preferences and environments throughout the trajectories and transitions of cancer treatment and youth development to achieve lifelong healthy lifestyles.
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Affiliation(s)
- Marilyn Wright
- McMaster Children's Hospital; School of Rehabilitation Sciences and Department of Pediatrics, McMaster University, Hamilton, Ont
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Asfar T, Dietz NA, Arheart KL, Tannenbaum SL, McClure LA, Fleming LE, Lee DJ. Smoking behavior among adult childhood cancer survivors: what are we missing? J Cancer Surviv 2016; 10:131-41. [PMID: 26031234 DOI: 10.1007/s11764-015-0459-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/20/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Childhood cancer survivors are a growing population at increased risk for smoking-related health complications. This study compared smoking prevalence, age at smoking initiation, and time trend of smoking prevalence from 1997 to 2010 between adult survivors of childhood cancer and adults without a cancer history (controls) and identified predictors of smoking among these survivors. METHODS Data were pooled from the 1997-2010 National Health Interview Survey (survivors, n = 1438; controls, n = 383,805). Smoking prevalence by age group was calculated using weighted least square regression analysis and weighted linear regression of prevalence on year for trend analysis. Logistic regression analyses adjusting for sample weights and design effects were performed to identify predictors of smoking among survivors. RESULTS Compared to controls, survivors were significantly more likely to be younger, female, non-Hispanic White, unemployed, with lower income, and to weigh less and smoke more. Survivors initiated smoking earlier than controls. Smoking prevalence among survivors peaked at age 30 and 40 years old, compared to age 25 years in controls. Smoking prevalence decreased consistently from 1997 to 2010 among controls, with larger significant declines in survivors that were subject to more year-to-year variability. Compared to nonsmoking survivors, those who smoke were significantly more likely to be non-Hispanic White, young, uninsured, poor, to have a high school education or less, and to report drinking alcohol. CONCLUSION Smoking in adult survivors of childhood cancer continues as a persistent risk factor across socioeconomic groups. IMPLICATIONS FOR CANCER SURVIVORS Targeted and tailored smoking cessation/prevention interventions for these survivors are needed.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Noella A Dietz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Stacey L Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Laura A McClure
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lora E Fleming
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Cornwall, UK
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Wu YP, Yi J, McClellan J, Kim J, Tian T, Grahmann B, Kirchhoff AC, Holton A, Wright J. Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions. J Adolesc Young Adult Oncol 2015; 4:184-91. [PMID: 26697268 PMCID: PMC4684662 DOI: 10.1089/jayao.2015.0028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18-39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters. METHODS Survivors (M(age) = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a self-reported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating. RESULTS In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support). CONCLUSION AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.
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Affiliation(s)
- Yelena P. Wu
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Department of Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, Utah
| | - Jessica McClellan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Jonghee Kim
- College of Social Work, University of Utah, Salt Lake City, Utah
| | - Tian Tian
- College of Social Work, University of Utah, Salt Lake City, Utah
| | - Bridget Grahmann
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Anne C. Kirchhoff
- Department of Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Avery Holton
- Department of Communication, University of Utah, Salt Lake City, Utah
| | - Jennifer Wright
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Daniel CL, Emmons KM, Fasciano K, Fuemmeler BF, Demark-Wahnefried W. Needs and Lifestyle Challenges of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine and Livestrong Foundation Workshop. Clin J Oncol Nurs 2015; 19:675-81. [PMID: 26583632 PMCID: PMC4795831 DOI: 10.1188/15.cjon.19-06ap] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Among adolescents and young adults (AYAs) in the United States, cancer is the leading cause of disease-related death. AYA survivors face numerous short- and long-term health and psychosocial issues, as well as increased risk for behavioral and lifestyle challenges, including poor diet, low physical activity (PA), and substance abuse. Many of these behaviors are modifiable, but gaps in care serve as barriers for AYA survivors. OBJECTIVES The purpose of this article is to (a) raise awareness of AYAs' increased risk for poor diet, low PA, and substance abuse; (b) examine previous interventions addressing these issues; and (c) provide recommendations for future directions. METHODS This article summarizes a workshop coordinated by the Institute of Medicine and the Livestrong Foundation to address AYA survivors' needs and ways to enhance their quality of care. FINDINGS Oncology nurses can promote the inclusion of lifestyle behaviors in survivorship care plans of AYA patients and serve as a valuable resource in improving AYA care on a larger scale. In addition, oncology nurse researchers may offer greater understanding of AYA patients' and survivors' needs and best practices by conducting much-needed research with this understudied population.
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Liebergall-Wischnitzer M, Buyum M, DeKeyser Ganz F. Health Promoting Lifestyle Among Israeli Adult Survivors of Childhood Cancer. J Pediatr Oncol Nurs 2015; 33:146-54. [DOI: 10.1177/1043454215600177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Childhood cancer survivors are at risk for recurrence of their primary cancer as well as other secondary site cancers. The survivors are also at increased risk for long-term effects such as chronic illnesses. Health promoting lifestyles are therefore especially important for childhood cancer survivors. The purpose of the study was to describe the health promoting behaviors of childhood cancer survivors and to determine whether these behaviors are associated with demographic and clinical characteristics. This is a descriptive-comparative study that took place in an oncology follow-up clinic in Israel. Sample: Seventy-seven childhood cancer survivors. Tools: Health Promoting Lifestyle Profile 2, questionnaire (interpersonal relationships, spiritual growth, physical activity, nutrition, health responsibility, and stress management), and smoking and alcohol consumption and a demographic–clinical questionnaire. The mean item score was moderate-high. Survivors scored highest on interpersonal relationships and spiritual growth while the lowest scoring activities were physical activity and nutrition. About 30% of the survivors abstained from smoking and alcohol consumption. Women, as opposed to men, were more likely to have higher scores related to nutrition and interpersonal relationships while singles as opposed to those who were married were found to have higher scores related to spiritual growth. Conclusions: Health behaviors associated with interpersonal relationships and spiritual growth were more likely to be performed compared to physical activity, good nutrition, and decreased smoking and alcohol consumption. Special attention should be placed on promoting physical activity and good nutrition among survivors of childhood cancer.
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Abstract
A high prevalence of obesity and cardiometabolic conditions has been increasingly recognized in childhood cancer survivors. In particular, survivors of pediatric acute lymphoblastic leukemia have been found to be at risk of becoming overweight or obese early in treatment, with increases in weight maintained throughout treatment and beyond. Nutrition plays an important role in the etiology of obesity and cardiometabolic conditions and is among the few modifiable factors that can prevent or delay the early onset of these chronic conditions. However, nutritional intake in childhood cancer survivors has not been adequately examined and the evidence is built on data from small cohorts of survivors. In addition, the long-term impact of cancer diagnosis and treatment on survivors' nutritional intake as well as how survivors' nutritional intake is associated with chronic health conditions have not been well quantified in large-scale studies. Promoting family-based healthy lifestyles, preferably at a sensitive window of unhealthy weight gain, is a priority for preventing the early onset of obesity and cardiometabolic conditions in childhood cancer survivors.
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Affiliation(s)
- Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA;
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and Departments of Medicine, Pediatrics, and Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
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Gibson TM, Liu W, Armstrong GT, Srivastava DK, Hudson MM, Leisenring WM, Mertens AC, Klesges RC, Oeffinger KC, Nathan PC, Robison LL. Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study. Cancer 2015; 121:4035-43. [PMID: 26287647 DOI: 10.1002/cncr.29609] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Survivors of pediatric cancer have elevated risks of mortality and morbidity. Many late adverse effects associated with cancer treatment (eg, second cancers and cardiac and pulmonary disease) are also associated with cigarette smoking, and this suggests that survivors who smoke may be at high risk for these conditions. METHODS This study examined the self-reported smoking status for 9397 adult survivors of childhood cancer across 3 questionnaires (median time interval, 13 years). The smoking prevalence among survivors was compared with the smoking prevalence among siblings and the prevalence expected on the basis of age-, sex-, race-, and calendar time-specific rates in the US population. Multivariable regression models examined characteristics associated with longitudinal smoking patterns across all 3 questionnaires. RESULTS At the baseline, 19% of survivors were current smokers, whereas 24% of siblings were current smokers, and 29% were expected to be current smokers on the basis of US rates. Current smoking among survivors dropped to 16% and 14% on follow-up questionnaires, with similar decreases in the sibling prevalence and the expected prevalence. Characteristics associated with consistent never-smoking included a higher household income (relative risk [RR], 1.16; 95% confidence interval [CI], 1.08-1.25), higher education (RR, 1.32; 95% CI, 1.22-1.43), and receipt of cranial radiation therapy (RR, 1.08; 95% CI, 1.03-1.14). Psychological distress (RR, 0.86; 95% CI, 0.80-0.92) and heavy alcohol drinking (RR, 0.64; 95% CI, 0.58-0.71) were inversely associated. Among ever-smokers, a higher income (RR, 1.17; 95% CI, 1.04-1.32) and education (RR, 1.23; 95% CI, 1.10-1.38) were associated with quitting, whereas cranial radiation (RR, 0.86; 95% CI, 0.76-0.97) and psychological distress (RR, 0.80; 95% CI, 0.72-0.90) were associated with not having quit. The development of adverse health conditions was not associated with smoking patterns. CONCLUSIONS Despite modest declines in smoking prevalence, the substantial number of consistent current smokers reinforces the need for continued development of effective smoking interventions for survivors.
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Affiliation(s)
- Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ann C Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Robert C Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul C Nathan
- Department of Pediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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