Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions

Informing Psychosocial Care for Young Couples Coping with Early-Onset Breast Cancer: A Cross-Sectional Examination of Unmet Service Needs and Their Association with Psychological Distress in the First Year Post-Diagnosis

Objective: Young women diagnosed with breast cancer report greater psychological and physical morbidity than both older women and healthy peers. Similarly, young partners experience elevated cancer-related distress. Psychosocial oncology programs are not frequently attuned to the needs of young adult patients and may exclude their social networks. This marks a critical gap in psychosocial care delivery. The study investigated unmet service needs, psychological distress, and care preferences of young couples managing breast cancer in the first year post-diagnosis. Methods: Forty dyads (n = 80) of women aged 18-45 and their partners completed measures of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and a service use questionnaire adapted from previously published Adolescent and Young Adult (AYA) literature. The resulting 25 items assessed perceived care needs and service utilization across three domains: informational, emotional/supportive, and practical issues. Descriptive statistics, cross-tabulations, and bivariate correlations were computed. Actor and partner effects of unmet needs on mental health outcomes were investigated with generalized estimating equations (GEE). Results: Patients and partners were in their late thirties, mostly non-Hispanic White, married, highly educated, and employed. Approximately 60% of patients and 43%-66% of partners presented one or more unmet service needs, which correlated with greater distress. Unmet needs about information related to exercise, recurrence, nutrition, and symptom management were prevalent. Unmet supportive service needs of both patients and partners included age-appropriate programs, sexual health, and family counseling. Women reported practical needs for work/school accommodations, integrative care, financial issues and health coverage; while financial concerns, health insurance, and caregiving demands were priorities for partners. Conclusion: Young couples facing early-onset breast cancer experience large proportions of unmet service needs. These challenges were exacerbated by the lack of developmentally targeted psychosocial programs pertaining to informational, supportive, and practical care needs. Enhancing providers' understanding of the psychosocial issues affecting young couples' well-being, and the implementation of systematic procedures to detect and respond to their distress, is urgently needed.

Experiences, behaviours, and perspectives of young cancer survivors on physical activity

This narrative review aimed to identify young cancer survivors' behaviours, experiences, and perspectives concerning physical activity, and identify useful strategies for promoting a healthy lifestyle. A manual search on the following databases was conducted: PubMed, Scopus, and Web of Science. The search was conducted between June 1, 2023, and April 12, 2024. Articles published from database inception up to April 12, 2024, were retrieved. Articles published in any language were considered. Perspectives including ideas, perceived barriers, and facilitators have been identified. Young cancer survivors seem to engage in physical activity as a useful coping strategy to regain normality and keep healthy after the cancer diagnosis. Although emotional and social support seems fundamental to increase participation, several other factors, including physical limitations, fatigue, sex, cancer type, and socio-economic status can influence physical activity participation. For those engaged in physical activity, the preferred activities are walking, biking, going to the gym, and exercising at home, while the least preferred are exercising at the hospital or boot camp-based exercises. Yoga is more frequently chosen by those still under treatment. Young cancer survivors appear to have unique needs different from those of adult cancer survivors. Mode of treatment delivery, increased awareness concerning the effects of physical activity, including families and friends, connecting survivors, and providing social support together with increasing motivation are key strategies for the promotion of physical activity in young cancer survivors. Fitness and healthcare professionals should consider these aspects to increase young cancer survivors' involvement in physical activities.

Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors: a Prisma systematic review

PURPOSE

Over the past few decades, the incidence of cancer among adolescents and young adults (AYA) has been increasing. The impact of behaviors, such as physical activity (PA) and nutrition, on disease progression, prognosis, and overall health and quality of life for AYA cancer survivors is of significant importance. This systematic review aims to evaluate the effectiveness of PA and diet interventions for AYA cancer survivors and to critically evaluate existing literature, gaps, and limitations.

METHODS

A search of literature was conducted in PubMed, Science Direct, Scopus, and Google Scholar following the PRISMA guidelines. Twenty-two studies were included from online databases from 2012 to 2022, 13 of which were randomized controlled trials.

RESULTS

Most interventions were related to PA, with only four studies including nutrition or Diet interventions. The interventions were generally feasible and acceptable to AYA cancer survivors, and digitally based PA interventions were commonly used. PA interventions mainly comprised aerobic and resistance training and were individualized. Overall, this review found various PA and diet interventions for AYA cancer survivors that were feasible and well-accepted, but gaps in knowledge and design still exist.

CONCLUSIONS

This systematic review underscores the importance of conducting more research on diet interventions for YCS. PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/#aboutregpage.

Health-related conditions among long-term cancer survivors diagnosed in adolescence and young adulthood (AYA): results of the SURVAYA study

BACKGROUND

With 5-year survival rates > 85%, gaining insight into the long-term and late health-related conditions of cancer survivors diagnosed in adolescence and young adulthood is of utmost importance to improve their quantity and quality of survival. This study examined the prevalence of and factors associated with, patient-reported health-related conditions and their latency times among long-term adolescent and young adult (AYA) cancer survivors.

METHODS

AYA cancer survivors (5-20 years after diagnosis) were identified by the population-based Netherlands Cancer Registry (NCR), and invited to participate in the SURVAYA questionnaire study. Participants reported the prevalence and date of diagnosis of health-related conditions. Clinical data were retrieved from the NCR.

RESULTS

Three thousand seven hundred seventy-six AYA cancer survivors (response rate 33.4%) were included for analyses. More than half of the AYAs (58.5%) experienced health-related conditions after their cancer diagnosis, of whom 51.4% were diagnosed with two or more conditions. Participants reported conditions related to vision (15.0%), digestive system (15.0%), endocrine system (14.1%), cardiovascular system (11.7%), respiratory system (11.3%), urinary tract system (10.9%), depression (8.6%), hearing (7.4%), arthrosis (6.9%), secondary malignancy (6.4%), speech-, taste and smell (4.5%), and rheumatoid arthritis (2.1%). Time since diagnosis, tumor type, age at diagnosis, and educational level were most frequently associated with a health-related condition.

CONCLUSIONS

A significant proportion of long-term AYA cancer survivors report having one or more health-related conditions.

IMPLICATIONS FOR CANCER SURVIVORS

Future research should focus on better understanding the underlying mechanisms of, and risk factors for, these health-related conditions to support the development and implementation of risk-stratified survivorship care for AYA cancer survivors to further improve their outcomes.

CLINICAL TRIALS REGISTRATION

NCT05379387.

Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study

BACKGROUND

Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions.

OBJECTIVE

This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution.

METHODS

This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068).

RESULTS

This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks.

CONCLUSIONS

In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52957.

Examining sociodemographic and health-related characteristics as moderators of an mHealth intervention on physical activity outcomes in young adult cancer survivors

PURPOSE

This study explored whether sociodemographic and health-related characteristics moderated mHealth PA intervention effects on total and moderate-to-vigorous physical activity (MVPA) at 6 months, relative to a self-help condition among young adult cancer survivors (YACS).

METHODS

We conducted exploratory secondary analyses of data from a randomized controlled trial among 280 YACS. All participants received digital tools; intervention participants also received lessons, adaptive goals, tailored feedback, text messages, and Facebook prompts. Potential moderators were assessed in baseline questionnaires. PA was measured at baseline and 6 months with accelerometers. Linear model repeated measures analyses examined within- and between-group PA changes stratified by levels of potential moderator variables.

RESULTS

Over 6 months, the intervention produced MVPA increases that were ≥ 30 min/week compared with the self-help among participants who were males (28.1 vs. -7.7, p = .0243), identified with racial/ethnic minority groups (35.2 vs. -8.0, p = .0006), had baseline BMI of 25-30 (25.4 vs. -7.2, p = .0034), or stage III/IV cancer diagnosis (26.0 vs. -6.8, p = .0041). Intervention participants who were ages 26-35, college graduates, married/living with a partner, had a solid tumor, or no baseline comorbidities had modest MVPA increases over 6 months compared to the self-help (ps = .0163-.0492). Baseline characteristics did not moderate intervention effects on total PA.

CONCLUSIONS

The mHealth intervention was more effective than a self-help group at improving MVPA among subgroups of YACS defined by characteristics (sex, race, BMI, cancer stage) that may be useful for tailoring PA interventions.

IMPLICATIONS FOR CANCER SURVIVORS

These potential moderators can guide future optimization of PA interventions for YACS.

CLINICALTRIALS

GOV IDENTIFIER

NCT03569605.

Facilitators and barriers to adherence to medical recommendations among adolescents with cancer: A systematic review

We aimed to systematically review barriers/facilitators of adherence among adolescents with cancer (aged 10-24 years), following a comprehensive approach to adherence that goes beyond medication-taking. Empirical studies published in English exploring determinants of adherence to medical recommendations among adolescents with cancer were identified in MEDLINE, PsycInfo, and Web of Science, up to October 2021. Records and full-text articles were reviewed by two independent reviewers, and results were classified according to the World Health Organization's (WHO) multidimensional adherence model. Eighteen studies were included. Despite heterogeneity in the definition and measurement of adherence, literature supported barriers/facilitators at patient, treatment, condition, healthcare team/system, and social/economic levels. Specifically, patient-related factors (i.e., psychological functioning and beliefs about disease and treatment) and social-related factors (i.e., family functioning) were major determinants of adolescent adherence. Few studies were conducted, and inconsistent findings were displayed for other dimensions (i.e., healthcare team/system, treatment, and condition-related factors). Adherence is a complex and multidetermined phenomenon. More research is needed to provide critical insights for policymakers and healthcare professionals in planning practices and interventions that effectively address meaningful barriers/facilitators of adolescents' adherence.

Physical activity maintenance among young adult cancer survivors in an mHealth intervention: Twelve-month outcomes from the IMPACT randomized controlled trial

BACKGROUND

Most physical activity (PA) interventions in young adult cancer survivors (YACS) have focused on short-term outcomes without evaluating longer-term outcomes and PA maintenance. This study examined the effects of an mHealth PA intervention at 12 months, after 6 months of tapered contacts, relative to a self-help group among 280 YACS.

METHODS

YACS participated in a 12-month randomized trial that compared self-help and intervention groups. All participants received an activity tracker, smart scale, individual videochat session, and access to a condition-specific Facebook group. Intervention participants also received lessons, tailored feedback, adaptive goal setting, text messages, and Facebook prompts for 6 months, followed by tapered contacts. Accelerometer-measured and self-reported PA (total [primary outcome], moderate-to-vigorous [MVPA], light, steps, sedentary behaviors) were collected at baseline, 6, and 12 months. Generalized estimating equation analyses evaluated group effects on outcomes from baseline to 12 months.

RESULTS

From baseline to 12 months, there were no between- or within-group differences in accelerometer-measured total PA min/week, while increases in self-reported total PA were greater in the intervention versus self-help group (mean difference = +55.8 min/week [95% CI, 6.0-105.6], p = 0.028). Over 12 months, both groups increased accelerometer-measured MVPA (intervention: +22.5 min/week [95% CI, 8.8-36.2] vs. self-help: +13.9 min/week [95% CI, 3.0-24.9]; p = 0.34), with no between-group differences. Both groups maintained accelerometer-measured and self-reported PA (total, MVPA) from 6 to 12 months. At 12 months, more intervention participants reported meeting national PA guidelines than self-help participants (47.9% vs. 33.1%, RR = 1.45, p = 0.02).

CONCLUSION

The intervention was not more effective than the self-help group at increasing accelerometer-measured total PA over 12 months. Both groups maintained PA from 6 to 12 months. Digital approaches have potential for promoting sustained PA participation in YACS, but additional research is needed to identify what strategies work for whom, and under what conditions.

Adult childhood cancer survivors' perceptions of factors that influence their ability to be physically active

PURPOSE

Studies indicate that adult childhood cancer survivors do not achieve recommended physical activity levels. A deeper understanding of factors that influence their ability to be physically active is essential to identify individuals in need of support. The aim was to explore factors that influence adult childhood cancer survivor's ability to be physically active.

METHOD

Semi-structured interviews were conducted from June to October 2020 with 20 adult childhood cancer survivors with a median age of 31 (min-max 20-47) years. Interviews were transcribed verbatim and analyzed with qualitative content analysis.

RESULTS

Four main categories: "The impact of environmental factors," "Personal factors of importance," "Consequences of the treatment or disease," and "The impact of support from healthcare" and 10 sub-categories, were identified. Participants described how family habits and encouragement from others influenced their present ability to be physically active. Experienced benefits of physical activity were described as a facilitator for current physical activity while suffering from late complications was identified as a barrier. Participants highlighted the importance of specific and individualized physical activity recommendations.

CONCLUSION

This study includes adult childhood cancer survivors several years after completion of treatment, hence highlighting the importance for support both during treatment and follow-up to sustain their physical activity. Healthcare providers need to identify individuals suffering from late complications, even several years after treatment; provide individualized physical activity recommendations; and educate families and schools about the importance of physical activity in childhood cancer survivorship.

TRIAL REGISTRATION

This research project was registered in the Swedish National Database of Research and Development, identifier 273320, December 6, 2019 ( https://www.researchweb.org/is/vgr/project/273320 ).

A qualitative study of stress experiences, health behaviors, and intervention preferences in young adult cancer survivors

PURPOSE

To inform behavioral intervention development, this study examined experiences and unmet needs related to stress, diet, and physical activity in young adult (YA) cancer survivors.

METHODS

Twenty-three semi-structured interviews were conducted with a purposive sample of YA cancer survivors (n = 12 aged 18-29 years; n = 11 aged 30-39 years; 57% racial or ethnic minority) between May and July 2022 via Zoom. Data were analyzed using a coding reliability approach to thematic analysis.

RESULTS

Stressor-related themes included health and health care, economic stability, social and community context, and balancing responsibilities. Transition to independent adulthood was discussed among younger participants (18-29 years). Coping-related themes included letting go, keeping anchored in faith, and distraction. Older participants (30-39 years) reported more diverse coping strategies. Routine and consistency and the impact of stress were themes aligning with health behaviors. Control was a cross-cutting theme regarding stressors, coping, and health behaviors. Themes related to intervention preferences included individualized approach, expert-based content, peer support, integrative self-care, and manageability. Younger participants preferred multiple intervention formats (e.g., website, tracking logs).

CONCLUSIONS

Findings highlighted unmet needs regarding social and environmental stressors in YA cancer survivors and a preference for individualized, expert-based content and peer support in stress management-enhanced behavioral interventions. Such interventions may be tailored for specific age groups to account for differences in stress experiences and intervention preferences.

Effect of an mHealth intervention on physical activity outcomes among young adult cancer survivors: The IMPACT randomized controlled trial

BACKGROUND

Physical inactivity is common in young adult cancer survivors (YACS), but evidence regarding effects of physical activity (PA) interventions among YACS is limited. The IMproving Physical Activity after Cancer Treatment (IMPACT) trial evaluated a theory-based mobile PA intervention on total PA minutes/week (primary) and secondary outcomes (moderate-to-vigorous PA [MVPA], light PA, steps, sedentary behaviors) at 6 months in YACS.

METHODS

YACS (N = 280) were randomized to an intervention group or self-help group. All participants received digital tools (activity tracker, smart scale, access to arm-specific Facebook group) and an individual video chat session. Intervention participants also received a 6-month program with behavioral lessons, adaptive goal-setting, tailored feedback, tailored text messages, and Facebook prompts. PA was assessed via accelerometry and questionnaires at baseline and 6 months. Generalized estimating equation analyses tested between-group differences in changes over time.

RESULTS

Of 280 YACS, 251 (90%) completed the 6-month accelerometry measures. Accelerometer-measured total PA minutes/week changed from 1974.26 at baseline to 2024.34 at 6 months in the intervention (mean change, 55.14 [95% CI, -40.91 to 151.19]) and from 1814.93 to 1877.68 in the self-help group (40.94 [95% CI, -62.14 to 144.02]; between-group p = .84). Increases in MVPA were +24.67 minutes/week (95% CI, 14.77-34.57) in the intervention versus +11.41 minutes/week in the self-help (95% CI, 1.44-21.38; between-group p = .07).

CONCLUSION

Although the intervention did not result in significant differences in total PA, the increase in MVPA relative to the self-help group might be associated with important health benefits. Future research should examine moderators to identify for whom, and under what conditions, the intervention might be effective.

CLINICALTRIALS

gov Identifier: NCT03569605.

PLAIN LANGUAGE SUMMARY

Physical inactivity is common in young adult cancer survivors. However, few interventions have focused on helping young adult cancer survivors to get more physical activity. The IMproving Physical Activity after Cancer Treatment trial compared a mobile health physical activity intervention with a self-help group on total amount of physical activity at 6 months in a nationwide sample of young adult cancer survivors. Intervention participants did not improve their total amount of physical activity, but they did increase their moderate-to-vigorous intensity physical activity by twice as much as the self-help participants. This increase in activity may be associated with health benefits.

Optimizing Fertility Treatment With Nutrition Guidance: Exploring Barriers and Facilitators to Healthful Nutrition Among Female Cancer Survivors With Fertility Challenges

INTRODUCTION

Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population.

METHODS

Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a thematic analysis approach. Quantitative data were analyzed using means, standard deviations, ranges, frequencies, and percentages.

RESULTS

The average age of respondents was 31.47 ± 3.5 years and the average BMI was 24.78 ± 4.1 kg/m2. All participants were college educated, 45% identified as White, 50% as Black, and 10% as Hispanic or Latinx. Cancer diagnoses included breast, thyroid, ovarian, leukemia, and gastrointestinal cancers. The following themes were identified: (1) Lack of nutrition-related resources and detailed guidance, (2) Work-life balance, (3) Perceived rigidity of dietary guidance, (4) Treatment-related fatigue, (5) Having trust in healthcare providers, (6) Higher motivation to change nutrition behavior, and (7) Recognizing the additional benefits of nutrition.

CONCLUSION

These findings indicate a sought-after yet unmet need for post-cancer treatment fertility nutrition recommendations. Interventions should be tailored to women's needs and focus on improving their self-efficacy to make healthful dietary choices.

Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective

Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders’ expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents’ limited attention span and avoiding the use of long-term health benefits as a motivator.

Association between Nutrition Behavior and Colorectal Cancer Diet Recommendation

The incidence of colorectal cancer has considerably increased worldwide, particularly among adults aged 50 and older. Despite numerous nutrition initiatives, colorectal cancer (CRC) remains a public health burden that affects younger adults in the United States. Understanding the potential factors contributing to non-adherence to nutrition recommendations can be helpful to develop effective nutrition initiatives to prevent CRC. This study aimed to determine differences in nutrition knowledge, attitudes, and beliefs (KAB); examine their associations on diet characteristics and weight status; and identify factors influencing eating patterns among ethnically diverse populations at risk for CRC and living in urban areas. The study used a quantitative descriptive and correlational research design in which data were collected through an online cross-sectional survey. A total of 377 participants responded to the survey. The study revealed a few significant differences in KAB levels between males and females. KAB levels were not associated with weight status but with meat recommendations among overweight or obese males. Ultimately, the study identified perceived barriers and facilitators as factors influencing participants’ diets. Differences in KAB among males and females were inconsistent with the diet characteristics and weight status variables. This study suggests acknowledging these differences and inconsistencies when designing nutrition initiatives focusing on colorectal cancer prevention.

"Your Body Is Not At All Where You Left It": Adolescent and Young Adult Cancer Survivors' Experiences Transitioning Back Into Physical Activity After Treatment

Physical activity (PA) can help manage cancer treatment-related side effects and improve well-being following treatment; however, resuming PA after a period of inactivity due to cancer can be challenging. The purpose of this study was to explore adolescents and young adults (AYAs) experiences transitioning back into PA after a period of inactivity due to cancer treatment. Twelve previously active AYAs (M_age = 30 ± 5.8 years) were purposefully sampled and engaged in a semi-structured interview. The following four themes were generated through a reflexive thematic analysis: PA is described as important and valuable; navigating one's appearance and fitness changes after cancer treatment within the PA context; supportive care is essential to successful PA transitions; and juxtaposed environments: fitness facilities, cities, and green spaces. Developing strategies aimed at gradually transitioning into PA should be a priority to improve AYAs' well-being through survivorship.

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature

Simple Summary

Although cancer survivors may experience health benefits from favorable lifestyle changes, many cancer survivors do not adhere to lifestyle recommendations or make favorable lifestyle changes after cancer diagnosis. This systematic review of the literature aimed to provide an overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. It provides a structured overview of the large variety of determinants of changes in different lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) derived from the 123 included papers (71 quantitative and 52 qualitative). Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors and inform researchers and healthcare professionals about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors.

Abstract

The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors.

Childhood cancer survivors' perceptions of the barriers and facilitators to physical activity: a systematic review and thematic synthesis of qualitative evidence using the Theoretical Domains Framework

AbstractDue to the potential for late adverse effects of treatment, and in particular cardiovascular problems, physical activity (PA) is recommended for childhood cancer survivors (CCSs). However, many CCSs have low levels of activity. This review aimed to systematically identify, appraise and synthesise qualitative research evidence on the barriers and facilitators to PA from the perspective of CCSs. Six databases (MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, and Scopus) were searched from inception to February 2021 to identify qualitative data on PA gathered from CCSs diagnosed ≤18 years of age, and who had completed active treatment. Two reviewers screened for eligibility and assessed methodological quality using CASP. An inductive thematic synthesis was undertaken to identify descriptive themes relating to barriers and facilitators to PA, before mapping these onto the Theoretical Domains Framework (TDF). Confidence in review findings was assessed using the GRADE-CERQual approach. Eight original studies including 126 CCSs were eligible. A total of 45 descriptive themes (29 facilitators and 16 barriers) were mapped onto nine domains of the TDF; they were most commonly mapped onto the Environmental Context and Resources (n = 13 descriptive themes) and the Social Influences (n = 13) domains. Between two and four descriptive themes were mapped onto each of the remaining seven domains. Study quality was variable and overall confidence in review findings was low. Although a range of perceived influences on PA were identified, few studies were eligible, and fewer focused specifically on identifying the barriers and facilitators to PA. These findings provide a first step required for the development of PA interventions for CCSs. However, conclusive/strong evidence for the barriers and facilitators to PA is lacking highlighting the need for further research on the perceived influences on PA in CCSs. PROSPERO Registration: CRD42019147829.

Testing the Associations Between Body Image, Social Support, and Physical Activity Among Adolescents and Young Adults Diagnosed With Cancer

Physical activity (PA) is important for managing the side effects and long-term outcomes of cancer treatment, yet many adolescents and young adults diagnosed with cancer (AYAs) are not meeting PA guidelines. Body image and social support are two factors that can influence PA behavior and require further attention in this population. The purpose of this study was to examine the associations between body image, social support, and PA among AYAs. An online cross-sectional survey administered through the Research Electronic Data Capture platform was used to assess self-reported body image (body-related self-conscious emotions of appearance and fitness shame, guilt, authentic pride, and hubristic pride), social support (general and cancer-specific), and PA (mild, moderate-to-vigorous, and resistance exercise) in AYAs (N = 119; M age = 34.5 ± 5.5 years). Based on findings from path analyses, body image and social support were directly associated with PA (R 2 = 0.09-0.33). Social support was also directly associated with body image. However, there were no indirect effects. These findings provide preliminary support for the influential role of appearance and fitness body-related emotions and cancer-specific social support on PA. The results have important implications for the development of targeted strategies aimed at improving body image (e.g., cognitive dissonance and compassion-focused interventions) and social support (e.g., facilitating the provision of cancer-specific support), with the overall goal of increasing AYAs' PA.

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

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.

Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial

BACKGROUND

Peer-based exercise interventions that cultivate new opportunities for support with a fellow cancer survivor may result in increased exercise volume. It is not clear whether adding qualified exercise professional (QEP) support to peer-based interventions improves health outcomes. Therefore, the purpose of this study is to determine whether breast cancer survivor (BCS) dyads who receive 10 weekly sessions of virtually delivered QEP support have improved outcomes compared to BCS dyads who do not receive QEP support.

METHODS

Participants Adult BCS with medical clearance for exercise, who have an internet-connected device, and currently engage in < 150 min of moderate-intensity exercise per week. Intervention BCS will be matched using evidence-based criteria. The intervention group will receive dyadic exercise information sessions and a program tailored by a QEP for 10 weeks (intervention period) and have access to the QEP for an additional 4 weeks (tapering period). The control will not receive any QEP support. Outcomes The primary outcome is post-intervention self-reported exercise volume. Secondary outcomes include device-assessed exercise volume (i.e., Fitbit), social support, and health-related quality of life. Randomization 108 participants, matched in dyads, will be randomized 1:1 to the MatchQEP or Match groups using a web-based scheme. Statistical analysis Outcomes will be measured at baseline, post-intervention, post-tapering, and at 12 weeks post-intervention follow-up.

DISCUSSION

The findings from this RCT will determine if matched BCS dyads who receive 10 weeks of virtually delivered QEP support have higher levels of self-report and device-measured exercise, social support, and health related quality of life compared to matched dyads without QEP-delivered exercise guidance. To our knowledge this will be the first study to assess the combined effect of peer- and QEP support on exercise volume. Project findings will inform and optimize intervention methods aimed to increase exercise among BCS through accessible exercise supports.

TRIAL REGISTRATION

The study is registered on ClinicalTrials.gov (study identifier: NCT04771975, protocol Version Number: 2, date: July 22, 2021).

Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis

The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I² 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.

Improving Food Literacy and Access Among Young Adult Cancer Survivors: A Cross-Sectional Descriptive Study

BACKGROUND

The links between nutrition and chronic disease are well established, but consumption of fruits and vegetables is low among young adult childhood cancer survivors (YACS) worldwide. Ensuring equitable access to fresh produce is a significant, persistent public health challenge.

OBJECTIVE

The purposes of this report are to describe patterns of access to fresh produce, daily intake of fruits/vegetables, and nutrition education preferences among a sample of YACS and to highlight early development of a mentored gardening intervention.

METHODS

A cross-sectional descriptive study design was used to assess dietary intake, access to fruits/vegetables, and preferences for nutrition education among 124 YACS through a comprehensive cancer survivorship program in a large pediatric cancer center.

RESULTS

Most participants (71.8%) live more than 10 minutes' walking distance from a supermarket, and 88.7% do not meet the recommended daily intake of 5 or more servings of fruit and vegetables. A total of 91% of participants express that nutrition is important, and 81.5% desire dietary improvement. Most (78.2%) are likely to use either their computer or cell phone for nutrition content. To establish healthy nutrition habits, many seek the support of a nutritionist (63.7%) or another survivor (41.9%).

CONCLUSIONS

Study findings underscore the need for advocacy to support equitable access to fresh produce and technology-enhanced nutrition education among YACS.

IMPLICATIONS FOR PRACTICE

To improve access to fresh produce and food literacy among YACS, providers can collaborate with community stakeholders to build capacity for sustainable, technology-enhanced, and mentored gardening interventions at the individual, family, and community level.

Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review

BACKGROUND

It has been posited that physical activity (PA) has the potential to improve health outcomes and the health-related quality of life of people living with or beyond cancer. Despite the well-documented health benefits of PA, there is a low level of PA among cancer patients. A systematic scoping review was conducted to investigate attitudes, perceptions, preferences and barriers vs. facilitators to cancer patients' PA participation.

METHODS

A systematic search was performed across four automated databases (PubMed, Embase, PsycINFO and Medline) in keeping with the PRISMA guideline. All cancer types were included, and any age/gender groups were eligible. Both qualitative and quantitative studies were included. The Health Belief Model provided a conceptual framework for the conduct of the scoping review as well as guiding thinking to inform evidence-based interventions.

RESULTS

Ninety-eight articles were included in this review. Nearly half of the studies focused on mixed cancer sites; breast cancer was the most commonly examined cancer type (19%). Post-treatment was the most commonly investigated stage (33%), followed by studies of mixed stages of the cancer trajectory (27%), the acute treatment stage (23%) and pre-treatment stage (1%). Patient treatment stage was not reported in 16% of studies. Cancer patients reported positive attitudes to PA and recognized its benefits for health and wellbeing. Cancer-related side effects (e.g. fatigue) were a leading physiological barrier to PA participation, whereas effective symptom management techniques/tools acted as a powerful facilitator. Psychosocial barriers included low motivation and kinesiophobia, and perceived health benefits and social support/guidance by healthcare providers were significant facilitators. Inaccessible fitness facilities hindered cancer patients' PA engagement though the availability of tailored amenities appeared to be a strong facilitator. PA preferences varied in terms of type, place, time, company and source of information and pointed to the need for individualized PA programs.

CONCLUSIONS

There is a need for further research to identify barriers and facilitators to PA that are faced by patients with particular cancer types. Recommended PA promoting-strategies involve including exercise science professionals in healthcare teams and ensuring that fitness facilities are accessible.

Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia

BACKGROUND

Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle-bone complex and prevent future impairment.

OBJECTIVE

This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment.

METHODS

ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist's clinical notes, to obtain a portrait of the participants' experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme.

RESULTS

Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent's disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient-parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants' perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits.

CONCLUSION

Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.

Associations Among Health Behaviors and Psychosocial Outcomes in Adolescent and Young Adult Cancer Survivors

Purpose: Adolescents and young adults (AYA) experience challenges both during and after their cancer treatment. Health behaviors are important contributors to health, yet little research examines health behaviors in AYA cancer survivors. We examined frequencies of health behaviors and associations between health behaviors, psychosocial, and clinical factors in AYA cancer survivors. Methods: Participants were survivors of AYA cancer (n = 60; 38.3% male; mean age = 25.3 years [standard deviation, SD = 4.6]; mean years since therapy completion = 9.0 [SD = 4.2]) from the Alberta Children's Hospital (ACH). Survivors were 13-21 years old at the time of diagnosis. Measures included demographic and clinical data, and the ACH Long-Term Survivor's Questionnaire. Health behaviors were compared with a control group (n = 600) using data from the 2017 Canadian Community Health Survey. Frequencies, conditional logistic regression, and logistic regression analyses were conducted. Results: Compared with controls, survivors reported engaging in physical activity (91.5% vs. 87.5%; odds ratio [OR] = 0.87, 95% confidence interval [CI] = 0.34-2.24; p = 0.77), smoking tobacco (15.3% vs. 19.7%; OR = 1.85, 95% CI = 0.89-3.85; p = 0.10), and street drug use (27.6% vs. 36.5%; OR = 1.60, 95% CI = 0.88-2.91; p = 0.12) at the same rate. Survivors reported binge drinking significantly less (61.0% vs. 76.6%; OR = 0.53, 95% CI = 0.30-0.92; p = 0.024) than controls. Logistic regression analyses revealed a significant model predicting binge drinking [χ²(5, 58) = 23.17, p < 0.001] with greater time off treatment, fear of another health condition, and higher mean body mass index emerging as significant predictors. Conclusion: AYA cancer survivors engage in risky health behaviors at rates similar to their peers. Further research is needed to understand factors mediating survivors' decision to participate in risky health behaviors.

Promoting physical activity in young adult cancer survivors using mHealth and adaptive tailored feedback strategies: Design of the Improving Physical Activity after Cancer Treatment (IMPACT) randomized controlled trial

INTRODUCTION

Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS.

PURPOSE

To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS.

METHODS

A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures.

CONCLUSIONS

IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.

Designing an exercise intervention for adult survivors of childhood cancers

BACKGROUND

This study examined current physical activity levels and preferences for exercise settings and activities among adult survivors of childhood cancers as a strategy to inform the feasibility and design of such programs.

METHODS

A mixed-methods design was used to investigate current activity levels as well as barriers to and preferences for physical activity among 20 adult survivors of pediatric cancer.

RESULTS

One-half of participants reported engaging in regular physical activity, although the frequency, intensity, and duration varied. Overall, 17 of the 20 participants (85%) stated they would be interested in participating in a structured exercise intervention, and they expressed a strong interest in walking (76%), bicycling (53%), and weight training (53%). Common barriers to participation in a potential structured exercise program were insufficient time, current health issues, and program location/distance. Nearly all participants agreed that information on nutrition and diet should be included as part of an exercise intervention.

CONCLUSIONS

These findings will help inform the design and implementation of future exercise programs to enhance physical activity among this high-risk group of cancer survivors.

Dietary behaviours, physical activity and quality of life among childhood cancer survivors in Mainland China: A cross-sectional study

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.

Exercise with Nutrition Education to Improve Quality of Life of Adolescent and Young Adult Cancer Survivors: A Pilot Study

Purpose: Most evidence for the relationship between physical activity, nutrition education, and late effects from cancer treatment come from cross-sectional studies. The purpose of this pilot study was to determine if 8 weeks of exercise and nutrition education in adolescent and young adult (AYA) survivors positively affects fatigue, quality of life, health-related fitness, and dietary intake. Methods: The exercise program targeted improvement in multiple areas of health-related fitness. A Registered Dietitian conducted nutrition education sessions with goal setting. To encourage activity, social engagement, and support, participants connected to a study-specific group. Fatigue and QoL (FACIT, PedsQL Teen, and Young Adult), health-related fitness (cardiovascular endurance, flexibility, muscular strength and endurance, anthropometrics), nutrition knowledge, and dietary intake assessments were conducted at weeks 1 and 10. Participant perceptions of strengths and weaknesses within the program were assessed after program completion. Results: Twenty four (16.6 ± 2.8 years) AYA cancer survivors began and completed the program. Problems with fatigue (PedsQL Teen and Young Adult) significantly improved along with decreased perceived barriers to exercise. Participants significantly improved cardiovascular endurance, flexibility, and muscular strength and endurance. Trying to make healthy nutrition choices, understanding how to read nutrition labels, and identifying a saturated fat significantly improved without a significant change in dietary intake. Participants' favorite program components related to exercise and social support. Conclusion: In view of the short- and long-term impacts of cancer diagnosis, treatment, and survivorship, as well as the benefits of physical activity on these factors, exercise programs with social support should be considered adjuvant therapy among AYA cancer survivors.

Feasibility and Acceptability Findings of an Energy Balance Data Repository of Children, Adolescents, and Young Adults with Cancer

Cancer patients suffer changes in energy balance (EB), the combination of energy intake (nutrition) and energy expenditure (physical activity (PA)), which may influence cancer-related morbidity, mortality, and quality of life. Significant gaps remain in our understanding of the frequency and magnitude of these EB changes. Herein, we report on the feasibility and acceptability of a longitudinal repository of EB outcomes in children, adolescents and young adults (AYA) with cancer along the cancer continuum to fill these gaps. This EB repository includes PA, nutrition, and physical function (PF) parameters. PA data were gathered through activity trackers. Nutritional data were gathered through food diaries and micronutrient labs. PF was assessed with validated objective and patient-reported measures. Feasibility was achieved with >50% enrollment of eligible patients (n = 80, Mage = 18.1 ± 7.5); 26 were children with cancer and 54 were AYAs with cancer. An 88.75% retention rate indicated acceptability. Despite COVID-19 disruptions, >50% of participants provided completed data for PA and micronutrient labs as of April 2020. Food diaries and PF data collection experienced disruptions. Methodological adaptations are in progress to minimize future disruptions. Overall, our findings demonstrate that prospective EB assessments are feasible and acceptable among children and AYAs with cancer.

Autonomy is not but competence and relatedness are associated with physical activity among colorectal cancer survivors

PURPOSE

The main objective of this study was to use the framework of the self-determination theory, incorporating both internal and external sources of motivation, to identify factors influencing physical activity among colorectal cancer survivors (CRC-S) in Korea.

METHOD

In total, 242 patients at a university-affiliated hospital in Seoul, Korea, responded to a descriptive survey, which comprised questionnaire sets including the Global Physical Activity Questionnaire and the Patient Health Questionnaire. Motivation was then assessed on three scales: the Treatment Self-Regulation (autonomy), Perceived Competence (competence), and the multidimensional Scale of Perceived Social Support (relatedness). Logistic regression analysis was then used to identify factors associated with physical activity.

RESULT

The mean physical activity score was 16.07 metabolic equivalent hours per week, and only 23.3% of patients had an appropriate level of exercise. In the logistic regression analysis, physical activity was associated with competence (odds ratio (OR) = 1.36, 95% confidence interval (CI): 1.06-1.74), relatedness (OR = 1.11, 95% CI: 1.04-1.18), depression (OR = 0.84, 95% CI: 0.75-0.94), and stage I or II disease (OR = 3.33, 95% CI: 1.28-1.86). This study indicated that competence, relatedness, depression, and the disease stage contributed to physical activity among these subjects while autonomy did not.

CONCLUSION

Future interventions to achieve the recommended levels of physical activity among CRC-S could benefit from taking into account the disease stage as well as psychosocial factors including motivation and depression.

The effect of exercise and motor interventions on physical activity and motor outcomes during and after medical intervention for children and adolescents with acute lymphoblastic leukemia: A systematic review

BACKGROUND

Children with acute lymphoblastic leukemia (ALL) experience detrimental effects on motor function during and after chemotherapy. The objective of this systematic review was to evaluate the effect of exercise and motor interventions on physical activity and motor outcomes of children with ALL during and after chemotherapy.

METHODS

Ten databases were searched. Nineteen studies were included: 11 randomized clinical trials (RCT), 2 controlled clinical trials (CCT), and 6 cohort studies.

RESULTS

Participants included 508 children with ALL. Between-group results from RCTs and CCTs supported that exercise and motor intervention improved: fatigue during acute chemotherapy; physical activity, range of motion (ROM), strength, bone mineral density, aerobic capacity, and fatigue during maintenance chemotherapy; functional mobility, ROM, strength, and aerobic capacity during post-treatment survivorship; and participation, physical activity, ROM, strength, and coordination during multiple-phase interventions.

CONCLUSION

Low quality evidence supports the efficacy of motor and exercise interventions for children and adolescents with ALL.

A Remotely Delivered, Peer-Led Physical Activity Intervention for Younger Breast Cancer Survivors (Pink Body Spirit): Protocol for a Feasibility Study and Mixed Methods Process Evaluation

Background

Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment.

Objective

The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life.

Methods

This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (<55 years old, >6 months post primary cancer treatment, self-report <60 min of moderate-to-vigorous-intensity physical activity [MVPA]) into a 3-month peer-delivered, fully remote exercise program. Participants will complete 6 biweekly video chat sessions with a trained peer mentor, a fellow younger breast cancer survivor. Participants will receive a Fitbit Charge 3; weekly feedback on Fitbit data from their peer mentor; and access to a private, in-app Fitbit Community to provide and receive support from other participants and all peer mentors. At baseline, 3 months, and 6 months, participants will complete quality of life questionnaires, and MVPA will be measured using the ActiGraph accelerometer. Feasibility and acceptability will be explored through a mixed methods approach (ie, quantitative questionnaires and qualitative interviews). Intervention delivery and adaptations by peer mentors will be tracked through peer mentor self-evaluations and reflections, review of video-recorded mentoring sessions, and monthly templated reflections by the research team.

Results

Recruitment began in September 2019. As of February 2020, the physical activity intervention is ongoing. Final measures are expected to occur in summer 2020.

Conclusions

This study explores the potential for physical activity to improve sexual function, body image, and fatigue, key quality of life issues in younger breast cancer survivors. Using peer mentors extends our reach into the young survivor community. The detailed process evaluation of intervention delivery and adaptations by mentors could inform a future hybrid-effectiveness implementation trial. Finally, remote delivery with commercially available technology could promote broader dissemination.

Trial Registration

ClinicalTrials.gov NCT04064892; https://clinicaltrials.gov/ct2/show/NCT04064892

International Registered Report Identifier (IRRID)

DERR1-10.2196/18420

Participant Perceptions on a Fitbit and Facebook Intervention for Young Adult Cancer Survivors: A Qualitative Study

Purpose: Among cancer survivors, physical activity (PA) is associated with reductions in cancer recurrence, morbidity, and mortality. Most young adult (YA) survivors do not attain adequate PA. Digital modalities, specifically wearable activity monitors with a paired mobile application and private social media group for support offer a promising approach for promoting PA among YAs. We conducted a pilot randomized controlled trial of this intervention. To evaluate its acceptability and perceptions of the intervention components, we conducted qualitative interviews with those in the intervention. The results of our interviews serve to refine future interventions to better serve this population. Methods: Semistructured qualitative interviews with 13 YA cancer survivors ages 20-39 who participated in the intervention assessed perceptions of the digital components of the study and buddy system of nominating a friend to participate in PA with the survivor. Analyses included a qualitative thematic analysis of the interview transcripts and coded interview segments into three predetermined categories: facilitators, limitations, and suggestions. Results: Participants described wide-ranging benefits of the intervention, citing the Fitbit device and buddy system as major motivators to engage in PA and reach goals. Most participants noted feelings of increased physical and emotional wellness. The most-cited limitation of the intervention was the automated text messages, which participants found impersonal. Suggestions for improvement included integrating more elements of competition and group challenges. Conclusion: This digital PA intervention was perceived as feasible and acceptable to YA cancer survivors and appears promising for promoting PA and improving long-term health and quality of life. Clinicaltrial.gov identifier number: NCT03233581; Date of registration: July 28, 2017.

Motivators and barriers to adoption of a healthy diet by survivors of stomach cancer: A cross-sectional study

PURPOSE

This study aimed to identify motivators and barriers to adopting a high-quality diet by survivors of stomach cancer.

BACKGROUND

Despite the benefits of a healthy diet and cancer survivors' motivation to stay healthy, few cancer survivors meet commonly prescribed dietary guidelines, and there have been few studies on the adequacy of dietary management in gastric cancer survivors.

METHODS

This cross-sectional study enrolled 124 adult survivors of stomach cancer. All patients were consecutively recruited from a single tertiary university hospital in South Korea from December 2015 to July 2016. Diet quality was assessed from patients' food diary data on 3 non-consecutive days. The barriers and motivators to following the dietary plan were measured using questionnaires.

RESULTS

Patients were more likely to consume amounts of carbohydrates if they perceived the presence of family and social support and personal disease control. Patients were more likely to consume appropriate carbohydrates and fats, and to have an appropriate intake of calcium if they perceived difficulties in eating with others. Patients were less likely to consume appropriate calcium if they perceived personal limits in their knowledge of shopping and cooking.

CONCLUSION

When caring for stomach cancer survivors, interventions that target patient-perceived barriers and motivators are likely to improve diet quality and lead to beneficial long-term improvements in health.

Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective

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.

A Quality Improvement Approach to Increase Exercise Assessment in Survivors of Childhood Leukemia

Introduction:

Survivors of childhood cancer are at increased risk of treatment-related cardiovascular disease, the severity of which is impacted by the level of regular exercise. Exercise assessments (EAs) are not a routine component of follow-up care.

Methods:

We incorporated a quantitative EA tool into the clinic triage during follow-up visits for survivors of acute lymphoblastic leukemia. The nursing staff was surveyed on the use of the EA tool to gauge understanding and level of comfort with addressing patient questions.

Results:

Over 27 months, the percentage of off-therapy acute lymphoblastic leukemia patients with documented EA increased from 0% to 80%. We noted degradation in EA completions in the last 6 months of the project, which we attributed to project nursing staff transition and failure to maintain education. Interventions that improved the percentage of completed EA included the incorporation the assessment tool into the electronic medical record and weekly reminders of scheduled eligible patients. A nurse incentive plan did not impact project success. Survey results revealed that the nursing staff were comfortable with the EA and did not view the new process as hurting patient flow.

Conclusion:

Implementation of an EA tool into routine clinic follow-up was successful. We met the project goal of assessing greater than 50% of the follow-up patients. This work will serve as the foundation for the next phase of the project, which will be to provide education on the importance of exercise and earlier intervention when a sedentary lifestyle is identified.

Dietary responses to a multiple sclerosis diagnosis: a qualitative study

BACKGROUND/OBJECTIVES

Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia.

SUBJECTS/METHODS

Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles.

RESULTS

Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS.

CONCLUSIONS

Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time.

A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer

OBJECTIVE

Physical activity can improve health, functional capacity, and quality of life among children and adults diagnosed with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to: determine the extent, range, and nature of published studies on physical activity among AYAs; identify knowledge gaps; and provide directions for future research.

METHODS

We searched 4 electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full-texts against inclusion criteria: original research with humans, published in an English-language peer-reviewed journal, ≥50% of participants were diagnosed with cancer between the ages of 15 and 39 years, and included at least 1 measure of physical activity behavior. Data were extracted from studies meeting these criteria and subsequently summarized narratively.

RESULTS

Our search yielded 4729 articles; 32 met inclusion criteria. These included 18 cross-sectional and 4 longitudinal studies that explored descriptive (ie, sociodemographic or medical), physical, personal/psychological, social, other health behaviors, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behavior or on testing the effects of physical activity.

CONCLUSIONS

We can conclude that physical activity is not well researched among AYAs. More high-quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behavior change interventions as well as to establish the benefits of physical activity for AYAs.

Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes

Obesity at diagnosis is a negative prognostic indicator for several pediatric cancers including acute leukemia and bone tumors. Incidence of obesity in children has increased three-fold over the past 2 decades, and causes for this include poor diet, excessive caloric intake, and lack of physical activity, which are collectively referred to as energy balance-related behaviors. Few energy balance interventions have been implemented in pediatric cancer patients during treatment, and here we will probe the rationale for pursuing such studies. The need to modify composition of calories consumed and to identify specific beneficial exercise regimens will be discussed, relative to weight reduction or management.

Building a Healthy Body After Cancer: Young Adult Lymphoma Survivors' Perspectives on Exercise After Cancer Treatment

PURPOSE

Our goals were to evaluate young adult lymphoma survivors' perceptions regarding benefits of exercise after cancer treatment, to identify barriers to exercise, and to understand the types of exercise interventions that may be useful in this patient population.

METHODS

Young adult lymphoma survivors were invited to participate in a survey and focus group. Questions focused on elucidating barriers to exercise as well as potential opportunities for supporting patients in adequate exercise. Focus groups were audiorecorded and transcribed, and data were coded inductively for themes and applied findings.

RESULTS

Eight survivors participated. Findings were categorized into five main themes: barriers to exercise, facilitators of exercise, personal responsibility for being active, interconnectedness of exercise with a healthy lifestyle, and recommendations.

CONCLUSIONS

Fatigue and frustration with postcancer physical limitations are major barriers to exercise for young adult survivors, whereas support from others, data tracking, and survivor-specific resources are facilitators. Interventions that incorporate fitness tracking technology, are individually tailored, and/or create a community with other young adult survivors may be successful in this population.

Supporting Adolescents and Young Adults with Cancer: Oncology Provider Perceptions of Adolescent and Young Adult Unmet Needs

Few studies have assessed oncology providers' perceptions of adolescent and young adult (AYA) cancer patients' unmet needs. In this statewide survey (N = 91), we found that most providers recognize the financial, insurance, and late effects needs of their AYA cancer patients. However, employment, education, behavioral health, sexuality, and social and family issues were endorsed by less than half of providers as areas where AYAs needed assistance. Few providers felt that their AYA cancer patients had unmet needs for these same concerns. Educational efforts are needed to improve providers' awareness of the impact of cancer for AYA cancer patients.

The Health Behavior Information Needs and Preferences of Teenage and Young Adult Cancer Survivors

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.

Adolescent and Young Adult Cancer Survivors' Perspectives on Their Internet Use for Seeking Information on Healthy Eating and Exercise

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.

Barriers to physical activity participation in colorectal cancer survivors at high risk of cardiovascular disease

BACKGROUND

Lifestyle factors including inadequate physical activity may contribute to increased risk of developing cardiovascular disease in colorectal cancer survivors. Identification of the barriers to physical activity is important for forming an evidence base of factors to target in future physical activity programs aimed at improving cardiovascular health in this population.

METHODS

Colorectal cancer survivors (N = 24) from St. John of God Subiaco Hospital participated in semi-structured interviews about their current physical activity behaviors and perceived barriers to physical activity.

RESULTS

Inductive thematic analysis of interviews revealed 5 overarching themes relating to barriers to physical activity: psychological barriers, environmental barriers, knowledge of guidelines, lack of practitioner support, and energy/age barriers.

CONCLUSIONS

Novel findings revealed participants' dependence on practitioner support, including a reliance on practitioners to recommend lifestyle change. Survivors also revealed that regular checkups to monitor cardiovascular risk replaced the need for healthy lifestyle changes.

IMPLICATIONS

With survivors holding the advice of clinicians in high regard, an opportunity exists for clinicians to facilitate lifestyle change. Health care professionals such as nurses can implement motivational strategies and provide additional health information during follow-up visits, to ensure long-term adherence. Individuals who reported psychological, motivational, and environmental barriers may benefit from interventions to improve self-regulation, planning, and problem-solving skills.