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

Sex differences in depression for childhood cancer survivors

OBJECTIVE

This study examines the differential association between sex and depression, and the possible mediating pathways.

METHODS

We analysed survey data from 296 (age 7-17.1 years) cancer survivors from three centres affiliated with Beijing Children's Hospital. Linear regression analysis was used to assess the association between sex and depression. Quantile regression analysis was used to estimate the regression coefficients (β) and 95% confidence intervals for sex in depression at different quantiles. Mediation analysis with multiple mediators was used to explore the effects of sex on depression.

RESULTS

Using linear regression, we found that the age ranged from 8.7 to 10.4 years and the regression coefficient of sex on depression was significant (β = -2.75, p = 0.03). Quantile regression results showed a significant negative association between sex and depression in the 0.30-0.75 quantiles. Mediation analysis revealed that boys were 1.545 times more depressed than girls, with family resilience, self-perceived burden, and behavioural problems explaining approximately 16.79%, 21.57%, and 43.94% of the sex difference, respectively. The combined effect of family functioning, resilience, social support, self-perceived burden, and behavioural problems might explain the 89.17% sex difference.

CONCLUSION

Clinicians should consider sex effects when assessing depression in childhood cancer survivors and target sex-specific interventions for further treatment.

Influence of social and behavioral determinants on health-related quality of life among cancer survivors in the USA

PURPOSE

Cancer survivors experience a worse health-related quality of life (HRQoL) than non-cancer survivors. However, it is not fully understood whether social determinants of health (SDOH) and health behaviors are significantly associated with HRQoL among cancer survivors. The purpose of this study was to investigate the influence of SDOH and health behaviors on HRQoL among cancer survivors.

METHODS

We identified adult (18 years or older) cancer survivors (n = 5784) in the 2017 and 2019 Behavioral Risk Factor Surveillance System. The primary outcome (HRQoL) was defined as whether cancer survivors reported having poor mental or physical health (e.g., 14 or more mentally or physically unhealthy days). Unadjusted and adjusted logistic regression was used to compute the odds ratios and 95% CIs of factors associated with poor HRQoL among the cancer survivors.

RESULTS

More than half of the cancer survivors were non-Hispanic White, female, and 65 years or older. In the adjusted multivariable logistic regression models, cancer survivors who were physically active and who did not avoid care because of costs had a lower risk of poor mental and physical health. Current smokers were more likely to report poor physical health. Homeowners were less likely to report poor mental health. Daily fruit and vegetable consumption and healthcare coverage were not associated with poor HRQoL.

CONCLUSIONS

Some SDOH (healthcare access, economic stability, and the neighborhood and built environment) and health behavior (physical activity) are associated with lower likelihood of experiencing poor mental and/or physical health in the cancer survivors. The study findings can be used to target survivors who experience suboptimal HRQoL and to inform research, public health policies, and/or programs.

Associated factors on physical activity among childhood cancer survivors in Mainland China: a qualitative exploration applied health belief model

PURPOSE

Regular physical activity (PA) is essential for childhood cancer survivors (CCS), yet most CCS have difficulty participating in it. The level of PA participation among CCS in China is lower than those of western countries, leading to a worse long-term survival of CCS in China. Here, the study aims to explore the associated factors on the PA performance among CCS.

METHODS

From September to December 2020, the study used purposive sampling to recruit 35 families (88.9%) as sampling units among two hospitals in Hangzhou City, China. The data collection conducted two designs on semi-structured interviews with different roles under family structure - children (n = 35) and parents (n = 35) - respectively. The design of predetermined questions relied on the health belief model (HBM) as a thematic framework. The qualitative analysis applied codebook thematic analysis and used the deductive approach to finalize the main findings.

RESULTS

The study only presented preliminary conclusions from interviews with CCS, which resulted in four themes (changes in PA performance; perceptions on participating PA; cognitions of PA; impacts from others) with eight sub-themes. In particular, CCS replied diversity changes in PA, but most of them mentioned the inactive PA after diagnosis, especially the decline of moderate-to-vigorous PA (MVPA). As for the "perceptions of PA," almost all CCS had substantial perceived benefits about PA, specifically on their physical well-being. All children also expressed perceived barriers to PA, including the side effects of disease and treatment, fatigue, academic burden, changes in psychological status, and lack of companions. On the cognitions of PA, the CCS had limited realizations of regular PA and low self-efficacy on MVPA. Furthermore, CCS expressed their need for support from their parents, school teachers, and healthcare providers. But in reality, they recieved less support on PA from these important people.

CONCLUSION

The changes in PA after illness among CCS are apparent and unavoidable because of the interaction impacts from internal factors (e.g., personal characters, cognization, perceptions of PA) and external factors (e.g., disease effects, interpersonal supports). The findings explained the main elements under HBM but also provided explored views as the evidence on developing theories and guiding motivations and practices on PA among CCS.

IMPLICATIONS FOR CANCER SURVIVORS

In this exploratory study of 35 CCS, we identified the current situation of PA among CCS in China and explored the associated factors. As the first qualitative study on the CCS in mainland China, the study considered particular effects on social culture and living environment.

The Relationship between the Unmet Needs of Chinese Family Caregivers and the Quality of Life of Childhood Cancer Patients Undergoing Inpatient Treatment: A Mediation Model through Caregiver Depression

A large proportion of the global burden of childhood cancer arises in China. These patients have a poor quality of life (QoL) and their family caregivers have high unmet needs. This paper examined the association between the unmet needs of family caregivers and the care recipient’s QoL. A total of 286 childhood cancer caregivers were included in this cross-sectional study. Unmet needs and depression among caregivers were assessed by the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) and the Patient Health Questionnaire (PHQ-9), respectively. The patient’s QoL was proxy-reported by the Pediatric Quality of Life Inventory Measurement Models (PedsQL 3.0 scale Cancer Module). Descriptive analyses, independent Student’s t-tests, one-way ANOVA, and mediation analyses were performed. The mean scores (standard deviations) for unmet needs, depression, and QoL were 65.47 (26.24), 9.87 (7.26), and 60.13 (22.12), respectively. A caregiver’s unmet needs (r = −0.272, p < 0.001) and depression (r = −0.279, p < 0.001) were negatively related to a care recipient’s QoL. Depression among caregivers played a mediating role in the relationship between a caregiver’s unmet needs and a care recipient’s QoL. As nursing interventions address depression among caregivers, it is important to standardize the programs that offer psychological support to caregivers.

Supervised Exercise Interventions in Childhood Cancer Survivors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Childhood cancer survivors (CCSs) may suffer from a multitude of health impairments, resulting in a compromised quality of life (QoL). This review’s objective was to examine CCSs’ adherence to supervised exercise training interventions and the impact of these interventions on health outcomes. Methods: The following databases were searched in May 2022: PubMed, Embase, Cochrane Library, and Web of Science. The included studies were limited to randomized controlled trials (RCTs), published in English involving CCSs aged 18 years and below. Results: Nine RCTs (n = 642 participants) were included in the systematic review, and seven of them (n = 551 participants) were included in the meta-analysis. Both the mean retention rate and adherence to the supervised exercise interventions were 87%. Supervised exercise interventions significantly improved muscle strength (standardized mean difference (SMD) = 1.42, p = 0.03), level of daily physical activity (SMD = 1.05, p < 0.001), body mass index (BMI) (mean difference (MD) = 1.06, p = 0.03), and fatigue (SMD = −0.44, p < 0.001), while there was no statistical significance in the quality of life (QoL) (SMD = 0.21, p = 0.20). Conclusions: The adherence of CCSs to supervised exercise interventions is high, and supervised exercise interventions are safe and effective.

Childhood cancer survivorship in China: An overview of the past two decades

Across countries in the world, China has the largest population of childhood cancer survivors. Research and care for the childhood cancer survivor population in China is fragmented. We searched studies published in English or Chinese language between January 1, 2000 and June 30, 2021, which examined various aspects of childhood cancer survivorship in China. The existing China-focused studies were largely based on a single institution, convenient samplings with relatively small sample sizes, restricted geographic areas, cross-sectional design, and focused on young survivors in their childhood or adolescence. These studies primarily focused on the physical late effects of cancer and its treatment, as well as the inferior psychological wellbeing among childhood cancer survivors, with few studies examining financial hardship, health promotion, and disease prevention, or healthcare delivery in survivorship. Our findings highlight the urgent need for research and evidence-based survivorship care to serve the childhood cancer survivor population in China.

Dietary Intake and Diet Quality of Adult Survivors of Childhood Cancer and the General Population: Results from the SCCSS-Nutrition Study

Childhood cancer survivors (CCSs) are at increased risk of developing chronic health conditions. This may potentially be reduced by a balanced diet. We aimed to compare dietary intake and diet quality using the Alternative Healthy Eating Index (AHEI) of adult CCSs and the general Swiss population. A food frequency questionnaire (FFQ) was completed by CCSs with a median age of 34 (IQR: 29-40) years. We compared dietary intake of 775 CCSs to two population-based cohorts who completed the same FFQ: 1276 CoLaus and 2529 Bus Santé study participants. CCSs consumed particular inadequate amounts of fiber and excessive amounts of sodium and saturated fat. Dietary intake was similar in CCSs and the general population. The mean AHEI was low with 49.8 in CCSs (men: 47.7, women: 51.9), 52.3 in CoLaus (men: 50.2, women: 54.0), and 53.7 in Bus Santé (men: 51.8, women: 54.4) out of a maximum score of 110. The AHEI scores for fish, fruit, vegetables, and alcohol were worse in CCSs than in the general population, whereas the score for sugar-sweetened beverages was better (all p < 0.001). Diet quality at follow-up did not differ between clinical characteristics of CCSs. Long-term CCSs and the general population have poor dietary intake and quality in Switzerland, which suggests similar population-based interventions for everyone.