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Cai CR, Cornelius S, Demedis J, Hagen AM, Abbey-Lambertz M, Armstrong GT, Oeffinger KC, Syrjala KL, Taylor SL, Yi JC, Chow EJ. Experiences of adult survivors of childhood cancer in a randomized cardiovascular health promotion trial: a qualitative report from the Childhood Cancer Survivor Study. J Cancer Surviv 2023:10.1007/s11764-023-01406-0. [PMID: 37253902 PMCID: PMC10228426 DOI: 10.1007/s11764-023-01406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To better understand preferences and attitudes that adult-aged survivors of childhood cancer have toward survivorship care plans (SCP) and related SCP-based counseling. METHODS Semi-structured qualitative interviews were conducted with 20 survivors participating in the Childhood Cancer Survivor Study who were at increased risk for cardiovascular disease secondary to their original cancer treatment. All participants were part of a larger randomized clinical trial (NCT03104543) testing the efficacy of an SCP-based counseling intervention with goal-setting designed to improve control of cardiovascular risk factors (i.e., hypertension, dyslipidemia, diabetes). A primarily deductive thematic analysis methodology guided interpretation; coded interview segments were grouped into primary themes of facilitators, barriers, suggestions, and positive sentiments. RESULTS Participants described benefits of the intervention including facilitation of accountability, goal-setting, and increased knowledge of their health. Many participants also noted improved knowledge of their cancer treatment and subsequent risks, and they were interested in sharing this information with their primary care provider. However, several participants were disappointed when they did not achieve their goals or felt that they had low motivation. Participants generally wanted increased flexibility in the intervention, whether in the duration, frequency, or method of delivery. CONCLUSIONS The SCP-based intervention was generally well-received by those interviewed and appears promising for promoting goal-setting and accountability as part of an SCP-based intervention to improve control of cardiovascular risk factors. IMPLICATIONS FOR CANCER SURVIVORS Many survivors are at risk for cardiovascular disease or other potentially modifiable effects of their treatment. SCP-based interventions may facilitate improved control of these late effects.
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Affiliation(s)
- Casey R Cai
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Shelby Cornelius
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jenna Demedis
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Denver, CO, USA
| | - Anna M Hagen
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mark Abbey-Lambertz
- Department of Radiation-Oncology, University of Washington, Seattle, WA, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Karen L Syrjala
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sarah L Taylor
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jean C Yi
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eric J Chow
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Johnson AM, Baker KS, Haviland MJ, Syrjala KL, Abbey-Lambertz M, Chow EJ, Mendoza JA. A Pilot Randomized Controlled Trial of a Fitbit- and Facebook-Based Physical Activity Intervention for Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2021; 11:379-388. [PMID: 34677081 PMCID: PMC9419976 DOI: 10.1089/jayao.2021.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Most young adult cancer survivors (YACS) do not meet physical activity (PA) guidelines. Although PA can improve health and quality of life (QOL), few randomized controlled trials (RCTs) of PA interventions for YACS exist. We conducted a pilot RCT to test feasibility of a PA intervention among YACS. Methods: We recruited 18-39-year-olds (≥1 and <5 years postcancer therapy) from Seattle Cancer Care Alliance. The 12-week intervention involved a wrist-worn PA-tracking device (Fitbit), a peer-based Facebook support group, step count goal setting, and a self-selected support "buddy." Controls received Fitbit only. Baseline assessments occurred before randomization; follow-up assessments occurred during intervention weeks 10-12. Feasibility criteria are listed below. Exploratory outcomes included PA, sedentary time (ST), QOL measures (e.g., fatigue), and self-determination theory (SDT) construct measures. Results: All feasibility criteria were met: We recruited 50 YACS, intervention participants wore the Fitbit on the majority of intervention days (82.9%), ≥75% of participants completed questionnaires at baseline (100%) and follow-up (93.9%). Exploratory analyses, adjusted for wave, accelerometer wear time, race, and income, showed significant group differences for change in ST (-52.4 vs. 2.5 minutes/day; p = 0.002) but no change in moderate-to-vigorous intensity PA (0.0 vs. -0.2 minutes/day; p = 0.40), comparing intervention participants to controls. The intervention (vs. control) group had a greater increase in fatigue interference (p = 0.03). No other significant differences in SDT or QOL measures were found. Conclusion: This Fitbit and Facebook-based PA intervention was feasible to YACS, with promising effects on reducing ST, and warrants a fully powered RCT. Clinical Trial Registration no.: NCT03233581.
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Affiliation(s)
- Ashleigh M Johnson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - K Scott Baker
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Mark Abbey-Lambertz
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Jason A Mendoza
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
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Abstract
INTRODUCTION Active school travel is an important way to promote children's physical activity, but it requires supportive environments that can safely and comfortably accommodate children's walking and biking. Few existing indices explicitly consider school neighborhood environmental factors related to children's walking to school. In this study, we used a street audit tool and Geographic Information System (GIS) to evaluate walkability near low-income elementary schools in Seattle, WA. METHODS The audit-based school walkability index was developed based on all street segments (n=841) within a 0.4km network buffer from each study school (n=18). The GIS-based school walkability, a combination of road connectivity, vehicular traffic exposure, and residential density, was also measured in a 2km network buffer around each school. The participants were individuals aged 8-11 years (n=315) who participated in the Walking School Bus randomized controlled trial project. Mixed-effects logistic and linear models were used to examine the association of the index's representations of the built environment with children's school travel mode (walking or biking to school 1+ times per week) and with objectively measured moderate-to-vigorous physical activity (MVPA, average weekday minutes during the 90-min before-school period). These associations were tested with the total sample as well as the subsample of children living within 1.5km from their schools. RESULTS The audit-based school walkability index (WI) was positively associated with both active commuting to school among the subsample living within 1.5km from their schools and with children's before-school MVPA among the subsample and the total sample. The GIS-based school WI showed significant associations with children's before-school MVPA but no relationships with active school travel among the subsample and the total sample. CONCLUSION The audit-based school walkability index can be used as a complementary tool for measuring walkability near low-income elementary schools along with existing GIS-based school walkability index.
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Affiliation(s)
- Sungmin Lee
- Department of Plant Science and Landscape Architecture, University of Connecticut
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M University
| | - Ji Won Nam
- Department of Recreation, Park and Tourism Sciences, Texas A&M University
| | | | - Jason Mendoza
- Seattle Children’s Research Institute
- Department of Pediatrics, University of Washington
- Public Health Sciences, Fred Hutchinson Cancer Research Center
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Miropolsky EM, Scott Baker K, Abbey-Lambertz M, Syrjala K, Chow EJ, Ceballos R, Mendoza JA. Participant Perceptions on a Fitbit and Facebook Intervention for Young Adult Cancer Survivors: A Qualitative Study. J Adolesc Young Adult Oncol 2020; 9:410-417. [PMID: 31928489 DOI: 10.1089/jayao.2019.0072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Evelina M Miropolsky
- Nutritional Sciences Program, University of Washington, Seattle, Washington, USA
| | - Kevin Scott Baker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Karen Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Eric J Chow
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel Ceballos
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jason A Mendoza
- Nutritional Sciences Program, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Mendoza JA, Baker KS, Moreno MA, Whitlock K, Abbey-Lambertz M, Waite A, Colburn T, Chow EJ. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study. Pediatr Blood Cancer 2017; 64. [PMID: 28618158 DOI: 10.1002/pbc.26660] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Physical activity (PA) may be important for preventing chronic diseases for adolescent and young adult (AYA) childhood cancer survivors. Randomized controlled trials (RCTs) of PA interventions for AYA survivors are sparse, but necessary to determine effective programs for increasing PA among this population. Thus, we conducted a pilot RCT, testing the feasibility of a mobile health (mHealth) intervention to promote PA among AYA survivors. PROCEDURE We recruited 14- to 18-year-olds who were ≥1-year post cancer therapy from Seattle Children's Hospital. The 10-week intervention consisted of a wearable PA-tracking device (Fitbit Flex) and a peer-based virtual support group (Facebook group). Research staff helped set step goals and awarded badges weekly. Controls received usual care. Baseline assessments occurred before randomization and follow-up assessments occurred during weeks 8-10 of the intervention period. Feasibility criteria are defined below. Qualitative interviews assessed acceptability. Exploratory outcomes included PA, quality of life, and motivation for PA. RESULTS All feasibility criteria were met: we recruited 60 survivors, intervention participants wore the Fitbit on the majority (71.5%) of intervention days, and ≥90% of all participants completed questionnaires. Qualitative data confirmed intervention acceptability. Exploratory analyses found no significant adjusted group differences for change in moderate-to-vigorous PA (4.4 vs. 5.0 min/day; P = 0.92) or sedentary time (-4.5 vs. 1.0 min/day; P = 0.73), comparing intervention subjects to controls. Some modest differences were found for select subscales of quality of life and motivation for PA. CONCLUSIONS This mHealth PA intervention was feasible and acceptable to AYA childhood cancer survivors and warrants a fully powered RCT.
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Affiliation(s)
- Jason A Mendoza
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - K Scott Baker
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Megan A Moreno
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | | | | | - Alan Waite
- Seattle Children's Research Institute, Seattle, Washington
| | - Trina Colburn
- Seattle Children's Research Institute, Seattle, Washington
| | - Eric J Chow
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
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Mendoza JA, Haaland W, Jacobs M, Abbey-Lambertz M, Miller J, Salls D, Todd W, Madding R, Ellis K, Kerr J. Bicycle Trains, Cycling, and Physical Activity: A Pilot Cluster RCT. Am J Prev Med 2017; 53:481-489. [PMID: 28668251 PMCID: PMC5894119 DOI: 10.1016/j.amepre.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/13/2017] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increasing children's cycling to school and physical activity are national health goals. The objective was to conduct an RCT of a bicycle train program to assess impact on students' school travel mode and moderate-to-vigorous physical activity (MVPA). STUDY DESIGN Pilot cluster RCT with randomization at the school level and N=54 participants. SETTING/PARTICIPANTS Fourth-fifth graders from four public schools serving low-income families in Seattle, WA in 2014 with analyses in 2015-2016. All participants were provided and fitted with bicycles, safety equipment (helmets, locks, and lights), and a 2- to 3-hour bicycle safety course. INTERVENTION The intervention was a bicycle train offered daily (i.e., students volunteered to cycle with study staff to and from school). MAIN OUTCOME MEASURES Time 1 assessments occurred prior to randomization. Time 2 assessments occurred after 3-5 weeks of the intervention (i.e., during Weeks 4-6 of the intervention period). The primary outcome was the percentage of daily commutes to school by cycling measured by validated survey. MVPA, measured by accelerometry and GPS units and processed by machine learning algorithms, was a secondary outcome. RESULTS For two separate adjusted repeated measures linear mixed effects models in which students (N=54) were nested within schools (N=4), intervention participants had: (1) an absolute increase in mean percentage of daily commutes by cycling of 44.9%, (95% CI=26.8, 63.0) and (2) an increase in mean MVPA of 21.6 minutes/day, (95% CI=8.7, 34.6) from Time 1 to Time 2 compared with controls. CONCLUSIONS A pilot bicycle train intervention increased cycling to school and daily MVPA in the short term among diverse, inner-city elementary school students. The bicycle train intervention appears promising and warrants further experimental trials among large, diverse samples with longer follow-up. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02006186.
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Affiliation(s)
- Jason A Mendoza
- Department of Pediatrics and Nutritional Sciences Program, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington; Fred Hutchinson Cancer Research Center, Health Disparities Research Center, Seattle, Washington.
| | - Wren Haaland
- Seattle Children's Research Institute, Seattle, Washington
| | - Maya Jacobs
- Seattle Children's Research Institute, Seattle, Washington
| | | | | | | | | | | | - Katherine Ellis
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, California
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California
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