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Feit T, Beals E, Dandekar S, Kadan-Lottick N, Joffe L. Nutritional assessment and dietary intervention among survivors of childhood cancer: current landscape and a look to the future. Front Nutr 2024; 10:1343104. [PMID: 38357463 PMCID: PMC10864514 DOI: 10.3389/fnut.2023.1343104] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
Over 85% of childhood cancer patients become long-term survivors. Still, cancer and its therapies are associated with a myriad of long-term complications such that childhood cancer survivors (CCS) endure excess disease burden, morbidity, and mortality throughout their lifetimes. Existing literature suggests that CCS maintain poor dietary intake and nutritional status. Thus, as childhood cancer cure rates continue to improve, the role of diet and nutrition in mitigating many of the most common adverse long-term health outcomes among CCS has gained significant interest. Herein we present an in-depth review of existing scientific literature evaluating dietary intake and nutrition status among CCS and its impact on treatment-related health complications; as well as contemporary intervention strategies aimed at overcoming distinctive barriers and improving deleterious lifestyle behaviors in this heterogeneous, at-risk population. Patient-specific, clinical, and systemic factors act as barriers to the timely conduct of comprehensive dietary/nutritional assessments and provision of tailored, risk-based recommendations. This Mini Review discusses the current state of the science, persisting research gaps, and opportunities for advancement of assessment and intervention strategies to address the unique needs of CCS. Search Strategy: We searched PubMed for peer-reviewed articles with the search terms "pediatric cancer," "pediatric malignancy," "pediatric oncology," "childhood cancer," "survivorship," "cancer late effects," "long-term follow-up," "body mass index," "nutritional status," "malnutrition," "body weight," "body weight changes," "body composition," "obesity," "overweight ", "Mediterranean diet," "DASH diet," "processed foods," "micronutrients," "antioxidants," "vitamin D," "calcium," "selenium," "zinc," "metabolic syndrome," "heart disease," "cardiovascular disease," "cardiometabolic disease," "hypertension," "hyperlipidemia," "HDL," "LDL," and "small dense LDL" from January 1, 1995, to July 21, 2023. We also selected relevant articles from our personal files and from reference lists of identified papers. We prioritized publications after 2013; however, commonly cited and highly regarded (defined by high citation count and journal impact factor) older publications were also included. Randomized controlled trials, observational studies, retrospective studies, meta-analysis, editorials, and review articles were included, whereas conference abstracts and case reports were excluded. We only searched for articles published in English, or those translated into English.
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Affiliation(s)
- Talia Feit
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Elizabeth Beals
- Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Smita Dandekar
- Division of Pediatric Hematology/Oncology, Milton S. Hershey Medical Center, Penn State Health Children’s Hospital, Hershey, PA, United States
| | - Nina Kadan-Lottick
- Departments of Oncology and Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Lenat Joffe
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY, United States
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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2
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Ware ME, Delaney A, Krull KR, Brinkman TM, Armstrong GT, Wilson CL, Mulrooney DA, Wang Z, Lanctot JQ, Krull MR, Partin RE, Shelton KC, Srivastava DK, Hudson MM, Robison LL, Ness KK. Cancer-Related Worry as a Predictor of 5-yr Physical Activity Level in Childhood Cancer Survivors. Med Sci Sports Exerc 2023; 55:1584-1591. [PMID: 37093894 PMCID: PMC10524368 DOI: 10.1249/mss.0000000000003195] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE Cancer-related worry (CRW; concerns related to cancer and its late effects) is prevalent among childhood cancer survivors. Elevated CRW has been associated with self-reported suboptimal physical activity. The aim of this investigation was to describe associations between CRW and objectively assessed physical activity in childhood cancer survivors. METHODS CRW was assessed at a baseline evaluation using six survey items. Weekly minutes of moderate and vigorous physical activity were captured by actigraphy 5.25 (3.8-8.0) yr later. Factor analysis was used to identify types of worry; multiple regression determined independent associations between CRW and moderate and vigorous physical activity adjusting for sex, race, diagnosis, age at baseline, anxiety level at baseline, self-reported physical activity at baseline, and pain interference at baseline. RESULTS Participants ( n = 1223) were an average of 30.9 (SD, 6.9) yr at baseline and 36.1 (SD, 7.1) yr at follow-up. Thirty-seven percent were survivors of leukemia, 26% of non-CNS solid tumors, 19% of lymphoma, 11% of CNS tumors, and 6% of other malignancies. Two types of CRW were identified: "body-focused" and "general fear." Body-focused CRW ( β = -19.6, P = 0.012), endorsing pain interference ( β = -27.7, P = 0.002) at baseline, and having a diagnosis of CNS tumor ( β = -41.3, P = 0.0003) or non-CNS solid tumor ( β = -19.4, P = 0.02) were negatively associated with physical activity at follow-up. CONCLUSIONS CRW related to bodily function and appearance is associated with decreased physical activity. Clinicians should consider the potential negative impact of CRW on physical activity levels and provide behavioral counseling.
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Affiliation(s)
- Megan E. Ware
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kyla C. Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Williamson Lewis R, Howell KE, Effinger KE, Meacham LR, Wasilewski-Masker K, Mertens A, Gilleland Marchak J. Feasibility of Fitbit Use in Adolescent Survivors of Pediatric Cancer: Who Consistently Uses It and for How Long? J Adolesc Young Adult Oncol 2023; 12:529-536. [PMID: 36178482 DOI: 10.1089/jayao.2022.0071] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Wearable activity trackers with real-time feedback and goal-setting features are being incorporated into programs to increase physical activity among childhood cancer survivors. This analysis describes the adoption and use of a Fitbit® Flex™ among adolescent-aged survivors of childhood cancer without incentives, reminders, or interventions to encourage use. Procedures: Cancer survivors aged 13-18 and ≥2 years from therapy received a Fitbit Flex with instructions to wear it daily. Researchers downloaded participants' daily total steps and active minutes for 1 year. Participants were classified as consistent (≥5 days/week for >4 weeks during the first 12 weeks) or inconsistent users, and comparisons between user types were made. Longitudinal use of the Fitbit and participants' 1-year acceptability evaluations are described. Results: Overall, 67.1% (47/70) of survivors enrolled, and Fitbit data were available for 36 participants. Initially, 30.6% (11/36) were consistent users. Consistent users had lower body mass index z-scores at enrollment (0.4 ± 0.7 vs. 1.2 ± 0.9; p = 0.01), but were otherwise comparable with inconsistent users. Over time survivors' use declined; at 12 months, only one participant was using his or her Fitbit. Survivors who completed a survey (n = 22) reported their Fitbit helped them self-monitor their exercise (72.7%, 16/22) and lead a more active lifestyle (63.6%, 14/22), but found it challenging to charge and not lose, forget about, or break the device. Conclusions: In the real-world setting, only a small subset of adolescent-aged survivors will initially consistently use a Fitbit and their interest diminishes over time. To maximize engagement, interventions incorporating wearable activity trackers likely need to include additional behavior change strategies.
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Affiliation(s)
- Rebecca Williamson Lewis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristen E Howell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Karen E Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ann Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jordan Gilleland Marchak
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Lan T, Wang M, Ehrhardt MJ, Jiang S, Lanctot JQ, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Park Y. Adherence to healthy diet and risk of cardiovascular disease in adult survivors of childhood cancer in the St. Jude Lifetime Cohort: a cross-sectional study. BMC Med 2023; 21:242. [PMID: 37400811 PMCID: PMC10318686 DOI: 10.1186/s12916-023-02956-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Whether diet has beneficial effects on cardiovascular disease (CVD) in childhood cancer survivors as in the general population is unknown. Therefore, we examined associations between dietary patterns and risk of CVD in adult survivors of childhood cancer. METHODS Childhood cancer survivors, 18-65 years old in the St Jude Lifetime Cohort (1882 men and 1634 women) were included in the analysis. Dietary patterns were defined by the adherence to the Healthy Eating Index (HEI)-2015, Dietary Approaches to Stop Hypertension (DASH), and alternate Mediterranean diet (aMED) based on a food frequency questionnaire at study entry. CVD cases (323 in men and 213 in women) were defined as participants with at least one grade 2 or higher CVD-related diagnosis at baseline. Multivariable logistic regression adjusted for confounders was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of CVD. RESULTS Greater adherence to HEI-2015 (OR=0.88, 95% CI: 0.75-1.03, per 10 score increment), DASH (OR=0.85, 95% CI: 0.71-1.01, per 10 score increment), and aMED (OR=0.92, 95% CI: 0.84-1.00, each score increment) were, albeit trending towards significance, associated with a lower risk of CVD in women. HEI-2015 was associated with a non-significantly lower risk of CVD in men (ORQ5 vs. Q1=0.80, 95% CI: 0.50-1.28). These dietary patterns were also associated with a lower risk of CVD in survivors with high underlying CVD risk. CONCLUSIONS As recommended to the general population, a diet rich in plant foods and moderate in animal foods needs to be a part of CVD management and prevention in childhood cancer survivors.
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Affiliation(s)
- Tuo Lan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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Webster RT, Dhaduk R, Gordon ML, Partin RE, Kunin-Batson AS, Brinkman TM, Willard VW, Allen JM, Alberts NM, Lanctot JQ, Ehrhardt MJ, Li Z, Hudson MM, Robison LL, Ness KK. Health behavior profiles in young survivors of childhood cancer: Findings from the St. Jude Lifetime Cohort Study. Cancer 2023; 129:2075-2083. [PMID: 36943740 PMCID: PMC10258145 DOI: 10.1002/cncr.34749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 01/31/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is limited understanding of associations between a combination of health behaviors (physical activity, sedentary/screen-time, diet) and cardiometabolic health risk factors, physical performance, and emotional health among young (<18) childhood cancer survivors (CCS). The aims of this research were to address this gap by 1) deriving health behavior adherence profiles among CCS, and 2) examining associations among demographic, diagnosis and/or treatment exposures, cardiometabolic, physical performance, and emotional functioning with health behavior profile membership. METHODS Participants included 397 CCS (≥5 years post-diagnosis; 10-17 years old) enrolled in the St. Jude Lifetime Cohort Study who completed physical health evaluations and questionnaires assessing health behaviors and psychological functioning. Latent profile analysis was used to derive profiles of health behavior adherence. Logistic regression and t-tests were used to examine mean-level differences and associations between profile membership with demographic, diagnosis, treatment exposures, cardiometabolic health, psychological functioning, and physical performance. RESULTS Two profiles emerged: inactive-unhealthy-diet ("IU") and active-sedentary-unhealthy-diet ("ASU") to guidelines. More participants in IU demonstrated higher resting heart rate (mean [M], 76.54; SD = 12.00) and lower motor proficiency scores (M = 34.73; SD = 29.15) compared to ASU (resting heart rate, M = 71.95, SD = 10.74; motor proficiency, M = 50.40, SD = 31.02). CONCLUSIONS CCS exhibited low adherence to multiple health behavior guidelines, with adherence patterns differentially associated with cardiometabolic health (i.e., resting heart rate) and physical performance. However, robust protection against all health variables was not observed. Findings suggest interventions designed to improve health outcomes should target multiple health behaviors simultaneously. PLAIN LANGUAGE SUMMARY Pediatric cancer survivors are at-risk for detrimental health outcomes associated with cancer and treatment. Engagement in healthy lifestyle behaviors serves to reduce health vulnerabilities among adult survivors but less is known about associations with lifestyle behaviors on young survivors. This study documents patterns of lifestyle behaviors among survivors of pediatric cancer, factors that increase susceptibility to nonadherence, and associations among lifestyle behaviors and health indicators.
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Affiliation(s)
- Rachel Tillery Webster
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rikeenkumar Dhaduk
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Tara M. Brinkman
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Victoria W. Willard
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhenghong Li
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Marchak JG, Kegler MC, Meacham LR, Mertens AC, Effinger KE. Cancer-Related Barriers to Health Behaviors Among Adolescent and Young Adult Survivors of Pediatric Cancer and Their Families. J Adolesc Young Adult Oncol 2023; 12:118-122. [PMID: 35325580 DOI: 10.1089/jayao.2021.0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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
Adolescent and young adult (AYA) survivors of pediatric cancer and their caregivers frequently do not meet national guidelines for physical activity (PA), nutrition, or sleep. Respondents from N = 73 AYA-aged (mean [M] = 19.0 years, range = 11-30 years) survivor families completed a survey on cancer-related barriers to health behaviors. Almost all respondents (68/73, 93.2%) endorsed ≥1 cancer-specific barrier(s) to current health behaviors (median = 5, standard deviation = 3.42, range = 0-16) in their family. Cancer-related barriers to PA, nutrition, and sleep were positively correlated (PA-nutrition: r = 0.39, p = 0.001; PA-sleep: r = 0.41, p < 0.001; nutrition-sleep: r = 0.52, p < 0.001). Wellness interventions are needed to address the unique needs of AYA-aged survivors and support multiple health behaviors simultaneously.
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Affiliation(s)
- Jordan Gilleland Marchak
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen E Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Crowder SL, Buro AW, Lacson JCA, Kim Y, Sutton SK, Roetzheim RG, Vadaparampil ST, Stern M, Kanetsky PA. Retention and Evaluation of Precision and Generic Prevention Materials for Melanoma: A Qualitative Study Comparing Young Adults and Adults. Cancer Prev Res (Phila) 2022; 15:533-542. [PMID: 35665800 PMCID: PMC9357111 DOI: 10.1158/1940-6207.capr-22-0033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/28/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
A randomized trial was conducted to examine whether providing precision prevention materials incorporating melanocortin-1 receptor genetic risk information would increase intention to practice melanoma preventive behaviors. Here, we determine retention/evaluation of prevention materials for adolescent and young adults (AYA) 18 to 39 years old versus adults aged 40+ at 6 and 12 months as an a priori adjunct analysis to the primary research question. Using qualitative methodology, open-ended questions probing most important information from prevention materials and additional comments were collected at 6 and 12 months after baseline. Descriptive statistics were performed on demographic/self-reported characteristics. Two independent researchers applied qualitative thematic content analysis to identify major themes in open-ended questions. Of the 1,134 participants randomized, 906 completed at least one of the follow-up surveys and contributed to analyses of intervention efficacy. Five major thematic categories emerged from the open-ended response data: (i) tips and tricks for sun protection; (ii) cancer prevention; (iii) risk factors and genetics; (iv) general information; and (v) intervention comments. Across all ages, the most important information retained were sun protection techniques in the generic prevention materials group and identifying the importance of genetic risk factors/implementing lifestyle behavior changes in the precision prevention materials group. For additional comments, AYA participants in the generic prevention materials group preferred more scientific information including statistics and citations for references while adults were more likely to state they already knew cancer prevention techniques. Results provide unique qualitative evaluation of AYA versus adult retention of prevention materials for melanoma that enhance quantitative findings. PREVENTION RELEVANCE It is important to evaluate information within groups defined by periods of the life trajectory, e.g., AYA and adults, to best inform preferences, knowledge, and motivation for behavior change. By assessing retention, evidence-based interventions can be designed to better support public health messaging and encourage positive health behaviors.
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Affiliation(s)
- Sylvia L. Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - Acadia W. Buro
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - John Charles A. Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Richard G. Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612
| | - Marilyn Stern
- College of Behavioral and Community Sciences, Department of Child and Family Studies, University of South Florida, Tampa, FL 33612, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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8
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Sheikh IN, Roth M, Stavinoha PL. Prevalence of Sleep Disturbances in Pediatric Cancer Patients and Their Diagnosis and Management. Children (Basel) 2021; 8:1100. [PMID: 34943294 PMCID: PMC8700400 DOI: 10.3390/children8121100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022]
Abstract
Sleep disturbances represent an understudied yet common source of distress among pediatric cancer patients and survivors, with deleterious effects on quality of life. Sleep issues stem from multiple risk factors, yet individual contributors are difficult to isolate, consequently impeding the identification of targets for intervention. In many pediatric cancer patients, disrupted sleep and its negative impact on quality of life continue into adulthood and may affect various functional domains. This literature review highlights the types and prevalence of sleep disturbances in pediatric cancer patients during active treatment and through survivorship. Potential etiological and risk factors for disturbed sleep are summarized, including the effects of cancer and its treatment, psychosocial and family factors, as well as individual-patient aspects, such as genetics, mood and coping skills. While existing assessment and management strategies are reviewed, the literature is incomplete, and significant gaps emerge in our understanding of sleep disturbances in pediatric cancer patients and survivors. The review concludes with recommendations of areas where further research is needed. The aims of this review include increasing clinicians' awareness of sleep disturbances as a significant source of poor quality of life in pediatric cancer patients and survivors and directing researchers to gaps in our understanding of sleep disturbances in pediatric cancer patients and survivors.
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Affiliation(s)
- Irtiza N. Sheikh
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
| | | | - Peter L. Stavinoha
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
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9
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Rossi F, Di Paola A, Pota E, Argenziano M, Di Pinto D, Marrapodi MM, Di Leva C, Di Martino M, Tortora C. Biological Aspects of Inflamm-Aging in Childhood Cancer Survivors. Cancers (Basel) 2021; 13:4933. [PMID: 34638416 DOI: 10.3390/cancers13194933] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022] Open
Abstract
Anti-cancer treatments improve survival in children with cancer. A total of 80% of children treated for childhood cancer achieve 5-year survival, becoming long-term survivors. However, they undergo several chronic late effects related to treatments. In childhood cancer survivors a chronic low-grade inflammation, known as inflamm-aging, is responsible for frailty, a condition characterized by vital organ failure and by premature aging processes. Inflamm-aging is closely related to chemotherapy and radiotherapy, which induce inflammation, accumulation of senescent cells, DNA mutations, and the production of reactive oxygen species. All these conditions are responsible for the onset of secondary diseases, such as osteoporosis, cardiovascular diseases, obesity, and infertility. Considering that the pathobiology of frailty among childhood cancer survivors is still unknown, investigations are needed to better understand frailty's biological and molecular processes and to identify inflamm-aging key biomarkers in order to facilitate the screening of comorbidities and to clarify whether treatments, normally used to modulate inflamm-aging, may be beneficial. This review offers an overview of the possible biological mechanisms involved in the development of inflamm-aging, focusing our attention on immune system alteration, oxidative stress, cellular senescence, and therapeutic strategies.
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10
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Hong HC, Kim YM, Min A. Factors influencing quality of life among childhood cancer survivors in Korea: A quantile regression approach. Res Nurs Health 2021; 45:108-122. [PMID: 34322889 DOI: 10.1002/nur.22170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
Cancer treatment in childhood may negatively affect survivors' quality of life. In this study, we aimed to determine the contributing factors for health-related quality of life (HRQOL) in survivors of childhood cancer in Korea using quantile regression analysis. This study was a secondary analysis. Data were collected from 130 childhood cancer survivors (CCS) from November 2018 to July 2019. Participants completed the Memorial Symptom Assessment Scale, Depression Anxiety Stress Scale, Health-Promoting Lifestyle Profile-II, and 36-Item Short Form Health Survey (physical component summary [PCS] and mental component summary [MCS]). Quantile and multiple linear regressions were used to analyze the factors contributing to HRQOL. The quantile and linear regression models revealed different results on the contributing factors to HRQOL in CCS. Mean PCS and MCS scores were 78.55 (SD = 15.08) and 64.02 (SD = 18.00), respectively. Symptoms (e.g., difficulty concentrating, worrying, pain, and lack of energy), physical activity, spiritual growth, interpersonal relationships, stress management, depression, and anxiety were significant influencing factors in some PCS quantiles, while symptoms, spiritual growth, interpersonal relationships, depression, and stress were significant influencing factors in some MCS quantiles. The findings of this study showed specific contributing factors in CCS with different levels of HRQOL. There is a need for targeted interventions related to risk reduction and stratification for CCS with different HRQOL levels. Symptom management strategies, early detection programs for CCS with psychological distress, and clinical and counseling interventions for CCS with poor HRQOL need to be developed.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Young Man Kim
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Jeollabuk-do, South Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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11
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Zheng J, Zhou X, Cai R, Liu Q, Yu R, Liu K. Individual, Interpersonal, and Home Environmental Factors Influencing Health Behaviors Among Chinese Childhood Cancer Survivors: A Structural Equation Analysis. Cancer Nurs 2021. [PMID: 34310386 DOI: 10.1097/NCC.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) are at increased risk of chronic health conditions, which could be controlled with health behaviors. However, the health behaviors and related factors of Chinese CCSs remain unclear. OBJECTIVE The aims of this study were to examine multiple health behaviors among Chinese CCSs and explore the individual, interpersonal, and home environmental factors affecting health behaviors. METHODS This cross-sectional study recruited 204 participants from 3 grade-A tertiary hospitals in Guangzhou, China. Participants provided data on health behaviors (smoking, drinking, drug use, screen time, internet addiction, dietary behaviors, physical activity, and sleep behaviors) and their determining factors. Structural equation modeling was used to analyze the data. RESULTS Chinese CCSs reported low rates of smoking, drinking, and drug use (0%-6.4%), but only 51% of survivors met screen time recommendations, and 24.5% of them had Internet addiction. Few survivors reported frequent soft-drink, sugar, and fast-food intake (2.0 to 7.4%), but many were finicky eaters (55.4%) or seldom drank milk (41.7%). In addition, 67.6% and 47.5% of survivors did not meet physical activity and sleep time recommendations. Childhood cancer survivors' health behaviors were influenced by the individual (age, education level, and time since diagnosis), interpersonal (peer and family support), and home environmental (residential location, parents' educations level, and household income) factors. CONCLUSIONS There were suboptimal health behaviors among Chinese CCSs. Targeted interventions should consider their individual, interpersonal, and home environmental factors. IMPLICATIONS FOR PRACTICE Knowledge of health behaviors and related factors of Chinese CCSs would help healthcare professionals develop further interventions to improve their care of this population.
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12
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Chardon ML, Pinto S, Slayton WB, Fisher RS, Janicke DM. Eating behaviors and dietary quality in childhood acute lymphoblastic leukemia survivors. Pediatr Blood Cancer 2021; 68:e28811. [PMID: 33381920 DOI: 10.1002/pbc.28811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/06/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood acute lymphoblastic leukemia (ALL) survivors' increased risk for adverse health outcomes could be mitigated through consuming a balanced diet. Nonetheless, >70% of adult survivors do not meet survivorship dietary recommendations. ALL treatment may amplify risk for restricted dietary preferences (picky eating) and poor self-regulation of food intake that could contribute to suboptimal diets in survivorship. This study aims to: (a) characterize differences in picky eating and self-regulation of food intake between survivors and peer controls; and (b) examine the associations between these eating behaviors and dietary quality in ALL survivors relative to peer controls. METHODS Participants were children (5-13 years) with (n = 32) and without (n = 32) a history of ALL and their caregivers. Children's dietary quality (Healthy Eating Index-2015) was calculated from 24-h dietary recalls. Caregivers completed the Child Eating Behavior Questionnaire-Food Fussiness subscale and the Child Self-Regulation in Eating Questionnaire. RESULTS Independent samples t-tests revealed survivors exhibited greater picky eating than peer controls but comparable self-regulation of food intake. Bootstrapped grouped multivariate regression results showed that for ALL survivors, greater picky eating was associated with worse dietary quality (controlling for age and self-regulation of food intake). For peer controls, worse self-regulation of food intake was associated with poorer dietary quality (controlling for picky eating and age). CONCLUSIONS Results provide preliminary support that different eating behaviors contribute to poor dietary quality in children with and without an ALL history. These findings suggest that interventions to improve ALL survivors' dietary quality may benefit targeting picky eating.
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Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stefania Pinto
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - William B Slayton
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Rachel S Fisher
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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13
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Darabos K, Barakat LP, Schapira M, Hill-Kayser C, Schwartz LA. Association of Demographic and Cancer-Specific Factors on Health Behavior Recommendations Specific to Cancer Prevention and Control Among Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2020; 10:619-628. [PMID: 33211609 DOI: 10.1089/jayao.2020.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for long-term health problems that are exacerbated by not meeting health behavior recommendations (e.g., exercise). To identify AYA at risk for not meeting health behavior recommendations, we explored demographic (e.g., age) and cancer-specific (e.g., intensity of treatment) factors associated with not meeting specific health behavior recommendations that have implications for cancer prevention and control. Methods: Regression (linear/binary) was used to examine demographic and cancer-specific associates regarding fruit/vegetable intake, binge drinking, sleep duration, sunscreen use, tobacco use, and physical activity among 307 AYA (Mage = 20.33, range = 15-34) across three combined studies, treated at a pediatric cancer center. Health behavior measures were adapted from The Health Behaviors Survey and the Youth Risk Behavior Surveillance System questionnaire. Results: AYA in general did not meet health behavior recommendations. Compared with AYA with public insurance, AYA with private insurance (β = -0.19, p < 0.01) were more likely to meet multiple health behavior recommendations. AYA at greatest risk for not meeting specific health behaviors were more likely to be diagnosed in middle childhood (11.35years) compared with early childhood (8.38years), be closer to diagnosis (8.77years vs. 11.76years) and closer to treatment completion (6.97years vs. 9.91years), and have a solid tumor (32.7%) compared with a brain tumor (10.6%). Conclusion: Not meeting health behavior recommendations is common among AYA survivors of childhood cancer. Early education in the context of survivorship care is critical to provide teachable moments to AYA; such interventions might impact future long-term health and reduce risk for secondary cancers.
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Affiliation(s)
- Katie Darabos
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn Schapira
- Department of Medicine, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Pinto S, Fresneau B, Hounsossou HC, Mayet A, Marchi J, Pein F, Journy N, Mansouri I, Drubay D, Letort V, Lemler S, Demoor-Goldschmidt C, Jackson A, Souchard V, Vu-Bezin G, Diallo I, Rubino C, Oberlin O, Haddy N, de Vathaire F, Dumas A, Allodji RS. Identifying clusters of health risk behaviors and their predictors in adult survivors of childhood cancer: A report from the French Childhood Cancer Survivor Study. Psychooncology 2020; 29:1595-1603. [PMID: 32658375 DOI: 10.1002/pon.5470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/20/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Health risk behaviors (HRB) of childhood cancer survivors (CCS) are generally studied separately, despite the evidence suggesting that HRB are not independent. To our knowledge, few studies have examined HRB profiles in the former pediatric cancer patients. In this study, we identified HRB profiles and examined predictors engaging in unhealthy behaviors in CCS. METHODS We used data from a French cohort of CCS that includes five-year survivors diagnosed between 1945 and 2000 and treated before reaching age 18, in five centers in France. A total of 2961 adult CCS answered a self-reported questionnaire pertaining to HRB. Latent class analysis was used to identify HRB profiles combining physical activity, smoking, cannabis use, and alcohol drinking. Multinomial logistic analyses examined predictors for engaging in unhealthy behaviors. RESULTS Three HRB patterns emerged: "Low-risk" (n = 1846, 62.3%) included CCS who exhibited the highest frequency for usual physical activity and the lowest probabilities for current smoking or cannabis use, but most drank at least moderately; "Moderate-risk behaviors" (n = 291, 9.8%), and "High-risk behaviors" (n = 824, 27.8%) for CCS who exhibited the highest frequencies for current smoking, cannabis use, and heavy drinking. The multivariable regression revealed that male CCS, less educated or not married were significantly more likely to be in the high-risk behaviors group than the low-risk group. CONCLUSIONS As CCS remain a vulnerable population, screening for HRB should be routinized in long-term follow-up care and interventions targeting multiple HRB simultaneously among survivors should be developed.
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Affiliation(s)
- Sandrine Pinto
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Pediatric oncology, Université Paris-Saclay, Villejuif, France
| | - Hubert C Hounsossou
- Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, Cotonou, Benin
| | - Aurélie Mayet
- Center for Epidemiology and Public Health of the French Army (CESPA), Marseille, France
| | - Joeffrey Marchi
- Center for Epidemiology and Public Health of the French Army (CESPA), Marseille, France
| | - François Pein
- Département de Recherche, Institut de Cancérologie de l'Ouest, Site René Gauducheau CLCC Nantes-Atlantique, Saint-Herblain, France
| | - Neige Journy
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Imene Mansouri
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Damien Drubay
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Véronique Letort
- Laboratory of Mathematics in Interaction with Computer Science (MICS), CentraleSupélec, Gif-sur-Yvette, France
| | - Sarah Lemler
- Laboratory of Mathematics in Interaction with Computer Science (MICS), CentraleSupélec, Gif-sur-Yvette, France
| | - Charlotte Demoor-Goldschmidt
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,Département de Recherche, Institut de Cancérologie de l'Ouest, Site René Gauducheau CLCC Nantes-Atlantique, Saint-Herblain, France.,Pediatric Oncology, Chu de Nantes, Nantes, France
| | - Angela Jackson
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Vincent Souchard
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Giao Vu-Bezin
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Ibrahima Diallo
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Carole Rubino
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Odile Oberlin
- Gustave Roussy, Department of Pediatric oncology, Université Paris-Saclay, Villejuif, France
| | - Nadia Haddy
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Florent de Vathaire
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Agnès Dumas
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,ECEVE-INSERM UMR 1123, Paris, France
| | - Rodrigue S Allodji
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, Cotonou, Benin
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15
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Cohen J, Collins L, Gregerson L, Chandra J, Cohn RJ. Nutritional concerns of survivors of childhood cancer: A "First World" perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28193. [PMID: 31994836 DOI: 10.1002/pbc.28193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [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: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.
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Affiliation(s)
- Jennifer Cohen
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laura Gregerson
- Department of Nutrition, Exercises and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joya Chandra
- Departments of Pediatrics Research, Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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16
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Abstract
PURPOSE OF REVIEW This article reviews the current literature on psychosocial care of children with cancer with particular focus on evidence-based standards of care, including developments in systematic distress screening, utilization of patient-reported outcomes, evidence-based interventions, survivorship, palliative care and bereavement. RECENT FINDINGS Although attention to the psychosocial needs of the child and family is increasingly recognized as an essential element of care for children with cancer, implementing evidence-based care remains suboptimal. Recent efforts have focused on utilizing technology to improve the reach of these interventions and to enhance engagement with special populations, such as adolescents and young adults. Increasing data elucidate the long-term psychological and physical late effects of childhood cancer survivorship and the impact of cancer on siblings and the family. Gaps in clinical care and important directions for future research include the needs of infants and toddlers, overlooked minorities, and patients with hereditary tumor predisposition syndromes, and attention to the psychosocial impact of exciting new treatments, such as autologous chimeric antigen receptor (CAR) T-cell therapy. SUMMARY The evidence base for the psychosocial standards of care for children with cancer and their families continues to grow, but more work is needed to successfully implement these standards across pediatric cancer centers.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 10 Center Drive, Room 1C247B-4, Bethesda, MD 20892
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Amanda L Thompson
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, DC
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17
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Van Dijk-Lokkart EM, Steur LMH, Braam KI, Veening MA, Huisman J, Takken T, Bierings M, Merks JH, Van den Heuvel-Eibrink MM, Kaspers GJL, Van Dulmen-den Broeder E, Van Litsenburg RRL. Longitudinal development of cancer-related fatigue and physical activity in childhood cancer patients. Pediatr Blood Cancer 2019; 66:e27949. [PMID: 31436372 DOI: 10.1002/pbc.27949] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 03/22/2019] [Revised: 06/27/2019] [Accepted: 07/14/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Cancer-related fatigue is one of the most distressing side effects of childhood cancer treatment. Physical activity can decrease fatigue and has positive effects on other health outcomes. Most research on physical activity pertains to adults, and the few studies that focus on children have limited follow-up time. This study evaluates cancer-related fatigue in children and its association with physical activity over a one-year time period. METHODS Sixty-eight children with cancer (7-18 years) were recruited during or within the first year after treatment. Physical activity (Actical activity monitor) and cancer-related fatigue (Pediatric Quality-of-Life Questionnaire Multidimensional Fatigue Scale (PedsQL-MFS), self- and parent- reports) were assessed at baseline, 4 months, and 12 months. PedsQL-MFS scores were compared with Dutch norms. Longitudinal association of cancer-related fatigue with physical activity was evaluated (No. NTR 1531). RESULTS Generally, PedsQL-MFS scores were worse than norms at baseline and 4 months, and recovered by 12 months except for the parent-proxy scores in adolescents. Younger children (≤12 years) self-reported comparable or better scores than norms. Physical activity generally improved over time, but patients mostly remained sedentary. During follow-up, increased physical activity was associated with less cancer-related fatigue. CONCLUSION Cancer-related fatigue in children improves over time, and increased physical activity is associated with less cancer-related fatigue. Given the sedentary lifestyle of this population, the positive effect of physical activity on cancer-related fatigue, and the many other health benefits of an active lifestyle, it is important to stimulate physical activity in childhood cancer patients and survivors.
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Affiliation(s)
- Elisabeth M Van Dijk-Lokkart
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Katja I Braam
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Faculty of Health, University of Applied Science, Amsterdam, the Netherlands
| | - Margreet A Veening
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jaap Huisman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina's Children's Hospital, UMC Utrecht, the Netherlands
| | - Marc Bierings
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, UMC Utrecht, the Netherlands
| | - Johannes H Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Department of Pediatric Oncology, Amsterdam, The Netherlands
| | - Marry M Van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eline Van Dulmen-den Broeder
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Raphaële R L Van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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18
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Touyz LM, Cohen J, Cohn RJ, Garnett SP, Anazodo A, Gohil P, Grech AM, Ng A, Wakefield CE. Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective. Pediatr Blood Cancer 2019; 66:e27922. [PMID: 31309668 DOI: 10.1002/pbc.27922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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: 02/07/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maintaining a healthy lifestyle can protect adolescent survivors of pediatric cancer against chronic diseases such as obesity and cardiovascular disease. In this study, we examined the attitudes of adolescent survivors of pediatric cancer and their parents toward improving lifestyle behaviors after cancer treatment, including their preferences for intervention delivery and perceived barriers and benefits to healthy eating and exercise. METHODS We recruited adolescent survivors of childhood cancer aged 11-19 years and their parents, from two hospitals. Participants completed a questionnaire via mail or at routine oncology clinic visits. RESULTS Thirty-three adolescents (response rate 39%, mean age 15, 61% male) and 32 parents (representing 30 parent-child dyads) participated. Parents were significantly more interested in having their child participate in a lifestyle intervention than adolescents (41% of adolescents and 72% of parents, P = .012). Both groups preferred that the survivor receive lifestyle support face to face rather than online. Adolescents preferred to involve their friends (39% of adolescents and 19% of parents) whereas parents preferred to involve the family in a lifestyle intervention (15% of adolescents and 47% of parents, P = .006). Adolescents and their parents perceived a dislike of the taste of fruits and vegetables, fatigue, lack of motivation, and fear of injury as barriers to change. They perceived that keeping healthy and having more energy were benefits to participation. Participants indicated that interventions that provide face-to-face personal training and dietary education at a local gym would be well accepted. CONCLUSIONS Adolescents who have had cancer in childhood have a preference for face-to-face contact with health professionals to overcome the barriers to participation in a lifestyle intervention.
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Affiliation(s)
- Lauren M Touyz
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Paayal Gohil
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Allison M Grech
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Anthea Ng
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Ryan TD, Nagarajan R, Godown J. Pediatric Cardio-Oncology: Development of Cancer Treatment-Related Cardiotoxicity and the Therapeutic Approach to Affected Patients. Curr Treat Options Oncol 2019; 20:56. [PMID: 31129800 DOI: 10.1007/s11864-019-0658-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OPINION STATEMENT The past 5 decades have seen significant improvements in outcomes for pediatric patients with cancer. Unfortunately, children and adolescents who have been treated for cancer are five to six times more likely to develop cardiovascular disease as a result of their therapies. Cardiovascular disease may manifest in a plethora of ways, from asymptomatic ventricular dysfunction to end-stage heart failure, hypertension, arrhythmia, valvular disease, early coronary artery disease, or peripheral vascular disease. A number of treatment modalities are implicated in pediatric and adult populations, including anthracyclines, radiation therapy, alkylating agents, targeted cancer therapies (small molecules and antibody therapies), antimetabolites, antimicrotubule agents, immunotherapy, interleukins, and chimeric antigen receptor T cells. For some therapies, such as anthracyclines, the mechanism of injury is elucidated, but for many others it is not. While a few protective strategies exist, in many cases, observation and close monitoring is the only defense against developing end-stage cardiovascular disease. Because of the variety of potential outcomes after cancer therapy, a one-size-fits-all approach is not appropriate. Rather, a good working relationship between oncology and cardiology to assess the risks and benefits of various therapies and planning for appropriate surveillance is the best model. When disease is identified, any of a number of therapies may be appropriate; however, in the pediatric and adolescent population supportive data are limited.
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