Feasibility and Preliminary Outcomes From a Pilot Study of Coping Skills Training for Adolescent—Young Adult Survivors of Childhood Cancer and Their Parents Efficacy of the Survivor Health and Resilience Education (SHARE) Program to Improve Bone Health Behaviors Among Adolescent Survivors of Childhood Cancer Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: A multicenter randomised controlled trial of Recapture Life-AYA Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging Psychological intervention in young brain tumor survivors: The efficacy of the cognitive behavioural approach Evaluation of a social-skills training group intervention with children treated for brain tumors: a pilot study. Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the partnership for health study. A group social skills intervention program for survivors of childhood brain tumors. Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial. Intervention to reduce intentions to use tobacco among pediatric cancer survivors. Predicting and modifying substance use in childhood cancer survivors: application of a conceptual model. Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. A process evaluation of a telephone-based peer-delivered smoking cessation intervention for adult survivors of childhood cancer: the partnership for health study. Internet-Based Physical Activity Intervention Targeting Young Adult Cancer Survivors. Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. An evaluation of a psychosocial intervention for survivors of childhood cancer: paradoxical effects of response shift over time. Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors. Cognitive and Problem Solving Training in Children with Cancer: A Pilot Project A Substance Use Decision Aid for Medically at-Risk Adolescents: Results of a Randomized Controlled Trial for Cancer-Surviving Adolescents Improving short-term sun safety practices among adolescent survivors of childhood cancer: a randomized controlled efficacy trial Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Working memory training in survivors of pediatric cancer: a randomized pilot study. Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan. A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy.
Uncertainty is a central feature of long-term childhood cancer survivorship during which time it principally has to do with late effects . Therefore , the purpose s of this article are ( a ) to assess feasibility of a r and omized clinical trial of a telephone-delivered coping skills training ( CST ) intervention in terms of recruitment , retention , and timeline , as well as the performance of the study measures ; and ( b ) to demonstrate trends in change on outcomes within the context of a small pilot study . The results of this pilot study suggest that HEROS PLUS CST has clinical relevance and that in-person long-term follow-up plus telephone-delivered psychosocial care is a practical way to deliver integrated care to adolescent — young adult childhood cancer survivors and their parents Purpose The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention — a manualized , behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer . Methods Participants were 75 teens aged 11–21 years , one or more years post-treatment , and currently cancer-free . Teens were r and omized to a group-based intervention focusing on bone health or a wait-list control .  Bone health behaviors were assessed at baseline and 1-month post-intervention . Results Controlling for baseline outcome measures and theoretical predictors , milk consumption frequency ( p = 0.03 ) , past month calcium supplementation ( p < 0.001 ) , days in the past month with calcium supplementation ( p < 0.001 ) , and dietary calcium intake ( p = 0.04 ) were significantly greater at 1-month follow-up among intervention participants compared with control participants . Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer . Research examining long-term intervention effectiveness is warranted Background A cancer diagnosis is 2.9 times more likely to occur during the adolescent and young adult years than in younger children . This spike in incidence coincides with a life stage characterised by psychological vulnerability as young people strive to attain numerous , critical developmental milestones . The distress young people experience after cancer treatment seriously jeopardises their ability to move into well-functioning adulthood . Methods / Design This article presents the protocol of the Recapture Life study , a phase II three-arm r and omised controlled trial design ed to evaluate the feasibility and efficacy of a new intervention in reducing distress and improving quality of life for adolescent and young adult cancer survivors . The novel intervention , “ ReCaPTure LiFe ” will be compared to a both a wait-list , and a peer-support group control .  Ninety young people aged 15–25 years who have completed cancer treatment in the past 1–6 months will be recruited from hospitals around Australia . Those r and omised to receive Recapture Life will participate in six , weekly , 90-minute online group sessions led by a psychologist , involving peer- discussion around cognitive-behavioural coping skills ( including : behavioural activation , thought challenging , communication and assertiveness skills training , problem-solving and goal - setting ) . Participants r and omised to the peer-support group control will receive non-directive peer support delivered in an identical manner . Participants will complete psychosocial measures at baseline , post-intervention , and 12-months post-intervention . The primary outcome will be quality of life . Secondary outcomes will include depression , anxiety , stress , family functioning , coping , and cancer-related identity . Discussion This article review s the empirical rationale for using group-based , online cognitive-behavioural therapy in young people after cancer treatment . The potential challenges of delivering skills-based programs in an online modality are highlighted , and the role of both peer and caregiver support in enhancing the effectiveness of this skills-based intervention is also discussed . The innovative videoconferencing delivery method Recapture Life uses has the potential to address the geographic and psychological isolation of adolescents and young adults as they move toward cancer survivorship . It is expected that teaching AYAs coping skills as they resume their normal lives after cancer may have long-term implication s for their quality of life . Trial Registration Objectives : To determine the effectiveness of a mobile phone text messaging smoking cessation programme . Design : R and omised controlled trial Setting : New Zeal and Participants : 1705 smokers from throughout New Zeal and who wanted to quit , were aged over 15 years , and owned a mobile phone were r and omised to an intervention group that received regular , personalised text messages providing smoking cessation advice , support , and distraction , or to a control group . All participants received a free month of text messaging ; starting for the intervention group on their quit day to assist with quitting , and starting for the control group at six months to encourage follow up . Follow up data were available for 1624 ( 95 % ) at six weeks and 1265 ( 74 % ) at six months . Main outcome measures : The main trial outcome was current non-smoking ( that is , not smoking in the past week ) six weeks after r and omisation . Secondary outcomes included current non-smoking at 12 and 26 weeks . Results : More participants had quit at six weeks in the intervention compared to the control group : 239 ( 28 % ) v 109 ( 13 % ) , relative risk 2.20 ( 95 % confidence interval 1.79 to 2.70 ) , p < 0.0001 . This treatment effect was consistent across subgroups defined by age , sex , income level , or geographic location ( p homogeneity > 0.2 ) . The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests . Reported quit rates remained high at six months , but there was some uncertainty about between group differences because of incomplete follow up . Conclusions : This programme offers potential for a new way to help young smokers to quit , being affordable , personalised , age appropriate , and not location dependent . Future research should test these findings in different setting s , and provide further assessment of long term quit rates Purpose . Cognitive and behavioural therapy ( CBT ) is often used to treat behavioural and emotional disorders in children , and its efficacy has been described in several studies . As behavioural and emotional disorders are frequent sequelae in brain tumor survivors , the goal of this work is to describe the efficacy of a CBT intervention in the treatment of young brain tumor survivors . Methods . Forty young patients , aged 4–18 years , were included in the study . The treatment group , composed of 17 patients , received sessions of CBT . The Child Behaviour Checklist 4–18 ( CBCL/4–18 ) and the Vinel and Adaptive Behavioural Scales ( VABS ) were administered to parents at the beginning and at the end of the hospitalisation . The statistical significance of changes for clinical subjects during the CBT administration was estimated . Results . With regard to the CBCL/4–18 , the clinical group showed a significant advantage on the withdrawn , somatic complaints , social problems , attention problems , internalising and total problem scales . On the VABS , the treatment group improved to a significantly greater extent in the social skills domain . Conclusions . These results substantiate our assumption that CBT is an effective intervention for young patients surviving brain tumors and may be particularly helpful to younger individuals in managing cancer-related limitations OBJECTIVE To evaluate the effectiveness of a manual-based , social-skills training , group intervention to improve social skills and social functioning of children treated for brain tumors , and to assess the impact of cognitive functioning on the effectiveness of the intervention . METHODS  Three social-skills training group interventions  , each comprised of 5 to 7 children ages 8 to 14 years , were conducted . A parent component was included . In total , 13 children and their parents and teachers completed st and ard measures prior to and 9 months after the intervention . Children participated in a neuropsychological test battery at baseline . RESULTS Social skills and social functioning variables changed in the direction of improved functioning , with several scores showing significant improvement from baseline to the follow-up assessment . Small to medium effect sizes were documented . Higher verbal and nonverbal functioning were associated with greater improvement . CONCLUSIONS Findings are suggestive of the potential effectiveness of social-skills training in groups for children with brain tumors . Multisite , r and omized , controlled studies are recommended as the next step PURPOSE Cancer survivors smoke at rates that are only slightly lower than the general population . This article reports on the final outcomes of Partnership for Health , a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study ( CCSS ) . METHODS This study is a r and omized control trial with follow-up at 8 and 12 months that involved smokers ( n = 796 ) enrolled onto the CCSS cohort . Participants were r and omly assigned to either a self-help or a peer-counseling program that included up to six telephone calls from a trained childhood cancer survivor , tailored and targeted material s , and free nicotine replacement therapy . The intervention was delivered by telephone and postal service mail . RESULTS The quit rate was significantly higher in the counseling group compared with the self-help group at both the 8-month ( 16.8 % v 8.5 % ; P < .01 ) and 12-month follow-ups ( 15 % v 9 % ; P < or = .01 ) . Controlling for baseline self-efficacy and readiness to change , the intervention group was twice as likely to quit smoking , compared with the self-help group . Smoking cessation rate increased with an increase in the number of counseling calls . The cost of delivering the intervention was approximately 300 dollars per participant . The incremental cost-effectiveness of the intervention compared with controls was 5,371 dollars per additional quit . CONCLUSION Interventions to prevent future illnesses are of critical importance to childhood cancer survivors . The Partnership for Health intervention result ed in a doubling of smoking cessation quit rates . Because of the seriousness of smoking among childhood cancer survivors , this intervention model may be appropriate as a multicomponent treatment program for survivors who smoke OBJECTIVE The purpose of this study was to evaluate the feasibility and preliminary outcomes of a social skills group intervention program for child brain tumor survivors . METHODS Participants were 32 survivors ( 14 females ) aged 8 - 18 years . Medulloblastoma ( 28 % ) was the main diagnosis . The intervention consisted of eight 2-hr weekly sessions focused on social skills including friendship making and assertion . Survivors and parents completed measures of social skills , quality of life , behavior and depression , at baseline , pre- and post-intervention , and 6 months later . RESULTS Feasibility analyses revealed promising acceptability , retention , recruitment , and treatment fidelity . Significant improvement was found after intervention based on parents ' reports of self-control [ F(1,27 ) = 5.97 , p < .05 ] , social skills [ F(1,28 ) = 5.70 , p < .05 ] , and quality of life [ F(1,15 ) = 17.98 , p < .01 ] . CONCLUSIONS The intervention is feasible and outcomes based on parental reports provide preliminary support for the efficacy of the program Posttraumatic stress symptoms ( PTSS ) , particularly intrusive thoughts , avoidance , and arousal , are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers . We conducted a r and omized wait-list control trial of a newly developed 4-session , 1-day intervention aim ed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches -- the Surviving Cancer Competently Intervention Program ( SCCIP ) . Participants were 150 adolescent survivors and their mothers , fathers , and adolescent siblings . Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group . A multiple imputations approach was used to address nonr and om missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained . The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family PURPOSE In this r and omized controlled trial , we sought to determine whether a risk counseling intervention would increase knowledge and perceived vulnerability to tobacco-related health risks and decrease future intentions to use tobacco among preadolescents and adolescents previously treated for cancer . PATIENT AND METHODS Participants included 103 cancer survivors between the ages of 10 and 18 years who were r and omly assigned to either a  st and ard care control ( SCC ) group or a tobacco intervention ( TI ) group .  Patients in the SCC group received st and ard advice about the risks of tobacco use . Patients in the TI group received more intensive late effects risk counseling in addition to an educational video , goal setting , written physician feedback , smoking literature , and follow-up telephone counseling . The effect of our intervention was assessed by self-reported knowledge , perceived vulnerability , and intentions at baseline , 6 , and 12 months . RESULTS Compared with the SCC group , patients who received our intervention had significantly higher knowledge scores , higher perceived vulnerability scores , and lower intention scores at 12 months . No significant differences between the SCC and TI groups at 6 months , across all measures , were found . CONCLUSION Pediatric survivors '  knowledge , perceived vulnerability to health risks , and intentions to use tobacco can be modified by a risk counseling intervention . The delayed effect of our intervention indicates that these changes may evolve over time . Implication s for health care providers who engage in tobacco counseling with young cancer survivors are discussed . Additional longitudinal studies are needed to determine definitive long-term intervention effects on actual tobacco use in this high-risk population PURPOSE / OBJECTIVES To identify factors that predict or modify substance use in childhood cancer survivors and to describe how a risk-counseling intervention reduced young survivors '  substance use . DESIGN Secondary analysis of clinical trial data and primary analysis of medical record data . SETTING Outpatient clinic . SAMPLE 149 females and 118 males 12 - 18 years of age whose cancer had been in remission for at least two years were r and omly assigned to intervention ( n = 132 ) and st and ard care ( n = 135 ) groups . METHODS Self-report question naires , abstract ed medical record data , confirmatory factor analysis , and structural equation modeling . MAIN RESEARCH VARIABLES Smoking , alcohol consumption , knowledge , risk perceptions , motivation , and worry about cancer and treatment effects . FINDINGS Three factors directly predicted substance use at baseline : being in a higher grade in school ( independent of age ) , feelings of being more susceptible to late effects of cancer therapy , and worrying more about cancer and its treatment . At follow-up a year later , grade in school and worry predicted increased substance use . In addition , a desire to change health behavior , influenced by the intervention and gender , predicted decreased substance use . The mechanism of influence of the intervention was evident : The intervention led to a need to change , which precipitated a desire to change and ultimately result ed in decreased substance use . CONCLUSIONS Young survivors ' worries and concerns about their cancer and treatment-related late effects are a new intervention target . Motivation is sensitive to behavioral change interventions and positively affects risk reduction . IMPLICATION S FOR NURSING Two new intervention strategies to address the impact of survivors ' concerns about their cancer and its treatment are implied : ( a ) Replace substance use with new coping methods to reduce fear and anxiety , and ( b ) tailor motivation-based interventions to age and gender to communicate graphically and realistically to survivors the personal importance of behavioral change in modifying the risks of late effects CONTEXT Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status . OBJECTIVES To compare the health status of adult survivors of childhood cancer and siblings  and to identify factors associated with adverse outcomes . DESIGN , SETTING , AND PARTICIPANTS Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study , a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986 . A r and omly selected cohort of the survivors ' siblings ( n = 2916 ) served as a comparison group . MAIN OUTCOME MEASURES Six health status domains were assessed : general health , mental health , functional status , activity limitations , cancer-related pain , and cancer-related anxiety/fears . The first 4 domains were assessed in the control group . RESULTS Survivors were significantly more likely to report adverse general health ( odds ratio [ OR ] , 2.5 ; 95 % confidence interval [ CI ] , 2.1 - 3.0 ; P<.001 ) , mental health ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) , activity limitations ( OR , 2.7 ; 95 % CI , 2.3 - 3.3 ; P<.001 ) , and functional impairment ( OR , 5.2 ; 95 % CI , 4.1 - 6.6 ; P<.001 ) , compared with siblings . Forty-four percent of survivors reported at least 1 adversely affected health status domain . Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female ( OR , 1.4 ; 95 % CI , 1.3 - 1.6 ; P<.001 ) , lower level of educational attainment ( OR , 2.0 ; 95 % CI , 1.8 - 2.2 ; P<.001 ) , and annual income less than 20 000 dollars ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) . Relative to those survivors with childhood leukemia , an increased risk was observed for at least 1 adverse health status domain among those with bone tumors ( OR , 2.1 ; 95 % CI , 1.8 - 2.5 ; P<.001 ) , central nervous system tumors ( OR , 1.7 ; 95 % CI , 1.5 - 2.0 ; P<.001 ) , and sarcomas ( OR , 1.2 ; 95 % CI , 1.1 - 1.5 ; P = .01 ) . CONCLUSION Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status , especially among females , those with low educational attainment , and those with low household incomes OBJECTIVE We report on the process evaluation of an efficacious national smoking cessation intervention for adult survivors of childhood cancer . We examine associations between intervention implementation characteristics and study outcomes , as well as participant characteristics related to level of involvement in the intervention . METHODS The study was conducted at the Dana-Farber Cancer Institute in Boston , Massachusetts , from 1999 - 2001 . Participants ( n = 398 ) were r and omly assigned to receive a proactive telephone-based peer counseling intervention . They received up to 6 counseling calls , individually tailored and survivor-targeted material s , and nicotine replacement therapy ( NRT ) patches if they were prepared to quit smoking . RESULTS Forty-two percent of survivors participated in the maximum number of calls ( 5 - 6 ) , and 29 % of participants requested and received NRT .  Total counseling time was an average of 51 min . Quit status at follow-up was related to intervention dose , and participants who received NRT were significantly more likely to make a 24-h quit attempt . Demographic variables ( females , White ) , higher daily smoking rate , poorer perceived health and moderate perceived risk of smoking were significantly related to greater intervention involvement . CONCLUSIONS A brief peer-delivered , telephone counseling intervention is an effective way to intervene with adult survivors of childhood cancer who are smoking . Findings from the process evaluation data ( call length and number , frequency , and spacing ) will inform future telephone counseling cessation programs Purpose : Young adults who have been treated for cancer face several health and psychosocial risks . To minimize these risks , is it imperative that they address any modifiable risk factors , such as sedentary lifestyle . Unfortunately , more than half of young adult cancer survivors remain sedentary . To facilitate the adoption of physical activity ( PA ) in this population -potentially reducing health and psychosocial risks-we developed and pilot tested an internet-based PA intervention for young survivors . Patients and methods : Eighteen young adults , aged 18 to 39 , who had been diagnosed with cancer in the past 10 years were recruited . Participants were r and omized to receive access to the PA website for 12 weeks or information about other cancer-related websites . Intervention feasibility and acceptability was assessed only among those in the PA website group ; PA and psychosocial outcomes ( mood , fatigue ) were assessed in both groups . Results : Findings revealed that 86 % of participants in the PA website group would recommend the intervention to others and most ( 71 % ) were " satisfied " or " very satisfied " with it . Further , 100 % rated getting onto the website as " very easy " and 86 % rated the information on the site as " very easy " to underst and . The logging feature , followed by the goal - setting feature , were most often accessed by participants . Participants also rated the graphing and stage-matched manual features as helpful . Estimates of effect sizes for between-group differences at 12 weeks were medium for PA outcomes and large for psychosocial outcomes . Conclusions : This internet-based PA intervention targeting young adult cancer survivors is feasible and acceptable and may benefit this population BACKGROUND Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy . Healthy behaviors can modify these risks . We initiated a controlled prospect i ve trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors ' health knowledge , health perceptions , and practice of health-protective behaviors . PROCEDURE Adolescent cancer survivors attending a long-term follow-up clinic were r and omized to receive st and ard follow-up care or st and ard care plus the educational intervention . Baseline measures were obtained at r and omization ( T(0 ) ) and repeated 1 year ( T(1 ) ) later during the survivors ' annual check-up . RESULTS Of 272 patients enrolled and r and omized , 251 are evaluable at both time points . Treatment and control groups were similar in regards to diagnosis , gender , race , and age . The change in outcome measures over the year ( T(1)-T(0 ) ) was not significantly different between the two groups as assessed by a two- sample pooled t test . However , additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores . In addition , patients who choose certain individual health goals , such as breast/testicular self-examination , showed improved practice of the health behavior . In addition , in a very exploratory analysis , a gender difference in response to the intervention was noted , with females exhibiting a greater improvement in knowledge scores than did males . CONCLUSIONS Although the multi-behavioral educational intervention did not induce change in health knowledge , perceptions , and behaviors of childhood cancer survivors for the treatment group as a whole , gender differences and specific health goal differences were found . These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment This study examined the impact of response shift on a psychosocial treatment evaluation of 22 young adult cancer survivors . An age-matched cohort of 54 healthy controls were included in the study to provide a comparison for normative levels and structure of quality -of-life ( QOL ) . It was found that this evaluation of a psychosocial intervention for young adult cancer survivors was notably influenced by response shift phenomenon . St and ard analyses suggested that the intervention had no impact on measured aspects of well-being . It did appear to yield an immediate gain in reported global QOL , but seemed to cause a significant decline over time . By considering response shift , it was highlighted that an apparently deleterious effect on QOL was largely a function of response shift . This response shift effect was reflected not only in changes in internal st and ards , but also in values and in conceptualization of QOL . The intervention seemed to have normalized survivors ' conceptualization of QOL so that it was increasingly similar to their age-matched cohort . Future psychosocial intervention research should explicitly consider response shift in a r and omized treatment evaluation BACKGROUND There is growing concern about declining levels of physical activity in childhood cancer survivors . This study aim ed to examine the effectiveness of an integrated adventure-based training and health education program in promoting changes in exercise behavior and enhancing the physical activity levels , self-efficacy , and quality of life of Hong Kong Chinese childhood cancer survivors . METHODS A r and omized controlled trial , two-group pretest and repeated post-test , between-subjects design was conducted to 71 childhood cancer survivors ( 9- to 16-year-olds ) . Participants in the experimental group joined a 4-day integrated adventure-based training and health education program . Control group participants received the same amount of time and attention as the experimental group but not in such a way as to have any specific effect on the outcome measures . Participants ' exercise behavior changes , levels of physical activity , self-efficacy , and quality of life were assessed at the time of recruitment , 3 , 6 , and 9 months after starting the intervention . RESULTS Participants in the experimental group reported statistically significant differences in physical activity stages of change ( p < 0.001 ) , higher levels of physical activity ( p < 0.001 ) and self-efficacy ( p = 0.04 ) than those in the control group . Besides , there were statistically significant mean differences ( p < 0.001 ) in physical activity levels ( -2.6 ) , self-efficacy ( -2.0 ) , and quality of life ( -4.3 ) of participants in the experimental group from baseline to 9 months after starting the intervention . CONCLUSIONS The integrated adventure-based training and health education program was found to Background Neurocognitive sequelae are among the most debilitating late effects experienced by survivors of childhood cancer , with far reaching consequences for educational , social , and adaptive development . Empirically vali date d interventions to address such disease and treatment related psychosocial morbidities are needed . Procedure We conducted a pilot study to evaluate participants ' acceptance and impact of a 15-session , clinic-based training program to teach compensatory learning and problem-solving skills in survivors with cognitive deficits . The intervention program consisted of 5 core components design ed to improve daily problem solving , attention and memory , and academic performance . Results A sample of 12 survivors completed the program . Virtually all objective performance scores showed gains from preintervention to postintervention in the expected positive direction , although only 2 of the gains were statistically significant . Parent responses indicated they perceived the skills taught to be useful , to have improved the child 's problem-solving ability and learning skills , to have provided concrete and practical interventions for the home , and to have increased parental knowledge . Similarly , the children rated the overall program high , and reported satisfaction with learning more about their relative cognitive strengths and weaknesses and practical problem solving for academic difficulties . Conclusions Although the majority of enrolled families completed at least 70 % of the training sessions , the overall low participation rate from eligible families raise concern about widespread acceptance of such programs in the oncology clinic . The limitations of the study design and recommendations for future research are discussed Background : Adolescent survivors of childhood cancer engage in risky behaviors . Objective : This study tested a decision aid for cancer-surviving adolescents aim ed at difficult decisions related to engaging in substance use behaviors . Methods : This r and omized controlled trial recruited 243 teen survivors at 3 cancer centers . The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment . Effects at 6 and 12 months were examined for decision making , risk motivation , and substance use behaviors using linear regression models . Results : The majority of the teen cancer survivors ( 90 % ) rated the program as positive . There was an intermediate effect at 6 months for change in risk motivation for low riskers , but this effect was not sustained at 12 months . For quality decision making , there was no significant effect between treatment groups for either time point . Conclusions : The overall program effects were modest . Once teen survivors are in the program and learn what quality decision making is , their written reports indicated adjustment in their perception of their decision-making ability ; thus , a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months . With 2 of 3 teen participants dealing with cognitive difficulties , the data suggest that this type of intervention will continue to be challenging , especially when 90 % of their household members and 56 % of their close friends model substance use . Implication s for Practice : This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents , particularly ones with cognitive difficulties Introduction Skin cancer is one of the most common secondary neoplasms among childhood cancer survivors . However , little evidence exists for effective interventions to promote sun safety behaviors within this population . Methods This small-scale r and omized controlled trial examined the efficacy of the Survivor Health and Resilience Education ( SHARE ) Program intervention , a multiple health behavior change intervention design ed to increase sun safety practice s among adolescent survivors of childhood cancer . Adolescent survivors of childhood cancer ( 11–21 years ) were r and omly allocated to a group-based behavioral intervention ( n = 38 ) or wait-list control ( n = 37 ) . Self-reported sun safety behaviors were assessed using a valid , 8-item scale at baseline and 1-month post-intervention . Results Controlling for baseline sun safety , gender , and seasonal influences , intervention participants reported significantly more sun safety practice s ( e.g. , using sunscreen , reapplying sunscreen regularly ) at 1-month post-intervention than control participants ( B = 2.64 , 95 % CI = 1.02 , 4.27 , p = 0.002 ) . Conclusions The results suggest that SHARE was efficacious in producing improvements in short-term self-reported sun safety practice s among adolescent survivors of childhood cancer . Future research is needed to build upon this work by incorporating objective measures of sun safety behaviors and examining intervention durability . Implication s for cancer survivorsBehavioral interventions addressing lifestyle factors , including sun safety behaviors , among adolescent survivors of childhood cancer should be integrated into long-term care to reduce the risk for secondary malignancies and diseases BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application OBJECTIVES Survivors of pediatric brain tumors and acute lymphoblastic leukemia ( ALL ) are at increased risk for neurocognitive deficits , but few empirically supported treatment options exist . We examined the feasibility and preliminary efficacy of a home-based , computerized working memory training program , CogmedRM , with survivors of childhood cancer . METHODS Survivors of brain tumors or ALL ( n = 20 ) with identified deficits in attention and /or working memory were r and omized to either the success-adapted computer intervention or a non-adaptive , active control condition . Specifically , children in the adaptive condition completed exercises that became more challenging with each correct trial , whereas those in the non-adaptive version trained with exercises that never increased in difficulty . All participants were asked to complete 25 training sessions at home , with weekly , phone-based coaching support . Brief assessment s were completed pre-intervention and post-intervention ; outcome measures included both performance-based and parent-report measures of working memory and attention . RESULTS Eighty-five percent of survivors were compliant with the intervention , with no adverse events reported . After controlling for baseline intellectual functioning , survivors who completed the intervention program evidence d significant post-training improvements in their visual working memory and in parent-rated learning problems compared with those in the active control group . No differences in verbal working memory functioning were evident between groups , however . CONCLUSIONS Home-based , computerized cognitive training demonstrates good feasibility and acceptability in our sample . Children with higher intellectual functioning at baseline appeared to benefit more from the training , although further study is needed to clarify the strength , scope , and particularly the generalizability of potential treatment effects BACKGROUND Hodgkin lymphoma ( HL ) survivors face substantially elevated risks of breast cancer and cardiovascular disease . They and their physicians are often unaware of these risks and surveillance recommendations . PROCEDURE A prospect i ve one-arm study was conducted among a r and om sample of 72 HL survivors , ages 27 - 55 years , participating in the Childhood Cancer Survivor Study ( CCSS ) who were at increased risk for breast cancer and /or cardiomyopathy and had not had a screening mammogram or echocardiogram , respectively , within the prior 2 years . A one-page survivorship care plan with recommendations for surveillance was mailed to participants . In addition , survivors ' primary physicians were contacted and provided patient-specific information and a web-based Virtual Information Center was made available for both survivors and physicians . Outcomes were assessed by telephone 6 months after the intervention . RESULTS The survivor participation ( 62/72 ; 86 % ) and 6-month retention ( 56/61 ; 92 % ) rates were high . Tension and anxiety , measured by the Profile of Mood States , did not increase following risk notification ; 91 % of survivors described their reactions to receiving the information in positive terms . At 6 months , 41 % of survivors reported having completed the recommended mammogram ; 20 % reported having an echocardiogram ( females 30 % , males 10 % ) . Only 29 % of survivors visited the website . Nine physicians enrolled , and none used the study re sources . CONCLUSION A mailed , personalized survivorship care plan was effective in communicating risk and increasing compliance with recommended medical surveillance . Internet- and telephone-based strategies to communicate risk were not utilized by survivors or physicians Survivors of childhood cancer whose malignancy and /or treatment involved the central nervous system may demonstrate a consistent pattern of neurocognitive deficits . The present study evaluated a r and omized clinical trial of the Cognitive Remediation Program ( CRP ) .  Participants were 6- to 17-year-old survivors of childhood cancer ( N = 161 ; 35 % female , 18 % Hispanic , 10 % African American , 64 % Caucasian , 8 % other ) who were at least 1 year off treatment and who manifested an attentional deficit . They were enrolled at 7 sites nationwide . Two thirds of the participants were r and omly assigned to cognitive remediation . All participants were assessed using a battery of academic achievement/neurocognitive tests and parent/teacher measures of attention . The CRP result ed in parent report of improved attention and statistically significant increases in academic achievement . Effect sizes were modest but were comparable with those for other clinical trials of brain injury rehabilitation and for psychological interventions in general . The CRP is presented as a potentially beneficial treatment for many survivors of pediatric cancer . Long-term clinical significance remains unproven . Further work is needed to improve effect sizes and treatment compliance and to address the needs of other population s with pediatric brain injury
OBJECTIVE Survivors of childhood cancer must contend with a number of medical and psychosocial vulnerabilities after their cancer treatment ends .
Interventions have been developed to alleviate or prevent adverse outcomes among this population .
This systematic review summarizes the efficacy of psychosocial , health behavior , and neurocognitive interventions for survivors of pediatric cancer .