Multiple behavioral risk factors among adolescent survivors of childhood cancer in the Survivor Health and Resilience Education (SHARE) program. Predictors of risk-based medical follow-up: a report from the childhood cancer survivor study Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the partnership for health study. Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. Multiple risk behaviors among smokers in the childhood cancer survivors study cohort. Feasibility of implementing health promotion interventions to improve health‐related quality of life Improving short-term sun safety practices among adolescent survivors of childhood cancer: a randomized controlled efficacy trial Antidepressant use among survivors of childhood, adolescent and young adult cancer: a report of the Childhood, Adolescent and Young Adult Cancer Survivor (CAYACS) Research Program.
BACKGROUND Health-compromising behaviors among survivors of childhood cancer may increase their risks of cancer recurrence and the onset of chronic disease in adulthood . Regardless of whether such behaviors occur singly or in combination with one another , multiple behavioral risk factors must be identified and addressed early to promote better health outcomes within this special population . Adolescent survivors may be especially vulnerable , as reported rates of smoking and other risky behaviors are at or near levels of their healthy peers . The psychological literature suggests stress may play a role in risk behavior initiation and maintenance , including multiple behavioral risks , and that adolescent survivors are stress-prone . This report focuses on the prevalence and co-occurrence of three behavioral risk factors ( cigarette use , insufficient physical activity , and non-adherence to sun protection recommendations ) and describes stress-health behavior relationships in this special population . PROCEDURE All patients in this study ( n = 75 ) were adolescent survivors of childhood cancer and completed a baseline assessment of their  health behaviors and stress  as part of a r and omized controlled trial of health promotion . RESULTS Twenty-eight percent of the patients reported one of three risk factors , 12 % reported two of three risk factors , and 7 % reported all three risk factors . Non-adherence to sun protection was the single most common risk factor ; physical inactivity and non-adherent sun protection were the most common co-occurring risk factors . Greater age and stress were significantly associated with the presence of more behavioral risk factors . CONCLUSIONS The evidence suggests interventions to reduce multiple health-compromising behaviors in these patients are warranted , and that efforts to address these patients ' personal and family stress levels are important as well Purpose The purpose of this study is to conduct an intervention study design ed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications . Methods Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease , breast cancer , or osteoporosis related to previous cancer treatment were r and omly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information . A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up . Results Overall , there were no differences found among the groups in terms of access to a treatment summary , medical follow-up , discussion of childhood cancer health risks , and medical screening for the targeted health behaviors . One exception , indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information ( 10.1 % vs. 4.0 % p = 0.05 ) . Discussion of breast cancer ( OR = 2.15 ; 95 % CI = 1.74 - 2.66 ) , heart disease ( OR = 5.54 ; 95 % CI = 4.67–6.57 ) and osteoporosis ( OR = 10.6 ; 95 % CI = 8.34–13.47 ) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary . Conclusions More detailed content in a newsletter had minimal effect on recommended screening . However , survivor ’s discussion of cancer-related risks with one ’s doctor significantly influenced participation in health screening . These results highlight the integral role of communication in health behavior . Implication s for Cancer SurvivorsThis study is design ed to assess communication strategies that increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications . The results are of great importance not only to the pediatric oncology community but also the broad range of adult oncology medical specialties who are directly involved in the long-term medical care of this ever increasing population of cancer survivors 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 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 The literature on health behaviors of young adult cancer survivors is very limited , and thus little is known about preventable risk factors in this population . This paper describes the prevalence of five behavioral risk factors among 541 young adult survivors of childhood cancers from the CCSS cohort who were identified as smokers and enrolled in a r and omized controlled trial of a smoking cessation intervention .  The relationship between presence of multiple risk factors and a number of smoking-related factors was examined . About 31 % of the sample engaged in zero or one health-risk behavior in addition to smoking ; 63 % engaged in 2 or 3 , and 6 % engaged in 4 or 5 . There were positive linear relationships between number of risk factors and smoking rate and nicotine dependence . Number of risk factors was not associated with self-efficacy for quitting , but was related to readiness to quit . This study demonstrated that childhood cancer survivors who smoke have a number of other risk factors for the development of preventable disease and the presence of these risks was associated with factors that decrease the likelihood of quitting smoking . Attention to other health behaviors may be an important strategy for helping smokers quit . In particular , helping childhood cancer survivors who smoke to reduce other risk behaviors might also encourage them to quit smoking Survivors of childhood cancer are a growing and vulnerable population . Cure rates for pediatric cancers now exceed 60 % and , by the year 2000 , an estimated 1 of every 1,000 young adults will be a cancer survivor . Because this population is at increased risk for late medical and neoplastic complications that impact adversely on health‐related quality of life , it is important to investigate methods to promote risk reduction by motivating survivors to practice health‐promoting behaviors . With this background , we initiated a prospect i ve , r and omized , controlled feasibility study in which survivors attending a long‐term follow‐up clinic were r and omized  to receive st and ard care or st and ard care plus an educational intervention . Our objectives were to determine if the intervention would improve the survivors ' knowledge about their cancer treatment and risks of late effects and increase their practice of health‐protective behaviors . Since July 1995 , 272 of 318 families ( 86 % ) approached about the study agreed to participate . Of these , 266 are evaluable for assessment of baseline knowledge and health behaviors . Demographic features , baseline knowledge , health perceptions and health behaviors did not differ among r and omized groups . Assessment of the intervention 's efficacy at changing health behaviors of survivors r and omized to the intervention group will be available when the 1‐year follow‐up evaluations are completed for the study cohort . Our preliminary experience with this pilot study supports the feasibility of educational intervention research in a specialty clinic dedicated to monitoring long‐term childhood cancer survivors . Int . J. Cancer Suppl . 12:138–142 , 1999 . © 1999 Wiley‐Liss , 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 Although survivors of childhood , adolescent , and young adult ( AYA ) cancer are at risk for late psychological sequelae , it is unclear if they are more likely to be prescription antidepressant users than their peers . PROCEDURE All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified . Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included ( n = 2,389 ) . A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was r and omly selected ( n = 23,890 ) . All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative data base . Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription . RESULTS After adjusting for sociodemographic factors , survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls ( OR 1.21 , 95 % CI 1.09 - 1.35 ) . Cancer survivors had an increased likelihood of using all categories of antidepressants , and of using drugs from two or more antidepressant categories , compared to peers ( OR 1.31 , 95 % CI 1.11 - 1.55 [ ≥2 antidepressant categories ] ) . Treatment was not a significant predictor of antidepressant use . Female survivors , those in young adulthood and those more than 20 years post-treatment had increased antidepressant use . CONCLUSIONS Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls . This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors
Due to a paucity of studies , and the heterogeneity of the studies included in this review , we are unable to draw conclusions regarding the effectiveness of nutritional interventions for use with childhood cancer survivors .
Although there is low quality evidence for the improvement in health behaviours using health behaviour change interventions , there remains no evidence as to whether this translates into an improvement in dietary intake .
There was also no evidence that the studies reduced the risk of cardiovascular and metabolic disorders in childhood cancer survivors , although no evidence of effect is not the same as evidence of no effect .
BACKGROUND Childhood cancer survivors are at a higher risk of developing health conditions such as osteoporosis , and cardiovascular disease than their peers .
Health-promoting behaviour , such as consuming a healthy diet , could lessen the impact of these chronic issues , yet the prevalence rate of health-protecting behaviour amongst survivors of childhood cancer is similar to that of the general population .
Targeted nutritional interventions may prevent or reduce the incidence of these chronic diseases .
OBJECTIVES The primary aim of this review was to assess the efficacy of a range of nutritional interventions design ed to improve the nutritional intake of childhood cancer survivors , as compared to a control group of childhood cancer survivors who did not receive the intervention .