Main findings
sleeplessness, anxiety, cancer survivors, cancer, constipation, insomnia, tiredness
CANCER, SECONDARY, HOLIDAY
The present study shows that it is feasible to perform a randomized-controlled study design on a complex intervention such as a wilderness program and with a medically vulnerable study group such as childhood and AYA cancer survivors. Within half a year, the number of participants needed for this pilot study was recruited and almost all childhood and AYA cancer survivors were willing to be randomized. These results are thus in sharp contrast to the previous study by Gabrielsen et al. [Another important finding of this study is that a supervised wilderness adventure is just as safe for childhood and AYA cancer survivors as enjoying a holiday program at a Spa hotel. The relative frequency of reported AEs was similar in both study arms, and all AEs were non-serious, mild, or moderate of severity, and resolved during the study period. Reports of tiredness, mosquito bites, situational anxiety, and constipation by participants in the wilderness program is to be expected when exposed to a wilderness expedition, challenging physical activities such as sea-kayaking and rock climbing, and outdoor food and no access to a bathroom. Despite the taxing wilderness conditions, it was interesting that tiredness was also frequently reported by participants in the holiday program. Whereas participants in the wilderness program had full days of physical activity in nature, participants in the holiday program were mostly relaxing, sleeping and enjoying good food. It may be that more vigorous outdoor physical activity resulted in higher quality sleep, increased group connectedness, and greater well-being, albeit, not statistically different between study programs. It is noted that sleeplessness and insomnia were more often reported by participants in the holiday program.Although AEs were commonly reported by participants during both programs, it should be noted that several of these were to a greater or lesser extent related to their existing long-term health issues prior to study start (see Table To the best of our knowledge, this is the first systematic and thorough analysis on the safety of wilderness programs for childhood and AYA cancer survivors. In a previous scoping review, we identified that only two out of the 15 included wilderness studies reported some program safety-related data [Exploratory analyses of secondary outcomes pointed towards increased nature connectedness among participants in the wilderness program. The construct of nature connectedness measured in this study captured differences in the way individuals view their relationship with the natural world [Previous non-randomized controlled studies have reported that wilderness programs improve health and well-being of childhood and AYA cancer survivors [