Considerations and recommendations for further research
cancer, cancer survivors
CANCER, SECONDARY, RECRUITMENT, CHILDHOOD CANCER
The purpose of this study was to lay the foundation for a future larger RCT investigating the effectiveness and safety of a wilderness program on the health and well-being of childhood and AYA cancer survivors. Although the time to recruit the participants for this pilot study was relatively short (six months), it appeared that the overall recruitment rate was very low (3.6%). It is likely that the number of cancer survivors exposed to the study outreach was much lower than the total number of people who were signed up with the two cancer organizations. Furthermore, response may have been lower due to COVID-19 concerns. Other recruitment strategies to supplement members of national cancer organizations may be needed in order to reach out to this population. Health care, educational and cultural systems are quite similar in the Nordic countries. It is therefore recommended to perform a future larger multi-center RCT in close collaboration with centers in Denmark, Finland, and Norway. Another recommended strategy for recruitment of participants is to collaborate with hospitals in future trials.Another important observation was that a substantial percentage of eligible individuals dropped out before study start (attrition rate 28.8%) because of lack of time or not being able to get free from work. Previous studies have published difficulties in recruiting AYA cancer survivors [It was intended to recruit both adolescent and young adults for participation in the present pilot study. To our surprise, it was only young adults from 20 years and older that participated. Only one eligible adolescent showed interest to participate but declined participation when she found out that she would be the youngest in the group. Since both national cancer organizations through which participants were recruited have adolescents among their members, it appears that such programs mainly appeal to young adults. The WAYA program was specifically developed for AYAs aged 16 to 39 years. This allowed for participation of individuals that were diagnosed with cancer throughout childhood, adolescents, and young adulthood. We previously reported that inclusion of a diverse group of young cancer survivors in a wilderness program seems to be of added value for group bonding and learning purposes [The choice for the secondary health-related outcome variables quality of life, self-esteem and self-efficacy in the present study was based on the results of a scoping review that mapped the concept, content and outcome of wilderness programs for childhood cancer survivors [