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. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study A process evaluation of a telephone-based peer-delivered smoking cessation intervention for adult survivors of childhood cancer: the partnership for health study. Response Rates to a Mailed Survey Targeting Childhood Cancer Survivors: A Comparison of Conditional versus Unconditional Incentives Exercise Interventions in Children with Cancer: A Review Social outcomes in adult survivors of childhood cancer compared to the general population: linkage of a cohort with population registers. Implementing an intervention to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia: BONEII, a prospective placebo-controlled double-blind randomized interventional longitudinal study design. Partnership for Health-2, A Web-Based Versus Print Smoking Cessation Intervention for Childhood and Young Adult Cancer Survivors: Randomized Comparative Effectiveness Study Rationale and design of the Children’s Oncology Group (COG) study ALTE1621: a randomized, placebo-controlled trial to determine if low-dose carvedilol can prevent anthracycline-related left ventricular remodeling in childhood cancer survivors at high risk for developing heart failure Incidence of second neoplasm in childhood cancer survivors treated with GH: an analysis of GeNeSIS and HypoCCS. Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: Cluster-randomised controlled trial Impact of a nutrition and physical activity intervention (ENRICH: Exercise and Nutrition Routine Improving Cancer Health) on health behaviors of cancer survivors and carers: a pragmatic randomized controlled trial Limitations on Physical Performance and Daily Activities among Long-Term Survivors of Childhood Cancer Efficacy of the Survivor Health and Resilience Education (SHARE) Program to Improve Bone Health Behaviors Among Adolescent Survivors of Childhood Cancer Exercise and nutrition routine improving cancer health (ENRICH): The protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers
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 BACKGROUND Physical activity ( PA ) may be important for preventing chronic diseases for adolescent and young adult ( AYA ) childhood cancer survivors . R and omized controlled trials ( RCTs ) of PA interventions for AYA survivors are sparse , but necessary to determine effective programs for increasing PA among this population . Thus , we conducted a pilot RCT , testing the feasibility of a mobile health ( mHealth ) intervention to promote PA among AYA survivors . PROCEDURE We recruited 14- to 18-year-olds who were ≥1-year post cancer therapy from Seattle Children 's Hospital . The 10-week intervention consisted of a wearable PA-tracking device ( Fitbit Flex ) and a peer-based virtual support group ( Facebook group ) . Research staff helped set step goals and awarded badges weekly . Controls received usual care . Baseline assessment s occurred before r and omization and follow-up assessment s occurred during weeks 8 - 10 of the intervention period . Feasibility criteria are defined below . Qualitative interviews assessed acceptability . Exploratory outcomes included PA , quality of life , and motivation for PA . RESULTS All feasibility criteria were met : we recruited 60 survivors , intervention participants wore the Fitbit  on the majority ( 71.5 % ) of intervention days , and ≥90 % of all participants completed question naires . Qualitative data confirmed intervention acceptability . Exploratory analyses found no significant adjusted group differences for change in moderate-to-vigorous PA ( 4.4 vs. 5.0 min/day ; P = 0.92 ) or sedentary time ( -4.5 vs. 1.0 min/day ; P = 0.73 ) , comparing intervention subjects to controls . Some modest differences were found for select subscales of quality of life and motivation for PA . CONCLUSIONS This mHealth PA intervention was feasible and acceptable to AYA childhood cancer survivors and warrants a fully powered RCT 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 Objective : Mailed surveys are widely used to collect epidemiologic and health service data . Given that nonresponse can threaten the validity of surveys , modest incentives are often used to increase response rates . A study was undertaken among childhood cancer survivors and their parents to determine if response rate to a mailed survey differed with provision of immediate versus delayed incentives . Design : A self-administered survey design ed to ascertain health behaviors was mailed to 397 childhood cancer survivors ( and their parents if the survivor was < 18 years of age ) . Subjects were r and omized into two groups based on gender , age , race , and cancer type . One group received a $ 10 incentive with their blank survey ( unconditional incentive ) , whereas the other group received the incentive upon receipt of their completed survey ( conditional incentive ) . If children were minors , both the parent and the child received incentives . Results : No significant differences in response rates were observed with respect to gender , age , race , or cancer type . However , significant differences in response rates were observed between incentive groups , with unconditional incentives yielding significantly higher response rates than conditional incentives for child survivors who were ≥18 years ( 64.4 % versus 49.0 % ) , as well as younger child survivors ( 62.5 % versus 43.6 % ) and their parents ( 64.8 % versus 41.5 % ; all P < 0.05 ) . Conclusions : The provision of an immediate incentive generated significantly higher response rates to this mailed health survey among childhood cancer survivors and their parents . Given that survey studies are commonly conducted across various pediatric population s , these findings may help inform the design of future pediatric survey research The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL OBJECTIVE Self-reported data show differences in social outcomes ( not being married/having a registered partnership ; not living independently ; using social benefits ) for childhood cancer survivors compared with their peers . We aim ed to determine differences in these social outcomes between survivors and the general population using national register data and explored associated risk factors . METHODS We performed medical record linkage between a single-centre cohort of 1768 ≥ 5-year survivors of childhood cancer ( diagnosed 1966 - 2001 ) and two national registers ( 1999 - 2011 ) and obtained a r and om reference sample matched on gender and year of birth per survivor . We used multivariable logistic regression to calculate in adult survivors of childhood cancer ( born before 1990 ) the odds of the specified social outcomes at the end of follow-up in both groups . Within the survivors , we analysed risk factors for the social outcomes . RESULTS We retrieved data from 1283 adult childhood cancer survivors and 25 082 reference persons . Survivors had higher odds ( odds ratio ; 95 % confidence interval ) of not being married ( 1.2 ; 1.07 - 1.42 ) , not living independently ( 1.7 ; 1.41 - 2.00 ) and using social benefits ( 2.3 ; 1.98 - 2.69 ) compared with reference persons . Radiotherapy to head and /or neck , and an original central nervous system tumour diagnosis negatively influenced all social outcomes examined in childhood cancer survivors . CONCLUSIONS National register data show differences between social outcomes in childhood cancer survivors and the general population , especially for survivors treated with radiotherapy to head and /or neck and those originally diagnosed with central nervous system tumours . Development and implementation of effective targeted support strategies to improve social outcomes of childhood cancer survivors needs consideration . Copyright © 2015 John Wiley & Sons , The BONEII study is a large two-phase study . The baseline study ( Study 1 ) aims to estimate the prevalence of diminished bone mineral density ( BMD ) in patients treated for childhood acute lymphoblastic leukemia ( ALL ) and identify risk factors for BMD deficits . The interventional phase ( Study 2 ) of BONEII has a placebo-controlled double-blind r and omized longitudinal design to evaluate the effects of nutritional counseling and calcium and vitamin D supplementation on changes in BMD and serum and urine markers of bone metabolism . The extensive information being collected through this large study will serve as a repository of relational data about BMD and bone turnover and will support further investigations to assess the association of calcium metabolism , bone turnover , nutritional intake , lifestyle factors ( such as exercise and the use of alcohol and tobacco ) , and the specific agents used in ALL therapy in this rapidly increasing population of childhood cancer survivors Background Smoking among cancer survivors increases the risk of late effects and second cancers . This article reports on Partnership for Health-2 (PFH-2)—an effort to develop an effective and scalable version of Partnership for Health ( PFH ) , which was a previously tested peer-delivered telephone counseling program that doubled smoking cessation rates among childhood cancer survivors who smoke . Objective This paper presents results from a r and omized controlled trial evaluating the effectiveness of PFH-2 in targeted and tailored Web-based versus print formats . The overall goal was to determine whether the intervention outcomes in these self-guided scalable formats approximate what was found in a more intensive telephone counseling program . Methods This study was a r and omized controlled trial with a 15-month follow-up that included 374 smokers who were survivors of childhood or young adult cancers , recruited from five survivorship clinics . Participants were r and omly assigned to a Web-based or print format of the PFH intervention ; all had access to free pharmacotherapy . The website was design ed to provide new content at each log-on , and a peer counselor moderated a forum/chat feature . The primary outcome was smoking status at 15 months post r and omization . Results In total , 58.3 % ( 77/132 ) of Web participants logged on at least once ( mean visits 3.25 ) . Using multiple imputation methods for missing data , there were similar rates of cessation in the two arms ( print : 20/128 , 15.6 % ; Web : 33/201 , 6.4 % ) , and no differences in quit attempts or readiness to quit . The quit rates were equivalent to those found in our previous telephone counseling intervention . There were high rates of satisfaction with both of the PFH-2 interventions . Conclusions The print and Web formats yielded equivalent levels of success to those found with our telephone-delivered intervention and are comparable to other Internet treatment studies . This study provides important options for survivorship programs that may not have re sources for interpersonal forms of cessation counseling . Efforts to increase patient use of the interventions may result in higher cessation rates . Trial Registration Clinical trials.gov NCT00588107 ; http:// clinical trials.gov/ct2/show/NCT00588107 ( Archived by WebCite at http://www.webcitation.org/6K1gJtFEC ) Background Anthracyclines are widely used in the treatment of childhood cancer . One of the well-recognized side-effects of anthracycline therapy is dose-dependent cardiomyopathy that may progress to heart failure ( HF ) years after completion of cancer-directed therapy . This study will evaluate the efficacy of low-dose beta-blocker ( carvedilol ) for HF risk reduction in childhood cancer survivors at highest risk for HF . The proposed intervention has the potential to significantly reduce chronic cardiac injury via interruption of neurohormonal systems responsible for left ventricular ( LV ) remodeling , result ing in improved cardiac function and decreased risk of HF . The intervention is informed by previous studies demonstrating efficacy in pediatric and adult non-oncology population s , yet remains unstudied in the pediatric oncology population . Methods / Design The primary objective of the trial is to determine impact of the intervention on echocardiographic markers of cardiac remodeling and HF risk , including : LV wall thickness/ dimension ratio ( LVWT/D ; primary endpoint ) , as well as LV ejection fraction , volume , and blood biomarkers ( natriuretic peptides , galectin-3 ) associated with HF risk . Secondary objectives are to establish safety and tolerability of the 2-year course of carvedilol using : 1 ) objective measures : hepatic and cardiovascular toxicity , treatment adherence , and 2 ) subjective measures : participant self-reported outcomes . Two hundred and fifty survivors of childhood cancer ( diagnosed < 21 years of age ) , and previously treated with high-dose ( ≥300 mg/m2 ) anthracyclines will be enrolled in a r and omized , double-blind , placebo controlled trial . After baseline assessment s , participants will be r and omized in a 1:1 ratio to low-dose carvedilol ( maximum dose : 12.5 mg/day ) or placebo . Carvedilol or placebo is up-titrated ( starting dose : 3.125 mg/day ) according to tolerability . Discussion When completed , this study will provide much-needed information regarding a physiologically plausible pharmacological risk-reduction strategy for childhood cancer survivors at high risk for developing anthracycline-related HF.Trial registration Clinical Trials.gov ; OBJECTIVE Childhood cancer survivors are commonly treated with GH for GH deficiency that develops either as a result of primary malignancy or its treatment . One study --the Childhood Cancer Survivor Study (CCSS)--demonstrated increased risk of second neoplasm ( SN ) in GH-treated childhood cancer survivors compared with non-GH treated , after adjusting for key risk factors . We assessed the incidence of SN in GH-treated childhood cancer survivors in outpatient observational studies of GH replacement . DESIGN Retrospective analysis of two prospect i ve cohort studies that collected data on safety of GH replacement as prescribed in clinical practice . METHODS Childhood cancer survivors enrolled in Eli Lilly and Company 's pediatric ( Genetics and Neuroendocrinology of Short Stature International Study ( GeNeSIS ) ) and adult ( Hypopituitary Control and Complications Study ( HypoCCS ) ) observational studies of GH treatment were assessed for incidence of SN . RESULTS The percentage of childhood cancer survivors treated with  GH  who developed a SN was 3.8 % in pediatric GeNeSIS participants and 6.0 % in adult HypoCCS participants . The estimated cumulative incidence of SN at 5 years of follow-up in these studies was 6.2 and 4.8 % respectively . CONCLUSIONS The incidence of SN in GeNeSIS and HypoCCS GH-treated participants is similar to the published literature and is thus consistent with increased risk of SN in childhood cancer survivors treated with GH . As follow-up times were relatively short ( <3 years ) , longer observation is recommended . Nevertheless , clinicians should be alerted to the possibility of increased risk of SN in childhood cancer survivors treated with GH  and continue chronic surveillance Introduction Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks , early detection of treatment-related morbidity , and implementation of health-promoting interventions . Despite the need for continued care , barriers to clinic attendance exist . The purpose of this prospect i ve study was to identify the demographic , medical , and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer . Methods  Adherence to clinic attendance  was monitored among 941 long-term childhood cancer survivors scheduled for evaluation . Patients were classified as “ attenders ” or “ non-attenders ” based on the outcome of their first scheduled clinic appointment over a one year period . Social work staff contacted non-attenders by telephone to determine reasons for missed appointments . Results Nearly 15 % of survivors were classified as non-attenders . Univariate findings revealed that older age , lower SES , being non-white , less medically insured , traveling by car , living shorter distance from clinic , having a scheduled social work consultation , and entering or exiting survivorship clinic were associated with clinic non-attendance ( all p values < 0.05 ) . The final multivariate model indicated that non-whites ( OR = 1.88 , 95 % CI = 1.19–2.97 ) , patients without insurance ( OR = 2.36 , 95 % CI = 1.98–3.79 ) , those traveling by car ( OR = 12.74 , 95 % CI = 3.97–40.86 ) , and those who have not experienced secondary cancer events ( OR = 1.76 , 95 % CI = 0.94–3.28 ) were more likely to be non-attenders . Work or school conflicts were the primary reasons cited for missed appointments . Discussion / conclusions Despite mechanisms design ed to reduce financial burdens associated with attending survivorship clinic at our institution , demographic , medical , and logistic barriers exist which impact participation in long-term follow-up . Implication s for cancer survivors and providersThese results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic non-attendance , particularly among underserved population Background Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours ( poor diet , low physical activity and high sedentary behaviour ) from their inception . These factors include the rapidly increasing prevalence of fatness throughout childhood , the instigation of obesity-promoting behaviours in infancy , and the tracking of these behaviours from childhood through to adolescence and adulthood . The Infant Feeding Activity and Nutrition Trial ( INFANT ) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents . The intervention , conducted with parents over the infant 's first 18 months of life , will use existing social networks ( first-time parent 's groups ) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours , and reduced sedentary behaviours in infancy . Methods / Design This cluster-r and omised controlled trial , with first-time parent groups as the unit of r and omisation , will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents ' group at Maternal and Child Health Centres . Using a two-stage sampling process , local government areas in Victoria , Australia will be r and omly selected at the first stage . At the second stage , a proportional sample of first-time parent groups within selected local government areas will be r and omly selected and invited to participate . Informed consent will be obtained and groups will then be r and omly allocated to the intervention or control group . Discussion The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge this will be the first r and omised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating , physical activity and reduced sedentary behaviours . If proven to be effective , INFANT may protect children from the development of obesity and its associated social and economic costs . Trial registration Current Controlled Trials IS RCT Background Physical activity and consuming a healthy diet have clear benefits to the physical and psychosocial health of cancer survivors , with guidelines recognising the importance of these behaviors for cancer survivors . Interventions to promote physical activity and improve dietary behaviors among cancer survivors and carers are needed . The aim of this study was to determine the effects of a group-based , face-to-face multiple health behavior change intervention on behavioral outcomes among cancer survivors of mixed diagnoses and carers . Methods The Exercise and Nutrition Routine Improving Cancer Health ( ENRICH ) intervention was evaluated using a two-group pragmatic r and omized controlled trial . Cancer survivors and carers ( n = 174 ) were r and omly allocated to the face-to-face , group-based intervention ( six , theory-based two-hour sessions delivered over 8 weeks targeting healthy eating and physical activity [ PA ] ) or wait-list control ( after completion of 20-week data collection ) . Assessment of the primary outcome ( pedometer-assessed mean daily step counts ) and secondary outcomes ( diet and alcohol intake [ Food Frequency Question naire ] , self-reported PA , weight , body mass index , and waist circumference ) were assessed at baseline , 8- and 20-weeks . Results There was a significant difference between the change over time in the intervention group and the control group . At 20 weeks , the intervention group had increased by 478 steps , and the control group had decreased by 1282 steps ; this represented an adjusted mean difference of 1761 steps ( 184 to 3337 ; P = 0.0028 ) . Significant intervention effects for secondary outcomes , included a half serving increase in vegetable intake ( difference 39 g/day ; 95 % CI : 12 to 67 ; P = 0.02 ) , weight loss ( kg ) ( difference -1.5 kg ; 95 % CI , -2.6 to -0.3 ; P = 0.014 ) and change in body mass index ( kg/m2 ) ( difference -0.55 kg/m2 ; 95 % CI , -0.97 to -0.13 ; P = 0.012 ) . No significant intervention effects were found for self-reported PA , total sitting time , waist circumference , fruit , energy , fibre , alcohol , meat , or fat consumption . Conclusions The ENRICH intervention was effective for improving PA , weight , body mass index , and vegetable consumption even with the inclusion of multiple cancer types and carers . As an example of successful research translation , the Cancer Council NSW has subsequently adopted ENRICH as a state-wide program . Trial registration Australian New Zeal and Clinical Trials Register identifier : ANZCTRN1260901086257 Context Long-term survivors of childhood cancer may be affected by treatment-associated impairments that limit physical performance and restrict participation in activities of daily living . Prevalence of these impairments and their association with particular types of cancer or treatment methods are not known . Contribution Patients surviving childhood cancer for at least 5 years were compared with their siblings who did not have cancer . All survivors were at an increased relative risk for persistent impairment , but survivors of brain and bone cancer were particularly likely to report performance limitations and restrictions in routine activities . Implication s Despite substantial improvements in treatment of childhood cancer , profound alterations in quality of life often persist into adulthood . The Editors Profound advances in treatment efficacy and a concomitant increase in the number of long-term survivors have generated a need for investigations into the adverse effects of childhood cancer and its treatment ( 1 - 5 ) . Surgery , chemotherapy , and radiotherapy are essential to providing a long-term cure in many children with malignant and nonmalignant neoplasms . Surgical procedures can result in structural and functional changes , which can have long-term implication s in young children who are growing and developing . Chemotherapy and radiotherapy are cytotoxic and thus can have deleterious effects on developing organ systems ( 6 - 18 ) . Long-term survivors of childhood cancer are at risk for many late effects , including early death , second cancer , and organ system dysfunction ( 19 - 22 ) . Endocrine , musculoskeletal , neurologic , sensory , cardiac , and pulmonary impairments also have been documented ( 1 , 19 , 20 , 22 - 29 ) . A malignant disease or its treatment may cause long-term impairments in intellectual , emotional , and physical domains that diminish functioning ( performance limitations ) . Performance limitations can restrict the survivor 's ability to participate fully in daily activities necessary for self-care , home management , or work ( participation restrictions ) . Delayed consequences of therapy are of special interest in children with cancer because of their young age and because of the potential remaining years of life that may be affected ( 30 ) . Performance limitations and participation restrictions have been reported in as many as 69 % of survivors of childhood cancer ( 31 - 33 ) . The aims of this analysis were to estimate the prevalence of performance limitations and participation restrictions among a cohort of long-term survivors of childhood cancer . We compared these results with similar findings in a comparative group of siblings of survivors . In addition , we evaluated whether performance limitations and participation restrictions were affected by cancer type ; treatment methods ; or delayed effects of the cancer , its treatment , or both . Methods Study Participants The Childhood Cancer Survivor Study ( 34 ) is an ongoing epidemiologic follow-up study of survivors of childhood cancer who received their primary treatment at 1 of 26 collaborating institutions . Eligibility was restricted to patients who received their diagnosis between 1970 and 1986 ; whose age at diagnosis was 20 years or younger ; and who survived at least 5 years after receiving the diagnosis of one of the following diseases : primary brain cancer , leukemia , Hodgkin disease , non-Hodgkin lymphoma , kidney tumor , neuroblastoma , soft-tissue sarcoma , or malignant bone tumor . The Human Subjects Research Review Committees at the University of Minnesota ( the study coordinating center ) and each collaborating institution approved the protocol s and documents of the Childhood Cancer Survivor Study . Participants provided informed consent to participate in the study and separate consent to allow the release and abstract ion of medical records , including treatment records . Siblings of the survivors were recruited as a comparison group . Of the enrolled survivors who indicated that they had a living sibling , 5800 whose r and omly generated 5-digit registration numbers ended with an odd digit were asked to seek permission for the investigators to contact the sibling who was closest in age to them . Four thous and six hundred ninety-one siblings ( 80.9 % ) agreed to be contacted . Data collection was conducted by abstract ing treatment-related information from medical records and by having participants , or a parent if the participant was younger than 18 years of age at the time of the survey , complete the Long Term Follow Up Study Question naire ( 35 ) , a 24-page document that contains questions regarding the presence and timing of medical conditions , the presence of physical limitations , and the presence of current participation restrictions . Variable Definitions Outcomes Performance limitations and participation restrictions were the primary outcome variables for this analysis . Physical performance was scored by adding the answers to a series of 6 questions about the participant 's performance of particular physical activities during the past 2 years . We asked , Over the past 2 years , how long ( if at all ) has your health limited you in each of the following activities : 1 ) vigorous activities like lifting heavy objects , running , or participating in strenuous sports ; 2 ) moderate activities like moving a table , carrying groceries , or bowling ; 3 ) walking uphill or climbing a few flights of stairs ; 4 ) bending , lifting , or stooping ; 5 ) walking 1 block ; and 6 ) eating , dressing , bathing , or using the toilet ? Scores of 1 to 3 were assigned to each of the 6 questions . A score of 1 indicated that the participant was limited for more than 3 months , a score of 2 indicated that the participant was limited for 3 months or less , and a score of 3 indicated that the participant was not limited at all . A lower score indicated a greater degree of limitation . On the basis of graphical examination of the distribution of physical performance for siblings and survivors , this continuous variable was dichotomized by using a natural cutoff value at or below the 10th percentile of the distribution of the sibling group . Survivors and siblings at or below this cutoff point were classified as having a performance limitation . Participation restrictions were evaluated in 3 separate categories : limited personal care skills ; limited routine activities ; and poor health preventing school or work attendance . A participation restriction was considered present if participants had a positive response to the following questions : 1 ) Because of any impairment or health problem , do you need the help of other persons with personal care needs , such as eating , bathing , dressing , or getting around the home ? 2 ) Because of any impairment or health problem , do you need the help of other persons in h and ling routine needs , such as everyday household chores , doing necessary business , shopping , or getting around for other purpose s ? 3 ) Does any impairment or health problem keep you from holding a job or attending school ? Predictor Variables Cancer type , treatment groups , and late effects were considered risk factors of interest for these analyses . Information about the original diagnosis was obtained from the treating institution , and information on primary therapy was abstract ed from the medical record . Because most survivors had had surgery , therapy was grouped into broad categories that included surgery only ; radiation with or without surgery ( radiation ) ; chemotherapy with or without surgery ( chemotherapy ) ; chemotherapy and radiation with or without surgery ( chemotherapy with radiation ) ; treatment other than surgery , radiation , or chemotherapy ; or unknown . Late effects were defined as dichotomous indicators based on participants ' self-reporting of answers to questions that asked if a doctor or other health care professional had ever told them that they had a particular condition . A late effect was considered prevalent if a participant answered yes to condition-specific questions . Late effects included impairment to any body system that occurred from the onset of the initial therapy to the time when the baseline question naire was completed . Participants who answered do n't know or who left a question blank were included in the no or not present category for that variable . Late effects were grouped as follows according to major body system : endocrine impairments ; bone and joint health ; neurologic impairments ; sensory impairments ; cardiac impairments ; and pulmonary impairments , as previously described ( 25 , 27 , 36 ) . Statistical Analyses The prevalence of performance limitations and participation restrictions among survivors was compared with that among the participating siblings , using generalized estimating equations with a Poisson distribution and a log link ( 37 - 39 ) , and was reported as a st and ardized risk ratio ( RR ) . These methods were used in all models to account for the possible correlation between survivors and siblings from the same family ( 40 ) . The Poisson distribution with a log link was selected to allow model convergence with conservative CIs . Cancer type , treatment group , and presence of a late effect were also evaluated in relation to the outcome variables in generalized estimating equations . All models were adjusted for the participant 's age at interview and sex . The model evaluating treatment was also adjusted for cancer type . Because the participant 's age at diagnosis and race and ethnicity were not independent predictors of the outcomes , and because they did not appreciably alter the estimates , they were not included in the final models . To confirm the results we obtained using generalized estimating equation models , we also completed matched analyses for each outcome , limiting these models to only survivors with a sibling in the comparison group . To evaluate the sensitivity of the results to dichotomization of the physical performance variable , this outcome measure was also evaluated as a continuous variable comparing survivors with 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 The Exercise and Nutrition Routine Improving Cancer Health ( ENRICH ) study is investigating a novel lifestyle intervention aim ed at improving the health behaviors of adult cancer survivors and their carers . The main purpose of the study is to determine the efficacy of lifestyle education and skill development delivered via group-based sessions on the physical activity and dietary behaviors of participants . This article describes the intervention development , study design , and participant recruitment . Methods / Design ENRICH is a r and omized controlled trial , conducted in Australia , with two arms : an intervention group participating in six , two-hour face-to-face sessions held over eight weeks , and a wait-list control group . Intervention sessions are co-facilitated by an exercise physiologist and dietician . Content includes healthy eating education , and a home-based walking ( utilizing a pedometer ) and resistance training program ( utilizing elastic tubing resistance devices ) . The program was developed with reference to social cognitive theory and chronic disease self-management models . The study population consists of cancer survivors ( post active-treatment ) and their carers recruited through community-based advertising and referral from health professionals . The primary outcome is seven-days of sealed pedometry . Secondary outcomes include : self-reported physical activity levels , dietary intake , sedentary behavior , waist circumference , body mass index , quality of life , and perceived social support . The outcomes will be measured at baseline ( one week prior to attending the program ) , eight-weeks ( at completion of intervention sessions ) , and 20-weeks . The intervention group will also be invited to complete 12-month follow-up data collection . Process evaluation data will be obtained from participants by question naire and attendance records . Discussion No trials are yet available that have evaluated the efficacy of group-based lifestyle education and skill development amongst mixed groups of cancer survivors and their carers . The results will have implication s for the planning and provision of health and support services during the cancer survivorship phase . Clinical Trials Registration Australian New Zeal and Clinical Trials Register identifier : ANZCTRN12609001086257
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 .