Perceptions on Weight Management for Survivors of Pediatric ALL from Parents and Pediatric Oncology Professionals: A Mixed Methods Study
Authors: Chang Winnie , Folta Sara , Hill Rachel , Kelly Michael , Meagher Susan , Danahy Ethan , Bowman Paul , Zhang Fang Fang 
Published: November 2023

BackgroundSurvivors of pediatric acute lymphoblastic leukemia (ALL) experience unhealthy weight gain early in treatment, and increases in weight are maintained throughout treatment and beyond. Unhealthy weight gain has been associated with inferior survival rates in ALL and places survivors at higher risk for chronic health issues associated with obesity. Parents and pediatric oncology professionals play central roles in preventing unhealthy weight gain in pediatric ALL survivors by promoting healthy lifestyles and can therefore offer important insights into integrating weight management into cancer care.MethodsWe conducted a mixed‐methods study that included a survey with 46 parents of pediatric ALL survivors (mean age of survivors = 6.5 years) and four focus groups with 19 pediatric oncology professionals to assess their perceptions on weight management in pediatric ALL survivors. The survey inquired about parents’ perceptions of their children's weight status and the time points at which they would be interested in participating in a weight management program. In focus groups, pediatric oncology professionals shared their thoughts about weight status of pediatric ALL survivors during and after treatment, their perceived roles in helping pediatric ALL survivors maintain a healthy weight, and their opinions regarding recommended specific topics/educational needs, preferred timing, route of delivery, and potential obstacles for a weight management program. Focus groups’ input was transcribed and analyzed by a multi‐disciplinary research team for common themes.ResultsBased on parental reports of children's heights and weights, 21% of the pediatric ALL survivors were overweight (BMI =85–94.9th percentile) and 26% were obese (BMI ≥95th percentile). The majority of the parents (76%) indicated that they would like to help their child maintain a healthy weight. Parents indicated that the preferred time for their child to participate in a weight management program would be within 3 months after the start of the remission maintenance chemotherapy (47%), followed by within 12 months after completion of all cancer treatments (40%). Pediatric oncology professionals also considered the maintenance phase an appropriate time to introduce weight management and suggested that a remotely‐delivered program would be most feasible to implement. They indicated that parents’ time constraints and literacy levels were potential barriers to participation, and access to technology was a barrier to web‐based programs. They also specified that their most appropriate role would involve promoting and supporting weight management rather than delivering the education due to their own time constraints in providing lifestyle counseling.ConclusionsParents and pediatric oncology professionals are interested in and supportive of early weight management in pediatric ALL survivors. Future research is needed to identify strategies to integrate weight management into the care of pediatric cancer patients and to evaluate the feasibility and efficacy of weight management strategies.Support or Funding InformationThis study was supported by Tufts Collaborates Grant and NIH/NCI 1R03CA199516‐01