Health Behaviors of Childhood Cancer Survivors

Abstract

There has been a dramatic increase in the number of childhood cancer survivors living to an old age due to improved cancer treatments. However, these survivors are at risk of numerous late effects as a result of their cancer therapy. Engaging in protective health behaviors and limiting health damaging behaviors are vitally important for these survivors given their increased risks. We reviewed the literature on childhood cancer survivors’ health behaviors by searching for published data and conference proceedings. We examine the prevalence of a variety of health behaviors among childhood cancer survivors, identify significant risk factors, and describe health behavior interventions for survivors.

Trajectories of health behaviors across early childhood cancer survivorship

“…It is likely that adherence to physical activity guidelines remains moderate in early survivorship and then declines as survivors age into adulthood. However, the factors examined in our study did not predict a change in physical activity in early survivorship, despite correlational findings in prior research . This may be due to timing.…”

“…Achievement of recommended levels of physical activity was moderate for high intensity exercise and poor for low intensity exercise. Reviews report that approximately 50% of survivors or less achieve recommendations for physical activity and/or exercise . Although few studies have specifically reported low‐ and high‐intensity physical activity levels in survivors of this age group, our finding of more survivors meeting recommendations for high intensity exercise than for low intensity exercise contradicts previous findings .…”

“…This may be due to the longitudinal nature of these data and factors such as the timing of assessments and the nature of selected predictors. Various medical factors not explored in the current study (eg, younger age at diagnosis, longer treatment length, lower health care utilization, and higher presence/severity of late effects) may serve as effective predictors of health behavior decline . Based on previous research, psychological constructs including beliefs about health self‐efficacy, health protection, and cognitive competence may predict health behavior change in childhood cancer survivors .…”

“…Few studies examining health behaviors in childhood cancer survivors have used longitudinal designs to clarify when and why health behaviors are poor. In cross‐sectional studies, survivors who are adolescents or young adults (AYA), of lower socioeconomic status, and black typically demonstrate worse health behaviors . Diagnoses of leukemia or central nervous system (CNS) malignancy, as well as receipt of CNS‐directed treatment, may also predict worse health behaviors .…”

“…We prioritized the use of cancer‐specific, measurable guidelines (ie, The American Cancer Society and the Children's Oncology Group) when available but consulted resources from the US government agencies (the US Department of Agriculture and the Center for Disease Control), as well as previous research, when needed . Considering developmental expectations and observed differences across age groups in this population, we expected health behaviors to worsen over time, as participants aged into adolescence/young adulthood . Age, income, diagnostic type, and treatment type (CNS vs non‐CNS directed treatment) were examined as potential predictors of health behavior change across early survivorship.…”