Feasibility of implementing health promotion interventions to improve health‐related quality of life Predictors of risk-based medical follow-up: a report from the childhood cancer survivor study Health behaviors of cancer survivors: data from an Australian population-based survey Long-term dietary outcomes of the FRESH START intervention for breast and prostate cancer survivors. Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. Efficacy of the Survivor Health and Resilience Education (SHARE) Program to Improve Bone Health Behaviors Among Adolescent Survivors of Childhood Cancer A Randomized Trial of Tailoring and Motivational Interviewing to Promote Fruit and Vegetable Consumption for Cancer Prevention and Control Multiple behavioral risk factors among adolescent survivors of childhood cancer in the Survivor Health and Resilience Education (SHARE) program. A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study Health Status in Survivors of Cancer in Childhood and Adolescence Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors 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 Health behaviors in cancer survivors. Nutrition Literacy among Cancer Survivors: Feasibility Results from the Healthy Eating and Living Against Breast Cancer (HEAL-BCa) Study: a Pilot Randomized Controlled Trial Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Promoting weight loss through diet and exercise in overweight or obese breast cancer survivors (InForma): study protocol for a randomized controlled trial Social outcomes in adult survivors of childhood cancer compared to the general population: linkage of a cohort with population registers.
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 , 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 Objective With increases in cancer survival , promotion of healthy lifestyle behaviors among survivors is receiving considerable attention . This study compared health behaviors among a large sample of Australian adult cancer survivors with an age- and sex-matched cohort of people with no cancer history . Methods Using the Australian National Health Survey , 968 cancer survivors were identified , and r and omly matched by age and sex to 5,808 respondents without a history of cancer . Six health behaviors were compared  ( smoking , physical activity , servings of vegetables , servings of fruit , alcohol use , skin checks )  , along with  overweight and obesity , using polytomous logistic regression analyses controlling for selected chronic conditions . Models were applied across both groups and by tumor site . Results Compared to the non-cancer comparison group , cancer survivors were significantly more likely to be current ( OR = 1.35 ) smokers , particularly those under 40 years ( OR = 1.69 ) , and more likely to have regular skin checks ( OR = 1.76 ) . Although not significant , there was consistent evidence that cancer survivors were slightly more likely to be overweight or obese ( p = 0.065 ) and have higher levels of alcohol consumption ( p = 0.088 ) . There was no evidence of differences between survivors and controls for levels of physical inactivity , vegetable consumption or fruit consumption .  Women with a history of gynecological cancers were much more likely to be current smokers ( OR = 2.37 ) , while other differences by sex and cancer site were consistent with overall patterns . Cancer survivors were also significantly more likely to report having a range of co-morbid chronic medical conditions . Conclusion Given their increased risk of second cancers and co-morbid chronic conditions , the lack of difference in behavioral risk factors confirms the need for a focus on improving the health behaviors of cancer survivors . Collaborative chronic disease management models may be particularly appropriate in this regard BACKGROUND Cancer survivors are at increased risk for secondary cancers and other diseases . Healthy dietary practice s may improve cancer survivors ' health and well-being . OBJECTIVE The durability of the effects of the FRESH START intervention , a program of sequentially tailored mailed material s , and st and ardized mailed material s ( for controls ) on cancer survivors ' dietary outcomes was assessed over a 2-year period . Greater dietary gains were expected for FRESH START participants relative to controls . DESIGN Participants were r and omized to receive tailored vs st and ardized 10-month mailed print interventions promoting diet and exercise behaviors . Data were collected at baseline and 1- and 2-year follow-ups . PARTICIPANTS / SETTING Breast and prostate cancer survivors ( n=543 ) were recruited from 39 states and two provinces within North America . A total of 489 participants completed the 2-year follow-up assessment ( 10 % attrition ) . INTERVENTION Participants were r and omly assigned to either a 10-month program of tailored mailed print material s promoting fruit and vegetable consumption , reduced total and saturated fat intake , and /or increased exercise or to a 10-month program of publicly available mailed material s on diet and exercise . MAIN OUTCOME MEASURES Telephone surveys ( supported with blood biomarkers ) assessed dietary habits at baseline and 1- and 2-year follow-ups . STATISTICAL ANALYSES PERFORMED Paired- sample s t tests were conducted to examine the durability of the intervention 's effects on dietary outcomes within each study arm . Arm differences in follow-up outcomes were then tested with the general linear model , controlling for the baseline value of the outcomes . RESULTS Both arms reported decreased saturated fat intake , increased servings of fruits and vegetables , and better overall diet quality at year 2 relative to baseline . However , FRESH START participants reported better overall diet quality and lower total and saturated fat intake compared to controls at the 2-year follow-up . CONCLUSIONS Results suggest that mailed material interventions , especially those that are tailored , can produce long-term dietary improvement among cancer survivors 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 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 Healthful dietary patterns , including eating fruits and vegetables ( F&V ) and avoiding obesity , may decrease the risk of cancer and other chronic diseases . In addition to promoting health for the general population , a cancer diagnosis may provide a “ teachable moment , ” facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health . Purpose This study was design ed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults ( average age of 66 years ) , including both colorectal cancer ( CRC ) survivors and noncolorectal cancer-affected ( N-CRC ) individuals . Methods CRC survivors and N-CRC individuals were recruited from a population -based case – control study and r and omly assigned to four conditions using a 2 × 2 design . We tested two different methods of communicating and promoting health behavior change alone or in combination : tailored print communication ( TPC ) and brief telephone-based motivational interviewing ( TMI ) . Results A significant increase in F&V consumption was found for the combined intervention group in the entire sample ( p < 0.05 ) . When stratified by cancer survivor status , the effect was concentrated in the N-CRC subset ( p < 0.01 ) versus CRC survivors . The combined intervention was also found to be most cost-effective for the N-CRC group , with TPC  more cost-effective than TMI . For physical activity , none of the interventions produced statistically significant improvements . Conclusions This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults . More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population 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 Background Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web , yet few Web-based studies exist in this population . Objective The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program , “ A Lifestyle Intervention Via Email ( ALIVE ) , ” delivered to a sample of racial and ethnic minority breast cancer survivors . Methods Survivors ( mean age : 52 years , 83 % [ 59/71 ] African American ) were recruited and r and omized to receive either the ALIVE program ’s 3-month physical activity track or its 3-month dietary track . The fully automated system provided tools for self-monitoring and goal setting , tailored content , and automated phone calls . Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study . Results Upon completion , 44 of 71 survivors completed the study . Our “ intention-to-treat ” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track ( + 97 vs. + 49 min/week , P<.001 ) . Similarly , reductions in total sedentary time among those in the physical activity track ( −304 vs. −59 min/week , P<.001 ) was nearly 5 times greater than that for participants in the dietary track . Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber ( + 4.4 g/day ) , fruits and vegetables ( + 1.0 cup equivalents/day ) , and reductions in saturated fat ( −2.3 g/day ) and trans fat ( −0.3 g/day ) ( all P<.05 ) . However , these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track ( all P>.05 ) . Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors ( 97 % ) , were satisfied with ALIVE ( 82 % ) , and felt that ALIVE was effective ( 73 % ) . However , survivors expressed concerns about the functionality of the interactive emails . Conclusions ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation . Although survivors favored the educational content , a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform . Trial Registration Clinical Trials.gov NCT02722850 ; https:// clinical trials.gov/ct2/show/NCT02722850 ( Archived by WebCite at http://www.webcitation.org/6tHN9VsPh Background : Assessing health status in survivors of childhood cancer is increasingly important due to improved survival rates . However , there are limited estimates available for this population based on large sample s and compared to population controls . Methods : In a retrospective cohort study , 2152 long-term survivors and 2432 controls , aged 5–37 , who had survived cancer during childhood or adolescence were compared on the Health Utilities Index Mark III ( HUI3 ) . Descriptive and logistic regression analyses were used to assess the effect of age at diagnosis , type of cancer and therapy received on HUI3 domains . Major findings : More survivors than controls showed deficits in dexterity , ambulation , hearing , speech and cognition but not in vision , emotion or pain . The largest numbers of survivors reporting excess impairment was found in the cognition attribute . Survivors of central nervous system tumors were most likely to show impairments across multiple domains . Lastly , impairments in cognition were found most commonly in survivors exposed to cranio-spinal radiation at young ages . Conclusions : Seventy-five percent of childhood cancer survivors and 80 % of controls were found to have two or fewer impaired attributes . Those reporting impairments that were most likely to be of clinical relevance were among survivors diagnosed with central nervous system and bone tumours , and those exposed to cranial radiation as young children . Tools assessing health status should be included in prospect i ve trials to more clearly assess the contribution of therapy to reduced long-term health status Purpose The effectiveness of survivorship care plans has not been widely tested . We evaluated whether a one-time brief lifestyle consultation as part of a broader survivorship care plan was effective at changing diet and lifestyle patterns . Methods A diverse sample of women with stage 0-III breast cancer were r and omized to control or intervention groups within 6 weeks of completing adjuvant treatment . Both groups received the National Cancer Institute publication , “ Facing Forward : Life after Cancer Treatment . ” The intervention group also met with a nurse ( 1 h ) and a nutritionist ( 1 h ) to receive personalized lifestyle recommendations based upon national guidelines . Diet , lifestyle , and perceived health were assessed at baseline , 3 and 6 months . Linear regression analyses evaluated the effects of the intervention adjusted for covariates . Results A total of 126 women completed the study ( 60 control/66 intervention , 61 Hispanic/65 non-Hispanic ) . At 3 months , the intervention group reported greater knowledge of a healthy diet ( P = 0.047 ) , importance of physical activity ( P = 0.03 ) , and appropriate use of dietary supplements ( P = 0.006 ) and reported lower frequency of alcohol drinking ( P = 0.03 ) than controls . At 6 months , only greater knowledge of a healthy diet ( P = 0.01 ) persisted . The intervention was more effective among non-Hispanics than Hispanics on improving attitude towards healthy eating ( P = 0.03 ) and frequency of physical activity ( P = 0.006 ) . Conclusions The intervention changed lifestyle behaviors and knowledge in the short-term , but the benefits did not persist . Implication s for Cancer SurvivorsCulturally competent long-term behavioral interventions should be tested beyond the survivorship care plan to facilitate long-term behavior change among breast cancer survivors 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 PURPOSE / OBJECTIVES To describe health behaviors of cancer survivors by cancer diagnosis and to compare them to people without a personal or family cancer history . DESIGN Cross-sectional secondary data analysis . SETTING A national , list-assisted telephone survey using r and om-digit dialing of U.S. adults about use of cancer-related information and cancer beliefs . SAMPLE 619 cancer survivors and 2,141 participants without a history of cancer from the original 6,369 Health Information National Trends Survey ( HINTS ) respondents . METHODS Using the National Cancer Institute 's 2003 HINTS , further analyses were conducted . MAIN RESEARCH VARIABLES Cancer history , current smoking , fruit and vegetable consumption , physical activity , and body mass index ( BMI ) . FINDINGS When controlling for demographic variables , no differences were found in self-reported health behaviors between survivors and those without cancer : 22.5 % of survivors and 18.4 % of those without cancer were current smokers , 18 % of survivors and 14.9 % of those without cancer consumed at least five fruits or vegetables per day , 45.3 % of survivors and 53 % of those without cancer were physically active at least weekly , and 58 % of survivors and 54.9 % of those without cancer were overweight or obese ( i.e. , BMI > 25 ) . Only 7.4 % of survivors and 6.4 % of participants without cancer reported positively on all three health behaviors and had a healthy or normal weight . CONCLUSIONS Survivors did not have different health behaviors when compared to participants without a history of cancer . Neither group met the American Cancer Society or Healthy People 2010 objectives for these behaviors . Adoption of healthy lifestyle behaviors should be addressed in cancer survivors . IMPLICATION S FOR NURSING Cancer survivors need to be assessed for current smoking , dietary habits , physical activity , and weight . Information and re sources should be made available , if needed , to promote the adoption of healthy lifestyle behaviors Knowledge of nutrition among breast cancer patients is insufficient , despite their motivation to seek valid information about healthy food choices . This study examines the feasibility of nutrition education workshops for cancer survivors , to inform the design of a multi-center intervention . Fifty-nine female English-speaking breast cancer patients , who had completed treatment , were enrolled . Participants were r and omized to the intervention or control group . The intervention group attended six nutrition education sessions , and the control group received brochures . Measurements were done at baseline and 3-month follow-up and included the Assessment Instrument for Breast Cancer ( NLit-BCa ) , fruit/vegetable and general health literacy screeners . Height and weight were measured . Changes in nutrition literacy , health literacy , and food intake from baseline to follow-up ( within-group change ) were calculated for both groups ( effect sizes were reported as Cohen ’s d ) . Participants were mostly white , with a mean age of 58 years , BMI of 31.6 kg/m2 , and had college degrees .  Follow-up rates were high ( 89 % = control and 77 % = intervention group ) . At baseline , participants scored high for most NLit-BCa assessment components except food portions in both groups . At the 3-month follow-up , effect sizes ( d ) on the NLit-BCa ranged from −0.5 to 0.16 . The study met its recruitment goals within 6 months . Focus groups indicated that ( a ) attending six sessions was acceptable , ( b ) patients found social/emotional support , ( c ) improvements should include information for special diets and booster sessions . This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to breast cancer survivors CONTEXT Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status . OBJECTIVES To compare the health status of adult survivors of childhood cancer and siblings  and to identify factors associated with adverse outcomes . DESIGN , SETTING , AND PARTICIPANTS Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study , a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986 . A r and omly selected cohort of the survivors ' siblings ( n = 2916 ) served as a comparison group . MAIN OUTCOME MEASURES Six health status domains were assessed : general health , mental health , functional status , activity limitations , cancer-related pain , and cancer-related anxiety/fears . The first 4 domains were assessed in the control group . RESULTS Survivors were significantly more likely to report adverse general health ( odds ratio [ OR ] , 2.5 ; 95 % confidence interval [ CI ] , 2.1 - 3.0 ; P<.001 ) , mental health ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) , activity limitations ( OR , 2.7 ; 95 % CI , 2.3 - 3.3 ; P<.001 ) , and functional impairment ( OR , 5.2 ; 95 % CI , 4.1 - 6.6 ; P<.001 ) , compared with siblings . Forty-four percent of survivors reported at least 1 adversely affected health status domain . Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female ( OR , 1.4 ; 95 % CI , 1.3 - 1.6 ; P<.001 ) , lower level of educational attainment ( OR , 2.0 ; 95 % CI , 1.8 - 2.2 ; P<.001 ) , and annual income less than 20 000 dollars ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) . Relative to those survivors with childhood leukemia , an increased risk was observed for at least 1 adverse health status domain among those with bone tumors ( OR , 2.1 ; 95 % CI , 1.8 - 2.5 ; P<.001 ) , central nervous system tumors ( OR , 1.7 ; 95 % CI , 1.5 - 2.0 ; P<.001 ) , and sarcomas ( OR , 1.2 ; 95 % CI , 1.1 - 1.5 ; P = .01 ) . CONCLUSION Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status , especially among females , those with low educational attainment , and those with low household incomes Background Most women with breast cancer experience a progressive weight gain during and after treatment . Obesity is associated with an increased risk of recurrence , contralateral breast cancer , and death . Physical activity after cancer diagnosis has been reported to have positive effects on body composition and quality of life . We present the protocol of the InForma study , a trial testing the efficacy of an intervention on weight loss ( ≥5 % of the baseline body weight ) in a group of overweight or obese breast cancer survivors . Methods / design This is a four-arm r and omized controlled trial . Patients will receive a 6-month intervention and be followed for a further 18 months . Intervention is design ed to improve adherence to a healthy diet and /or to increase physical activity , taking advantage of a wrist-based activity monitor .  Participants will be recruited among overweight or obese breast cancer patients treated at the European Institute of Oncology , after completion of eventual adjuvant chemotherapy and /or radiotherapy . It is envisaged that 260 patients will be r and omized into four arms : Dietary Intervention ; Physical Activity Intervention ; Physical Activity and Dietary Intervention ; and Less Intensive Intervention . Women will be offered individualized counseling consisting of face-to face discussion and phone calls in addition to group meetings . A motivational interviewing approach will be used to encourage health behavior change . All participants will be given a pedometer device to monitor their physical activity . Participants ’ dietary intake will be repeatedly assessed using a vali date d food frequency question naire . Participants ’ quality of life and anxiety will be assessed with the Functional Assessment of Cancer Therapy-Breast and the State-Trait Anxiety Inventory question naires . Blood sample s will be collected at baseline and follow-up visits to assess lipid and hormone profiles . Body composition will be repeatedly assessed using bioelectrical impedance vector analysis for identifying changes of fat and fat-free mass . Women allocated to the less intensive intervention arm will be considered as the control group . Discussion While there is a rising concern about the role of obesity in cancer recurrence and survival , this trial with its multi-arm design , motivational approach and use of a pedometer device will provide important insights regarding the most effective approach in promoting weight control in breast cancer survivors . Trial registration IS RCT N53325751 ( registration date : 16 October 2015 ) ; Clinical Trials.gov NCT02622711 ( registration date : 2 December 2015 ) 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 ,
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 .