Promoting Physical Activity in Childhood Cancer Survivors Results From the Childhood Cancer Survivor Study

Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
Cancer (Impact Factor: 4.89). 02/2009; 115(3):642-54. DOI: 10.1002/cncr.24043
Source: PubMed


Although physical activity may modify the late effects of childhood cancer treatment, from 20% to 52% of adult survivors are sedentary. The authors of this report sought to identify modifiable factors that influence survivors' participation in physical activity.
Structural equation modeling of data were derived from the Childhood Cancer Survivors Study of adult survivors (current mean age, 30.98 years; mean years since diagnosis, 23.74; mean age at diagnosis, 9.25 years) who were diagnosed between 1970 and 1986.
Approximately 40% of the variance in male survivors' recent participation versus nonparticipation in physical activity was explained directly and/or indirectly by self-reported health fears (P = .01), perceived primary-care physician (PCP) expertise (P = .01), baseline exercise frequency (P ≤ .001), education level (P = .01), self-reported stamina (P = .01), cancer-related pain (P ≤ .001), fatigue (P ≤ .001), age at diagnosis (P = .01), cancer-related anxiety (P ≤ .001), motivation (P = .01), affect (P = .01), and discussion of subsequent cancer risk with the PCP (P ≤ .001) (N = 256; chi-square test statistic = 53.38; degrees of freedom [df] = 51; P = .38, Comparative Fit Index [CFI] = 1.000; Tucker Lewis Index [TLI] = 1.000; root mean square of approximation [RMSEA] = 0.014; weighted root mean square residual [WRMR] = 0.76). Thirty-one percent of the variance in women' recent physical activity participation was explained directly and/or indirectly by self-reported stamina (P ≤ .001), fatigue (P = .01), baseline exercise frequency (P = .01), cancer-related pain (P ≤ .001), cancer-related anxiety (P = .01), recency of visits with PCP (<0.001), quality of interaction with the PCP (P = .01), and motivation (P ≤ .001; N = 366; chi-square test statistic = 67.52; df = 55; P = .12; CFI = 0.98; TLI = 0.98; RMSEA = 0.025; WRMR = 0.76).
Gender-tailored intervention strategies in which providers specifically target motivation, fear, and affect may support physical activity in childhood cancer survivors. Cancer 2009.

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    • "Given their susceptibility to certain health problems, the high prevalence of overweight and obesity that we observed among survivors of childhood cancer, although similar to the general population, is of concern. Diet, nutrition, and physical activity guidelines for cancer survivors have been developed by the American Cancer Society [47], yet most exercise and diet interventions for childhood cancer survivors have had a modest impact on behavior [48] [49]. Thus, childhood cancer survivors can benefit from access to resources to help them maintain a healthy weight and to minimize their risk for late effects. "
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    ABSTRACT: Background. Population-based studies are needed to estimate the prevalence of underweight or overweight/obese childhood cancer survivors. Procedure. Adult survivors (diagnosed ≤20 years) were identified from the linked Utah Cancer Registry and Utah Population Database. We included survivors currently aged ≥20 years and ≥5 years from diagnosis (N = 1060), and a comparison cohort selected on birth year and sex (N = 5410). BMI was calculated from driver license data available from 2000 to 2010. Multivariable generalized linear regression models were used to calculate prevalence relative risks (RR) and 95% confidence intervals (95% CI) of BMI outcomes for survivors and the comparison cohort. Results. Average time since diagnosis was 18.5 years (SD = 7.8), and mean age at BMI for both groups was 30.5 (survivors SD = 7.7, comparison SD = 8.0). Considering all diagnoses, survivors were not at higher risk for being underweight or overweight/obese than the comparison. Male central nervous system tumor survivors were overweight (RR = 1.12, 95% CI 1.01-1.23) more often than the comparison. Female survivors, who were diagnosed at age 10 and under, had a 10% higher risk of being obese than survivors diagnosed at ages 16-20 (P < 0.05). Conclusion. While certain groups of childhood cancer survivors are at risk for being overweight/obese, in general they do not differ from population estimates.
    Full-text · Article · Jan 2014 · Journal of Cancer Epidemiology
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    • "The importance of families as facilitators of physical activity in this study is supported by Norris et al. who noted that a link exists between social support and physical activity and that family is the most important social influence in the promotion of healthy behaviours [23]. Therefore family education on the importance of physical activity and strategies to integrate physical activity into the busy day-to-day lives of these children both during and following treatment should be a standard of care [30]. Recognition of inactive survivors those and maintaining physical activity participation into older adolescence and adulthood is essential. "
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    ABSTRACT: The purpose of this study was to examine physical activity levels and influencing individual and environmental factors in a group of adolescent survivors of cancer and a comparison group. Methods. The study was conducted using a "mixed methods" design. Quantitative data was collected from 48 adolescent survivors of cancer and 48 comparison adolescents using the Godin Leisure-Time Exercise Questionnaire, the Fatigue Scale-Adolescents, and the Amherst Health and Activity Study-Student Survey. Qualitative data was collected in individual semistructured interviews. Results. Reported leisure-time physical activity total scores were not significantly different between groups. Physical activity levels were positively correlated with adult social support factors in the group of adolescent survivors of cancer, but not in the comparison group. Time was the primary barrier to physical activity in both groups. Fatigue scores were higher for the comparison but were not associated with physical activity levels in either group. The qualitative data further supported these findings. Conclusions. Barriers to physical activity were common between adolescent survivors of cancer and a comparative group. Increased knowledge of the motivators and barriers to physical activity may help health care providers and families provide more effective health promotion strategies to adolescent survivors of pediatric cancer.
    Full-text · Article · Sep 2013
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    • "This survey and others have found that some long-term childhood survivors may be unable to comply with these guidelines as a result of the physical limitations incurred by their cancer-related surgery or treatment-related cardiac damage. Hopefully, interventions that lead to appropriate and safe increases in the physical activity of long-term survivors may decrease risk of atherosclerotic disease and its associated negative health outcomes [107]. "
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    ABSTRACT: Anthracyclines are commonly used to treat childhood leukemias and lymphomas, as well as other malignancies, leading to a growing population of long-term childhood cancer survivors. However, their use is limited by cardiotoxicity, increasing survivors' vulnerability to treatment-related complications that can markedly affect their quality of life. Survivors are more likely to suffer from heart failure, coronary artery disease, and cerebrovascular accidents compared to the general population. The specific mechanisms of anthracycline cardiotoxicity are complex and remain unclear. Hence, determining the factors that may increase susceptibility to cardiotoxicity is of great importance, as is monitoring patients during and after treatment. Additionally, treatment and prevention options, such as limiting cumulative dosage, liposomal anthracyclines, and dexrazoxane, continue to be explored. Here, we review the cardiovascular complications associated with the use of anthracyclines in treating malignancies in children and discuss methods for preventing, screening, and treating such complications in childhood cancer survivors.
    Full-text · Article · Feb 2011 · Cardiology Research and Practice
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