Journal of Cancer Survivorship

, Volume 8, Issue 4, pp 671-679

First online:

Childhood cancer survivors and adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity

  • Chloe A. BerdanAffiliated withCommunity Advocacy Department, ProMedica
  • , Christy C. TangneyAffiliated withDepartment of Clinical Nutrition, Rush University Medical CenterSection of Health Promotion Research, University of Illinois at Chicago Email author 
  • , Celina ScalaAffiliated withDepartment of Clinical Nutrition, Rush University Medical Center
  • , Melinda StolleyAffiliated withSection of Health Promotion Research, University of Illinois at Chicago

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The objective of this study was to assess adherence of childhood cancer survivors in comparison to cancer-free adults of comparable age and sex (or “controls”) to the 2012 American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity.


As part of the Chicago Healthy Living Study, 431 childhood cancer survivors (18.5 ± 8.1 years from diagnosis) and 361 controls completed a structured, health-focused interview including the Block Brief Food Frequency Questionnaire and Modifiable Activity Questionnaire. From these data, modified adherence scores were computed based on ACS guidelines (maximum score of 8 reflecting complete adherence). Comparisons were made between survivors and controls and among racial-ethnic groups of survivors and controls.


There was no difference in overall ACS adherence scores between survivors and controls (4.3 ± 1.5 vs. 4.2 ± 1.5, p = 0.54). As compared to controls, survivors, on average, had a lower body mass index or BMI (27.9 ± 7.0 vs. 29.3 ± 7.8 kg/m2, p = 0.01) and consumed less fiber (9.2 ± 3.5 vs. 9.7 ± 3.8 g/1,000 kcal, p = 0.05). Within the survivor group, ACS adherence scores did not differ across racial-ethnic groups, but differences were observed with respect to component behaviors. Hispanic survivors had a higher BMI when compared to those of whites (29.2 ± 7.4 vs. 26.2 ± 5.3 kg/m2, p = 0.001). Daily alcohol consumption was greater for whites among both survivors and controls as compared to other racial-ethnic groups (p < 0.017 for all comparisons).


Compared to controls, survivors were not practicing healthier behaviors. Among minority survivors, excess body weight, particularly among Hispanics, is a major concern. Assessment of these behaviors should be incorporated into survivor follow-up care.

Implications for Cancer Survivors

There is much room for improvement in educating and encouraging survivors to follow healthier diet and lifestyle routines to prevent obesity and further morbidity.


Childhood cancer survivors Adherence to cancer prevention guidelines Diet Physical activity American Cancer Society