Journal of Cancer Survivorship

, Volume 8, Issue 4, pp 671–679 | Cite as

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

  • Chloe A. Berdan
  • Christy C. Tangney
  • Celina Scala
  • Melinda Stolley



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 

Supplementary material

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  1. 1.
    American Cancer Society. Cancer facts & figures 2012. Atlanta: American Cancer Society; 2012.Google Scholar
  2. 2.
    Oeffinger K, Mertens A, Sklar C, Kawashima T, Hudson M, Meadows A, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Diller L, Chow E, Gurney J, Hudson M, Kadin Lottick N, Kawashima T, et al. Chronic disease in the childhood cancer survivor study cohort: a review of published findings. J Clin Oncol. 2009;27:2339–55.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Meacham L, Gurney J, Mertens A, Ness K, Sklar C, Robison L, et al. Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study. Cancer. 2005;103:1730–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Winter C, Miller C, Hoffmann C, Boos J, Rosenbaum D. Physical activity and childhood cancer. Pediatr Blood Cancer. 2010;54:501–10.PubMedGoogle Scholar
  6. 6.
    Robien K, Ness K, Klesges L, Baker KS, Gurney J. Poor adherence to dietary guidelines among adult survivors of childhood acute lymphoblastic leukemia. J Pediat Hemat Onc. 2008;30:815–22.CrossRefGoogle Scholar
  7. 7.
    Demark Wahnefried W, Werner C, Clipp E, Guill A, Bonner M, Jones L, et al. Survivors of childhood cancer and their guardians. Cancer. 2005;103:2171–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Castellino S, Casillas J, Hudson M, Mertens A, Whitton J, Brooks S, et al. Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study. J Clin Oncol. 2005;23:6499–507.CrossRefPubMedGoogle Scholar
  9. 9.
    Mariotto A, Rowland J, Yabroff KR, Scoppa S, Hachey M, Ries L, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidem Biomar. 2009;18:1033–40.CrossRefGoogle Scholar
  10. 10.
    Rock C, Doyle C, Demark Wahnefried W, Meyerhardt J, Courneya K, Schwartz A, et al. Nutrition and physical activity guidelines for cancer survivors. Cancer. 2012;62:243–74.Google Scholar
  11. 11.
    Kushi L, Doyle C, McCullough M, Rock C, Demark Wahnefried W, Bandera E, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. Cancer. 2012;62:30–67.Google Scholar
  12. 12.
    McCullough M, Patel A, Kushi L, Patel R, Willett W, Doyle C, et al. Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidem Biomar. 2011;20:1089–97.CrossRefGoogle Scholar
  13. 13.
    Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology. 1990;1:58–64.CrossRefPubMedGoogle Scholar
  14. 14.
    Kriska AM, Caspersen CJ. Introduction to a collection of physical activity questionnaires. Med Sci Sports Exerc. 1997;29:5.CrossRefGoogle Scholar
  15. 15.
    Stolley M, Sharp L, Arroyo C, Ruffin C, Restrepo J, Campbell R. Design and recruitment of the Chicago Healthy Living Study: a study of health behaviors in a diverse cohort of adult childhood cancer survivors. Cancer. 2009;115:4385–96.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Ainsworth BE, Haskell WL, Leon AS, Jacobs DR, Montoye HJ, Sallis JF, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25:71–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Ainsworth B, Haskell W, Herrmann S, Meckes N, Bassett D, Tudor Locke C, et al. Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.CrossRefPubMedGoogle Scholar
  18. 18.
    U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans. 7th ed. Washington, DC: U.S. Government Printing Office; 2010. December 2010.Google Scholar
  19. 19.
    Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, Gansler T, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA- Cancer J Clin. 2006;56:254–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Larcombe I, Mott M, Hunt L. Lifestyle behaviours of young adult survivors of childhood cancer. Br J Cancer. 2002;87:1204–9.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Ness K, Leisenring W, Huang S, Hudson M, Gurney J, Whelan K, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2009;115:1984–94.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Keats M, Culos Reed SN, Courneya K, McBride M. An examination of physical activity behaviors in a sample of adolescent cancer survivors. J Pediatr Oncol Nurs. 2006;23:135–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Lown EA, Goldsby R, Mertens A, Greenfield T, Bond J, Whitton J, et al. Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction. 2008;103:1139–48.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Chloe A. Berdan
    • 1
  • Christy C. Tangney
    • 2
    • 3
  • Celina Scala
    • 2
  • Melinda Stolley
    • 3
  1. 1.Community Advocacy DepartmentProMedicaToledoUSA
  2. 2.Department of Clinical NutritionRush University Medical CenterChicagoUSA
  3. 3.Section of Health Promotion ResearchUniversity of Illinois at ChicagoChicagoUSA

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