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Health-related quality of life, lifestyle behaviors, and intervention preferences of survivors of childhood cancer

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Abstract

Purpose

Childhood cancer survivors (CCSs) are at increased risk for poor health-related quality of life (HRQOL) and chronic health conditions—both of which can be exacerbated by unhealthy lifestyle behaviors. Developing a clearer understanding of the associations between HRQOL, lifestyle behaviors, and medical and demographic variables (e.g., age/developmental stage at time of diagnosis) is an important step toward developing more targeted behavioral interventions for this population.

Method

Cross-sectional questionnaires were completed by 170 CCSs who were diagnosed with leukemia, lymphoma, sarcoma, or a cancer of the central nervous system (CNS) and treated at a comprehensive cancer center between 1992 and 2007. Questionnaires addressed weight status, lifestyle behaviors, aspects of HRQOL, and intervention preferences.

Results

Adolescent and young adult survivors (AYAs) and survivors of CNS tumors or lymphoma reported significantly (p < .05) poorer HRQOL across multiple domains compared to those diagnosed at an earlier age, survivors of leukemia or sarcoma, and healthy populations. A significant proportion also failed to meet national recommendations for dietary intakes (39–94 %) and physical activity (65 %). Female survivors reported poorer physical functioning and consumed less dietary fiber and fruits and vegetables than did male survivors. They also expressed the strongest interest in participating in diet and exercise interventions.

Conclusion

Findings support the premise that females, AYAs, and survivors of cancers of the CNS or lymphoma are “at risk” subgroups within the CCS population for poor dietary practices, sedentary behaviors, and poor HRQOL. Future research should focus on developing diet and PA interventions to improve HRQOL that target these groups.

Implications for Cancer Survivors

Greater consideration of the role of gender, developmental stage, and the HRQOL challenges facing CCSs may help researchers to develop targeted behavioral interventions for those who stand to benefit the most.

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Notes

  1. The NCI and CDC definition for an AYA survivor is having received a diagnosis of cancer between the ages 15 and 29; however, given the eligibility criteria in the current study, all the AYA cancer survivors in our sample were diagnosed between the ages of 15 and 18.

  2. Given the wide range in attained developmental age in our sample, we also examined differences in HRQOL and intervention preferences based on whether an individual was ≤14 years old at time of survey completion or 15–29 years old at time of survey completion. The results for these analyses did not significantly differ from the results for the analyses conducted based on developmental stage at time of diagnosis (child or AYA) with the exception that survivors who were age 15–29 at time of survey completion were significantly (t = 2.41, p < .05) more likely to prefer mail-based interventions (M = 1.84, SD = .78) than those who were age 14 or less at time of survey completion (M = 2.15, SD = .76).

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Acknowledgments

This research was supported in part by a National Cancer Institute grant (R03CA136537) awarded to Dr. Badr and by a generous donation from the Santa’s Elves Fund at The University of Texas MD Anderson Cancer Center awarded to Drs. Demark-Wahnefried, Chandra, and Ater. The authors would like to thank Angela Xu, Cody Cruz, Karen Basen-Engquist, Martha Askins, and Michael Rytting for their input on the project.

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Authors and Affiliations

  1. Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Hoda Badr

  2. Division of Pediatrics, The Children’s Cancer Hospital at The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joya Chandra, Joann L. Ater & Cody Scott Cruz

  3. Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA

    Raheem J. Paxton

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA

    Diana Urbauer

  5. Department of Nutrition Sciences, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, UK

    Wendy Demark-Wahnefried

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  1. Hoda Badr
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  2. Joya Chandra
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Correspondence to Hoda Badr.

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Badr, H., Chandra, J., Paxton, R.J. et al. Health-related quality of life, lifestyle behaviors, and intervention preferences of survivors of childhood cancer. J Cancer Surviv 7, 523–534 (2013). https://doi.org/10.1007/s11764-013-0289-3

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