This article describes current evidence-based guidelines for diet and physical activity for cancer survivors, specifically focusing on weight management. We also discuss practical interventions to help survivors undertake behavioral changes to manage their weight.
Background: Pediatric obesity is common and a significant burden. Supplementing pediatric obesity treatment with technology is needed. This manuscript examines the usability and satisfaction, as well as explores initial effectiveness, of a remote patient monitoring system (RPMS) designed for youth presenting for pediatric weight management treatment. Methods: 47 youth, 10 to 17 years old, with obesity and a caregiver participated. For three months, families received treatment via the RPMS. Usability and satisfaction outcomes were examined. Exploratory analyses were conducted to examine initial effectiveness from baseline and post-treatment (month 3) assessments. Results: More than 80% of patients used the RPMS, and overall, patients completed 27 out of 90 daily sessions (30%). Youth and caregivers reported high satisfaction. Non-parametric tests revealed no significant improvements for youth or caregiver weight status after the RPMS treatment. Significant improvements in other outcomes examined were limited. Conclusions: Families were satisfied with the RPMS, but use of the system was limited. Initial effectiveness was not able to be determined due to the amount of missing data, which was impacted by the COVID-19 pandemic. Modifications of the RPMS and future evaluation of usability and effectiveness are warranted to determine utility in supplementing pediatric obesity clinical treatment.
Background Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID) DERR1-10.2196/29858
Purpose: Anthracyclines effectively treat many pediatric cancers, but their use is limited by cardiotoxicity and new approaches to mitigate anthracycline-induced cardiac damage are urgently needed. Nanoparticle drug delivery is one solution to maintain anticancer efficacy while mitigating both acute and long-term cardiac complications. Additionally, novel treatments are needed to improve cure rates in certain cancer diagnoses that have not seen advancements in decades, particularly Ewing Sarcoma (EWS). Experimental Design: We investigated the use of a self-assembling micelle structure composed of myristic acid conjugated to an Apo-A1 mimetic 5A peptide, termed Myr5A nanoparticles (Myr5A NPs). These nanoparticles are transported into cells via the cholesterol scavenger receptor class B type-1 (SR-B1). Doxorubicin (DOX) and the Myr5A NP cannot form a stable micelle due to the hydrophilic nature of DOX, which results in preferential binding to the peptide shell, as opposed to the hydrophobic core. To favor micelle stability, we opted to use the novel, highly hydrophobic anthracyclines valrubicin and AD198 to test the nanoparticle delivery system. The potency of these anthracyclines encapsulated in Myr5A NPs were evaluated in human EWS cell lines with high and low SR-B1 expression via MTT assay. Additionally, 5 mg/kg intraperitoneal injections were administered weekly to 4-week-old wild type C57BL6/J mice and immune compromised homozygous null forkhead box N1 mice (Foxn1null/null mice) over 5 weeks, to assess by echocardiography, acute and long-term cardiac dysfunction. Results: Treatment with Myr5A-encapsulated AD198 and Myr5A-encapsulated valrubicin significantly inhibited EWS cell proliferation at concentrations comparable to conventional anthracyclines. Moreover, compared to unencapsulated valrubicin and AD198, encapsulation resulted in a lower IC50 in EWS lines with higher SR-B1 surface expression. By 19 weeks of age, DOX-treated C57BL6/J mice exhibited significantly decreased ejection fraction (EF) compared to PBS control and Myr5A-encapsulated anthracyclines (p<0.05). Additionally, an increase in Left Ventricular Mass (LVM) was observed in all groups except DOX by 19 weeks (p<0.05). Lastly, DOX-treated Foxn1null/null mice showed diminished survival rate compared to all treatment groups, and similar results to C57BL6/J mice in EF and LVM. Conclusions: Our results indicate that AD198 and valrubicin, when encapsulated in Myr5A NPs, induce minimal cardiac dysfunction while maintaining antitumor efficacy in EWS tumors. Myr5A NP drug delivery may be a viable option for the treatment of high SR-B1 expressing tumors with a decreased risk of acute and long-term cardiac complications. Future studies will evaluate the drug potency in non-cancer cell lines, such as cardiac fibroblasts and myocytes, and the effects of Myr5A-encaspulated anthracyclines on EWS xenografts and other pediatric tumors. Citation Format: Kathryn Crouch, Logan Davis, Nirupama Sabnis, Alexander Pertsemlidis, Laura Rutledge, James Graham, Jason Yustein, Gregory J. Aune. SR-B1-targeted nanoparticle delivery of novel anthracyclines to Ewing's Tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 375.
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