Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods

Abstract

BackgroundDue to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age.ObjectiveIn this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL).MethodsA Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories.ResultsThe Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents’ awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors’ long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change.ConclusionsLifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors’ targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors’ health outcomes.

Acceptability and feasibility of a parent‐targeted dietary intervention in young survivors of childhood cancer: “Reboot”

“…Given that most young survivors had an earlier diagnosis of ALL, which has an approximate treatment time of 2 years, 4 our preliminary data suggest that the optimal time to recruit families may be at least 2 years after treatment completion 20 . While lymphoid leukemias are among the most frequently diagnosed cancers in childhood 40 and often overrepresented in dietary interventions in this population, 17,20,38 evidence of unhealthy weight patterns 4,41 and suboptimal dietary intake 8,29,42 in young survivors of ALL indicates that this subgroup of young survivors may be the most appropriate target for a parent‐targeted dietary intervention 14 . Socioeconomic ranking may further influence study participation, with study respondents more likely to reside in geographical areas associated with a higher socioeconomic ranking compared with nonrespondents 18 .…”

“…While these changes reflect an adaptive response to treatment‐related side effects such as nausea and vomiting, 13 evidence of poor dietary intake beyond treatment completion indicates that children's maladaptive eating behaviors are difficult to reverse and likely to persist into adulthood 14,15 . Thus, evidence‐based dietary interventions delivered early in the lifecycle 16 and survivorship trajectory 14 are a clear priority for promoting healthy eating behaviors in this at‐risk population 17 …”

The Role of Exercise in Pediatric and Adolescent Cancers: A Review of Assessments and Suggestions for Clinical Implementation

“…It is clear that psychological or social consequences interfere with quality of life (QoL), which comprises elements of physical, functional, social, and psychological health [21,22,47,[55][56][57][58]. QoL may be affected by the level of integration into society, as measured by the survivors' probability (compared to age and sex-matched general population peers) of securing employment or health insurance, or of marrying [57].…”

“…Of the few studies published on exercise programs for childhood cancer patients, a combination of home-based (2× per week) and clinically based (hospital) programs (1× per week) for approximately 60 min per session appears to work well [27,[37][38][39][40]43,47]. For children who may not be able to attend a supervised exercise training session, home-based, parent-supervised exercise is considered appropriate [39,40].…”

“…As a result of the numerous LAE related to pediatric cancer treatment, an interest in using exercise as a therapeutic measure to attenuate or reverse many cancer-related LAE in the pediatric population has surfaced. While comparatively less studied, the research suggests that there is a positive effect of physical activity on organ system function, fatigue, and physical well-being in children during and after cancer treatment [39][40][41][42][43][44][45][46][47][48][49]. It is clear that children who exercise can increase aerobic fitness and strength, with the latter a result of neuromuscular adaptations rather than skeletal muscle hypertrophy.…”