As cancer survival rates continually improve there is a growing number of young people living with and beyond a cancer diagnosis. However, teenage and young adult (TYA) aged cancer survivors face a number of potential health problems as a result of their original cancer diagnosis and treatment. These health problems such as cardiovascular disease, metabolic syndrome and endocrine dysfunction pose a significant burden to survivors throughout their life-course. There is emerging evidence that healthy lifestyle choices may prevent or delay the onset of such chronic disease problems, and improve the wellbeing and quality of life of young people with cancer.
However, observational and survey data indicate that most TYA cancer survivors are inactive, consume poor diets and engage in health risk behaviours such as smoking and heavy drinking. Efforts to support TYA cancer survivors to adopt healthy lifestyle behaviours are therefore required. However, very little is understood about how best to deliver lifestyle interventions to young people affected by cancer. Identifying common characteristics of successful interventions is an important step in informing the development of new health behaviour interventions designed specifically for this unique cohort of the cancer survivor population.
This systematic review of health behaviour interventions for TYA cancer survivors, published in the Journal of Adolescent and Young Adult Oncology aimed to identify health behaviour change interventions that were developed specifically for young people with cancer. A search for interventions targeting positive changes in physical activity, diet, smoking and/or alcohol consumption was carried out. As this systematic review is part of a programme of research aiming to develop a health behaviour intervention for TYA aged cancer survivors it was necessary that the principal summary measure reported was health behaviour change (e.g. magnitude of increase or decrease in health behaviour outcome). Any study which reported such an intervention designed for TYA cancer patients between the age of 13 and 24 years of age was considered for review.
In total, 12 intervention studies were identified from the search and included for full review. Most intervention studies were small pilot studies assessing the feasibility and efficacy of the health behaviour change intervention in question. The majority of studies were conducted in the United States among TYA cancer survivors of childhood malignancies and targeted physical activity behaviour change. The smallest sample included 10 participants and the largest 266. All twelve of the intervention studies were deemed to be feasible methods of promoting behaviour change among TYA cancer survivors however only six studies reported any significant change in the target behaviour. Due to the variability in intervention design between studies it was not possible to draw links between intervention content, delivery mode or theoretical design and successful intervention outcome. Nevertheless, trends emerged relating to the delivery and content of health behaviour interventions designed specifically for TYA cancer survivors.
Remote intervention delivery, meaning the intervention was delivered without any face-to-face communication with the researchers conducting the study, was a feature within six of the twelve intervention studies included for review. These interventions were typically computer-based or involved a mail out of paper based intervention materials. One such intervention conducted by Valle and colleagues (2013) which aimed to increase moderate- vigorous intensity physical activity was delivered via Facebook. This intervention demonstrated that social networking sites are a feasible method of delivering health information and support to young people with cancer. Previous studies investigating the intervention preferences of TYA-aged cancer survivors found young people were highly supportive of remote-based interventions and the delivery of information online. Specifically designed websites or electronic patient platforms that create easily accessible enriched information environments (e.g. additional content, links or testimonials), provide tailored information, facilitate behaviour tracking, and provide an aspect of peer support are worth further investigation. Such mediums of information delivery may overcome typical barriers young people report to information engagement such as time obligations (e.g. studying or working) and physical limitations (e.g. chronic fatigue).
In this review, emotional or social support in the form of contact with health professionals, facilitated group workshops, or the opportunity to interact online with other young people with cancer was a key feature of many of the interventions. As in general adolescent and young adult populations, as a young person matures from adolescence to adulthood, familial influence on behaviour decreases and young people often seek direct and indirect support from close friends or peers. Efforts to deliver health information and support to TYA aged cancer survivors should take into account this developmental phenomenon and potentially target social groups as mediators of behaviour change.
Moreover, this review provides some evidence that health behaviour interventions should also address cognitive factors influencing TYA health behaviour change. Half of the interventions were individually tailored to the participant and four interventions included education and personalized risk counselling regarding late effects. Tailored information or risk-stratified behavioural counselling could be especially beneficial among TYA cancer survivors as such directive approaches to information delivery may be more beneficial in supporting the development of autonomous motivation and decision making to behaviour change than standard traditional approaches to health and lifestyle information delivery.
Although only six of the intervention studies included within this review reported significant behaviour change, the results of all studies indicate promising results suggesting that if such interventions were piloted among larger samples, with significant power, behaviour change could be achieved. Given that many of the interventions included for review were heavily resource intensive and incentivised there is a need to develop low cost and easy to disseminate health behaviour interventions for young people who have had a cancer diagnosis. As previously mentioned mobile technologies and e-health platforms are worth further investigation within this context. Moreover, further work is required to address how such interventions could be rolled out within existing health care systems. It is imperative that lifestyle information resources and health behaviour change interventions for TYA cancer survivors are developed in consultation with young people and health professionals specializing in this field of cancer care.
Link to the study: http://online.liebertpub.com/doi/pdf/10.1089/jayao.2015.0042
Dr. Abi Fisher is a Lecturer in Physical Activity and Health in the Department of Epidemiology and Public Health, University College London. Abi has a background in physiology, specializing in exercise science, with specific research interests in physical activity for the prevention and treatment of chronic disease, with particular focus on cancer. She currently leads a programme of work with cancer survivors, including the ‘ASCOT’ trial of a habit-based lifestyle intervention for breast, prostate and colorectal cancer patients, ‘MASCOT’ for patients with multiple myeloma, and health behaviour change for teenage and young adults cancer survivors.
Gemma Pugh is a PhD candidate in the Department of Epidemiology and Public Health, University College London developing a health behaviour intervention designed specifically for teenage and young adult cancer survivors in the United Kingdom. Gemma is currently carrying out several studies of TYA cancer survivors investigating their current health and lifestyle behaviours, their perceived importance of health related behaviour, experience of receiving lifestyle advice and interest in information relating to health behaviour such as physical activity, diet, smoking, alcohol consumption and sun safety.