Abstract: Adolescents diagnosed with cancer are at increased risk for current and future health problems and premature death. As such, it is important to foster the development of health-promoting behaviors that may ameliorate some of this risk. Specific attention has been given to diet and physical activity, as these are behaviors that can be directly controlled and modified by the survivor. Despite the importance of adequate nutrition and physical activity, a large proportion of adolescents with a history of cancer do not meet recommended guidelines for these health behaviors. The current review summarizes the beneficial effects of diet and physical activity in adolescent cancer patients both during and after treatment, evaluates interventions that have been developed to address these behaviors, and provides recommendations for future strategies on how to improve these behaviors in this population. A structured literature review identified ten empirical articles examining diet and/or physical activity interventions in adolescents with a history of cancer. While several interventions aimed at increasing diet and physical activity in this population have been successful, more research is needed to evaluate long-term maintenance of health behaviors, as well as the impact these behavioral changes have on adolescents as they continue into adulthood. Future interventions should incorporate key elements of adolescent development including individualized and specific intervention components and the incorporation of both peer and family support to increase saliency and long-term commitment.
Keywords: oncology, adolescence, health-promoting behaviors
Approximately 13,907 individuals under the age of 20 are diagnosed with cancer each year in the USA.1 Over 80% of these patients will be cured of their cancer based on new and refined treatment protocols that have resulted from the collaborative organization of care across national and international clinical trials. Despite the significant improvement in survival rate, treatment has drawbacks, as its effects are felt both during active treatment and throughout survivorship. During treatment, child and adolescent cancer patients may experience significant effects of medical treatment, including nausea, fatigue, pain, loss of appetite, and decreased health-related quality of life.2,3 Following treatment, these survivors continue to be at risk for late effects, such as high risk of early mortality from second cancers, cardiac complications, and pulmonary conditions.4 Research indicates that two-thirds of survivors experience at least one physical or psychological late effect following treatment for childhood cancer.5 Additionally, long-term childhood cancer survivors are over eight times more likely to die prematurely when compared with age- and sex-matched peers in the general population.4
Given that children and adolescents diagnosed with cancer are at increased risk for current and future health problems and premature death, it is important to foster the development of health promoting behaviors that may ameliorate some of this risk. Specific attention has been given to diet and physical activity (PA), as these are behaviors that can be directly controlled and modified by the survivor. Consuming a nutritionally balanced diet high in fruits and vegetables and lower in fat, as well as engaging in recommended amounts of PA may shield survivors from some of the late effects related to their cancer diagnosis and treatment. In the general population, balanced nutrition and adequate PA can lower risk for obesity, heart disease, cancer, stroke, and diabetes, as well as promote growth and development during childhood.6 Additional specific benefits of PA have been noted in child and adolescent survivors of cancer.
Findings indicate that higher PA is associated with better health-related quality of life across the domains of physical, social, and cognitive functioning in childhood cancer survivors.7 Further, two recent exercise intervention trials designed for children and adolescents with cancer found that participation in each of the interventions was associated with improved fitness, muscular strength, and mental health, as well as reduced fatigue.8,9