The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A low-calorie diet and physical activity intervention did not result in greater weight loss or reduce cardiovascular (CV) risk factors in survivors of childhood ALL, despite the success of this intervention among the general population. These findings were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for obesity and cardiovascular (CV) disease. The risks are increased for those exposed to cranial radiotherapy (CRT). A weight loss intervention comprising a low-calorie DASH diet and physical activity was successful in the general population; therefore, the Exercise and Quality Diet After Leukemia: The EQUAL Study ( Identifier: NCT02244411) sought to determine whether this intervention could result in weight loss or improve CV risk factors for ALL survivors.

Researchers recruited 358 adult (18 years and older) 5-year survivors whose ALL was diagnosed before age 21 years from the Childhood Cancer Survivor Study (CCSS) and reported obesity or overweight on the most recent CCSS questionnaire. The participants were randomly assigned to the intervention group (181 participants; mean weight, 98.7±24.1 kg) or the control group (177 participants; mean weight, 95.0±20.3 kg), stratified by CRT exposure.

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The intervention was Healthways at Hopkins, a diet and physical activity program delivered via an app/website and weekly coach call. The control group participants followed a self-directed weight loss program.

The primary endpoint was difference in weight loss between the groups at 24 months. Secondary endpoints were differences in changes in blood pressure, cholesterol, and triglycerides. Analyses were performed using linear mixed effects; the study was designed to detect a difference of 2.75 kg.

After controlling for CRT, sex, race/ethnicity, and age, the adjusted mean change (SE) in weight from baseline at 12 months was -1.83 kg (0.7) in the intervention group and -0.16 kg (0.64) in the control group, with an average difference of -1.67 (95% CI, -3.5 to 0.2) between the groups.

Fifty-five (30%) intervention group participants were adherent beyond 1 year. At 24 months, the weight changes were -0.36 kg (0.78) in the intervention group and +0.18 kg (0.66) for the control participants, with an average difference of -0.54 kg (95% CI, -2.5 to 1.5; P =.59) between the groups.

At 24 months, 24.2% and 17.1% of participants in the intervention and control groups, respectively, achieved a weight loss of at least 5% below their baseline weight; 10.9% and 10.3%, respectively, achieved a weight loss of at least 10% below their baseline weight. No significant differences in CV risk factors were observed.

“A 24-month diet and physical activity intervention that was successful for weight loss in the general population did not result in greater weight loss or improvements in secondary measures, when compared to self-directed weight loss,” concluded the researchers. However, these findings may be due to reduced adherence beyond 12 months or the lack of tailoring to the ALL survivor population. The researchers also note that etiology of obesity in ALL survivors may differ from the general population.

Disclosures: This research was supported by US National Institutes of Health. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.


Tonorezos ES, Clark JM, Moskowitz CS, et al. Exercise and QUality diet After Leukemia (The EQUAL Study): an intervention trial in the Childhood Cancer Survivor Study (CCSS). J Clin Oncol. 2021;39(suppl15; abstr 10015). doi:10.1200/JCO.2021.3.9.15_suppl.10015