Multiple behavioral risk factors among adolescent cancer survivors

A significant number of young survivors of childhood cancers smoke, are physically inactive and/or don't use sunscreen, according to researchers at Lombardi Comprehensive Cancer Center.

While these behaviors can be a future cancer risk to adolescents who have not had cancer, they can pose special peril to those who have been treated for the disease, investigators say.

Their study, published recently in Pediatric Blood & Cancer, samples 75 adolescent cancer survivors whose average age was 14, and found 28 percent reported one of the three risk factors, 12 percent reported two of the three, and 7 percent reported all three. This is among the first studies to look at multiple behavioral risk factors among adolescent cancer survivors.

"Our findings suggest that young survivors need ongoing assistance in dealing with these issues--much as do all children," said the lead author, Kenneth Tercyak, assistant professor of oncology and pediatrics. "The key difference here is that we believe these survivors are an especially vulnerable population and any lifestyle risk they take may increase their chance of cancer recurrence and/or the onset of chronic disease in adulthood."

Some of these youths may be especially "stress prone," and thus more likely to have difficulty protecting their health, Tercyak said. "We have looked within a group of survivors to better understand what might lead some survivors toward risky behaviors, and have found that older children and those with more personal and family stress appear to be at greatest risk," he said.

The research was conducted through the SHARE (Survivor Health and Resilience Education) Program, a health counseling program offered in cooperation with the Lombardi Comprehensive Cancer Center. Through the SHARE Program, survivors of childhood cancer received information and counseling about eating healthy, exercising, living well, and other tips to stay healthy. This research was funded by the Lance Armstrong Foundation.

Cancer survivors are at increased risk for developing cancer for specific reasons, researchers say. For example, skin and lung cancer risk increases if a patient has been treated with radiation as part of treatment, and certain treatments, such as chemotherapy, can weaken lungs, making them more susceptible to future disease.

Young cancer patients are strongly encouraged to follow a healthy lifestyle "in an effort to possibly manage their disease recurrence risk and to help them to continue to lead healthy lives," Tercyak said. "Their primary disease may be cured, but they remain at increased health risk."

To find out if these healthy lifestyles were being followed, the researchers surveyed patients between ages 11-21, who were one or more years from treatment and were cancer-free for one or more years. More than one-half of respondents were girls that had been treated for leukemia, and most were white, living in dual parent households in areas with upper middle class incomes, reportedly earning As and Bs in school.

The researchers found that 15 percent of the patients had a history of cigarette use, 20 percent engaged in insufficient physical activity, and 37 percent did not use sun protection as recommended. Patients with these behavioral risk factors tended to be older, had greater symptoms of stress, and reported greater family discord.

These results suggest that because stress may mediate or moderate the health promotion behaviors in this special population, interventions to address personal and family stress levels are warranted, Tercyak said.