Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort

Abstract

Childhood cancer survivors are at risk for medical and psychosocial late effects as a result of their cancer and its therapy. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify the evolution of these late effects. This manuscript summarizes publications from the Childhood Cancer Survivor Study (CCSS) that have examined health behaviors, risk-based health care, and interventions to promote healthy lifestyle practices. Long-term survivors use tobacco and alcohol and have inactive lifestyles at higher rates than is ideal given their increased risk of cardiac, pulmonary, and metabolic late effects. Nearly 90% of survivors report receiving some form of medical care. However, only 18% report medical visits related to their prior cancer that include discussion or ordering of screening tests or counseling on how to reduce the specific risks arising from their cancer. One low-cost, peer-driven intervention trial has been successful in improving smoking cessation within the CCSS cohort. On the basis of data from CCSS investigations, several trials to promote improved medical surveillance among high-risk groups within the cohort are underway. Despite their long-term risks, many survivors of childhood cancer engage in risky health behaviors and do not receive adequate risk-based medical care.

Fig 1.

Actuarial estimates of proportion of individuals who smoked by age at initiation.

Fig 2.

Percentage of survivors with a visit to a cancer center in the past 2 years and cumulative incidence of any chronic condition by years since cancer diagnosis.

Fig 3.

Levels of medical care, dental care, and indicated screening practices (in high-risk groups) by location of care.

Fig 4.

Factors associated with optimum risk-based care. Adapted with permission.