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. 2025 Jun;19(3):1028-1042.
doi: 10.1007/s11764-023-01529-4. Epub 2024 Jan 15.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention in adolescent and young adult (AYA) cancer survivors: results from the SURVAYA study

Costanza Gavioli  1 , Carla Vlooswijk  1 , Silvie H M Janssen  2   3 , Suzanne E J Kaal  4 , J Martijn Kerst  3 , Jacqueline M Tromp  5 , Monique E M M Bos  6 , Tom van der Hulle  7 , Winette T A van der Graaf  3   6 , Roy I Lalisang  8 , Janine Nuver  9 , Rhodé M Bijlsma  10 , Mathilde C M Kouwenhoven  11 , Olga Husson  12   13   14 , Sandra Beijer  1
Affiliations

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention in adolescent and young adult (AYA) cancer survivors: results from the SURVAYA study

Costanza Gavioli et al. J Cancer Surviv. 2025 Jun.

Abstract

Purpose: For adolescent and young adult (AYA) cancer survivors with a good prognosis, having a healthy lifestyle prevents morbidity and mortality after treatment. The aim of this study was to investigate the prevalence of (un)healthy lifestyle behaviors and related determinants in AYA cancer survivors.

Methods: A population-based, cross-sectional study was performed among long-term (5-20 years) AYA cancer survivors (18-39 years old at diagnosis) registered within the Netherlands Cancer Registry. Self-reported questionnaires data about health behaviors were used to calculate the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) adherence score. Associations between the score and clinical/sociodemographic determinants of (un)healthy behaviors were investigated using logistic regression models.

Results: The mean WCRF/AICR score was low to moderate, 3.8 ± 1.2 (0.5-7.0) (n = 3668). Sixty-one percent adhered to "limit the consumption of sugar sweetened drinks," 28% to "be a healthy weight," 25% to "fruit and vegetable consumption," and 31% to "limit alcohol consumption." Moderate and high adherence were associated with being a woman (ORmoderate = 1.46, 95% CI = 1.14-1.85, and ORhigh = 1.87, 95% CI = 1.46-2.4) and highly educated (ORmoderate = 1.54, 95% CI = 1.30-1.83, and ORhigh = 1.87, 95% CI = 1.46-2.4). Low adherence was associated with smoking (ORmoderate = 0.68, 95% CI = 0.50-0.92, and ORhigh = 0.30, 95% CI = 0.21-0.44) and diagnosis of germ cell tumor (ORmoderate = 0.58, 95% CI = 0.39-0.86, and ORhigh = 0.45, 95% CI = 0.30-0.69).

Conclusions: Adherence to the 2018 WCRF/AICR lifestyle recommendations was low to moderate, especially regarding body weight, fruit, vegetables, and alcohol consumption. Men, current smokers, lower-educated participants, and/or those diagnosed with germ cell tumors were less likely to have a healthy lifestyle.

Implications for cancer survivors: Health-promotion programs (e.g., age-specific tools) are needed, focusing on high-risk groups.

Keywords: Adolescents and young adults with cancer (AYAs); Determinants; Health behavior; Survivors; WCRF/AICR recommendations.

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Conflict of interest statement

Declarations. Ethics approval: The SURVAYA study was conducted according to the Declaration of Helsinki guidelines and approved by the NKI Institutional Review Board (IRB-IRBd18122). Consent to participate: Informed consent was obtained from all subjects (responders) involved in the study. Competing interests: The authors declare no competing interests.

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