Review

. 2025 Apr 13;17(8):1310.

doi: 10.3390/cancers17081310.

Addressing Akrasia in Childhood, Adolescent and Young Adult Cancer Survivors: Implications for Long-Term Follow-Up and Preventive Health Interventions

Charlotte Demoor-Goldschmidt^{1

2

3

4}, Kristopher Lamore⁵, Zsuzsanna Jakab⁶, Maëlle de Ville de Goyet⁷, Sabine Heinrich⁸, Laura Bathilde⁸, Claire Berger^{9

10}, Laura Beek¹¹, Marion Beauchesne⁴, Erika Borszekine Cserhati¹², Bénédicte Brichard¹³, Louis S Constine¹⁴, Jeroen Te Dorsthorst¹⁵, Michele Favreau¹⁶, Desiree Grabow¹⁷, Louise Hinckel¹, Anita Keresztes¹³, Luc Ollivier¹⁸, Baptiste Sauterey¹⁹, Roderick Skinner²⁰, Eric Thebault²¹, Isabelle Thierry-Chef²², Sarolta Trinh²³, Lorna Zadravec Zaletel^{24

25}, Jelena Roganovic^{26

27}, Marie-Celine Chades-Esnault^{28

29}, Aurore Armand^{29

30

31}

Affiliations

¹ Pediatric Oncology-Hematology-Immunology Department, University Hospital of Angers, 49933 Angers, France.
² Pediatric Oncology-Hematology-Immunology Department, University Hospital of Caen, 14033 Caen, France.
³ Epidemiology of Radiation, U1018 Inserm, Gustave Roussy, 94805 Villejuif, France.
⁴ GCS HUGO, University Hospitals of "Grand Ouest", 49000 Angers, France.
⁵ Univ. Lille, CNRS, UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, F 59000 Lille, France.
⁶ National Childhood Oncologic Registry, Hungarian Pediatric Oncology Network, 1085 Budapest, Hungary.
⁷ Pediatric Hematology and Oncology Department, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, UCLouvain, 1200 Brussels, Belgium.
⁸ Les Aguerris Association, 75014 Paris, France.
⁹ Department of Pediatric Hematology and Oncology, University-Hospital, 42055 Saint-Etienne, France.
¹⁰ UMR-S1153, Inserm, Paris Descartes University, 75006 Paris, France.
¹¹ Department of Psycho-Oncology, Princess Máxima Centre for Paediatric Oncology, 3584 CS Utrecht, The Netherlands.
¹² Érintettek Association, 1088 Budapest, Hungary.
¹³ Pediatric Hematology and Oncology Department, Institut Roi Albert II-Ethics Committee-Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium.
¹⁴ Departments of Radiation Oncology and Pediatrics, University of Rochester Wilmot Cancer Institute, Rochester, NY 14642, USA.
¹⁵ PanCare, 1401 AZ Bussum, The Netherlands.
¹⁶ University Angers, GRANEM, SFR CONFLUENCES, 49000 Angers, France.
¹⁷ Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
¹⁸ Department of Radiation Oncology, ICO, 44800 Saint Herblain, France.
¹⁹ Department of Oncology, ICO, 49000 Angers, France.
²⁰ Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute and Centre for Cancer, Newcastle NE7 7DN, UK.
²¹ Department of Pediatric Oncology, Oscar Lambret Center, 59000 Lille, France.
²² Barcelona Institute for Global Health, 08036 Barcelona, Spain.
²³ Hungarian Pediatric Oncology Network, 1088 Budapest, Hungary.
²⁴ Radiotherapy Department, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.
²⁵ Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
²⁶ Department of Pediatric Hematology and Oncology, Children's Hospital Zagreb, 10000 Zagreb, Croatia.
²⁷ Faculty of Biotechnology and Drug Development, University of Rijeka, 51000 Rijeka, Croatia.
²⁸ CAPHI (Centre Atlantique de Philosophie, Atlantic Centre for Philosophy), UR 7463, 44312 Nantes, France.
²⁹ EREPL (Espace de Réflexion Ethique des Pays de la Loire, Ethics Reflection Space of the Pays de la Loire Region), 49000 Angers, France.
³⁰ Adult Emergency Department, University Hospital of Angers, 49100 Angers, France.
³¹ République des Savoirs-Lettres, Sciences, Philosophie (Republic of Knowledge: Literature, Science, Philosophy)-USR3608-ED540-ENS-PSL, 75005 Paris, France.

PMID: 40282486
PMCID: PMC12025612
DOI: 10.3390/cancers17081310

Review

Addressing Akrasia in Childhood, Adolescent and Young Adult Cancer Survivors: Implications for Long-Term Follow-Up and Preventive Health Interventions

Charlotte Demoor-Goldschmidt et al. Cancers (Basel). 2025.

. 2025 Apr 13;17(8):1310.

doi: 10.3390/cancers17081310.

Authors

Affiliations

¹ Pediatric Oncology-Hematology-Immunology Department, University Hospital of Angers, 49933 Angers, France.
² Pediatric Oncology-Hematology-Immunology Department, University Hospital of Caen, 14033 Caen, France.
³ Epidemiology of Radiation, U1018 Inserm, Gustave Roussy, 94805 Villejuif, France.
⁴ GCS HUGO, University Hospitals of "Grand Ouest", 49000 Angers, France.
⁵ Univ. Lille, CNRS, UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, F 59000 Lille, France.
⁶ National Childhood Oncologic Registry, Hungarian Pediatric Oncology Network, 1085 Budapest, Hungary.
⁷ Pediatric Hematology and Oncology Department, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, UCLouvain, 1200 Brussels, Belgium.
⁸ Les Aguerris Association, 75014 Paris, France.
⁹ Department of Pediatric Hematology and Oncology, University-Hospital, 42055 Saint-Etienne, France.
¹⁰ UMR-S1153, Inserm, Paris Descartes University, 75006 Paris, France.
¹¹ Department of Psycho-Oncology, Princess Máxima Centre for Paediatric Oncology, 3584 CS Utrecht, The Netherlands.
¹² Érintettek Association, 1088 Budapest, Hungary.
¹³ Pediatric Hematology and Oncology Department, Institut Roi Albert II-Ethics Committee-Cliniques Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium.
¹⁴ Departments of Radiation Oncology and Pediatrics, University of Rochester Wilmot Cancer Institute, Rochester, NY 14642, USA.
¹⁵ PanCare, 1401 AZ Bussum, The Netherlands.
¹⁶ University Angers, GRANEM, SFR CONFLUENCES, 49000 Angers, France.
¹⁷ Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
¹⁸ Department of Radiation Oncology, ICO, 44800 Saint Herblain, France.
¹⁹ Department of Oncology, ICO, 49000 Angers, France.
²⁰ Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute and Centre for Cancer, Newcastle NE7 7DN, UK.
²¹ Department of Pediatric Oncology, Oscar Lambret Center, 59000 Lille, France.
²² Barcelona Institute for Global Health, 08036 Barcelona, Spain.
²³ Hungarian Pediatric Oncology Network, 1088 Budapest, Hungary.
²⁴ Radiotherapy Department, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.
²⁵ Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
²⁶ Department of Pediatric Hematology and Oncology, Children's Hospital Zagreb, 10000 Zagreb, Croatia.
²⁷ Faculty of Biotechnology and Drug Development, University of Rijeka, 51000 Rijeka, Croatia.
²⁸ CAPHI (Centre Atlantique de Philosophie, Atlantic Centre for Philosophy), UR 7463, 44312 Nantes, France.
²⁹ EREPL (Espace de Réflexion Ethique des Pays de la Loire, Ethics Reflection Space of the Pays de la Loire Region), 49000 Angers, France.
³⁰ Adult Emergency Department, University Hospital of Angers, 49100 Angers, France.
³¹ République des Savoirs-Lettres, Sciences, Philosophie (Republic of Knowledge: Literature, Science, Philosophy)-USR3608-ED540-ENS-PSL, 75005 Paris, France.

PMID: 40282486
PMCID: PMC12025612
DOI: 10.3390/cancers17081310

Abstract

Background: Childhood, adolescent, and young adult cancer survivors (CAYACS) face significant long-term health risks, yet adherence to long-term follow-up (LTFU) care remains inconsistent. This study explores the concept of akrasia (i.e., acting against one's better judgment by engaging in behaviors known to be harmful or counterproductive) to understand the psychological, cognitive, and systemic barriers influencing survivor engagement in LTFU.

Method: Using an ethical reflection approach based on a literature review, we discussed survivor experiences, behavioral science insights, and ethical principles to identify solutions that balance patient autonomy with supportive interventions. A narrative approach was used to summarize the key points discussed during the ethics reflection group meetings.

Results: Our findings highlight key barriers such as trauma, avoidance behaviors, and cognitive constraints that contribute to non-adherence. Strategies such as shared decision-making, digital health tools, and nudge-based interventions are proposed to enhance survivor engagement. Ethical considerations emphasize the need for personalized and flexible care approaches that respect survivor agency while mitigating obstacles to adherence.

Conclusions: Addressing akrasia through ethical and behavioral frameworks could improve LTFU adherence, ultimately enhancing survivorship care and long-term health outcomes.

Keywords: adhesion; akrasia; autonomy; childhood cancer survivors; nudge; patient activation; screening; shared decision-making; survivorship; tailored information; young adult cancer survivors.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

**Figure 1**
Methodological approach to ethical reflection in the e-QuoL project.

See this image and copyright information in PMC

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Addressing Akrasia in Childhood, Adolescent and Young Adult Cancer Survivors: Implications for Long-Term Follow-Up and Preventive Health Interventions

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Addressing Akrasia in Childhood, Adolescent and Young Adult Cancer Survivors: Implications for Long-Term Follow-Up and Preventive Health Interventions

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