Top

BMC Cancer

Published in:

Open Access 01-12-2024 | Research

Health-related risk behaviors among U.S. childhood cancer survivors: a nationwide estimate

Authors: Van T. Nghiem, Jing Jin, Stephen T. Mennemeyer, F. Lennie Wong

Published in: BMC Cancer | Issue 1/2024

Abstract

Background

Childhood cancer survivors (CCS) are subject to a substantial burden of treatment-related morbidity. Engaging in health protective behaviors and eliminating risk behaviors are critical to preventing chronic diseases and premature deaths. This study is aimed to provide updated information on currently smoking, physical inactivity, binge drinking patterns and associated factors among CCS using a nationwide dataset.

Methods

We constructed a sample of CCS (cancer diagnosis at ages < 21y) and healthy controls (matched on age, sex, residency, race/ethnicity) using 2020 Behavioral Risk Factor Surveillance System. We used Chi-square tests and Wilcoxon rank-sum test to examine differences in sociodemographics and clinical characteristics between two groups. Logistic, ordinal regression and multivariable models (conditional models for matching) were used to determine factors associated with risk behaviors.

Results

The final sample (18-80y) included 372 CCS and 1107 controls. Compared to controls, CCS had a similar proportion of binge drinking (~ 18%) but higher prevalence of currently smoking (26.6% vs. 14.4%, p < 0.001), physical inactivity (23.7% vs. 17.7%, p = 0.012), and of having 2-or-3 risk behaviors (17.2% vs. 8.1%, p < 0.001). Younger age, lower educational attainment, and having multiple chronic health conditions were associated with engaging in more risk behaviors among CCS. Females, compared to male counterparts, had lower odds of binge drinking (adjusted odds ratio (aOR) = 0.30, 95% confidence interval (CI): 0.16–0.57) among CCS but not in all sample. Having multiple chronic health conditions increased odds of both currently smoking (aOR = 3.52 95%CI: 1.76–7.02) and binge drinking (aOR = 2.13 95%CI: 1.11–4.08) among CCS while it only increased odds of currently smoking in all sample.

Discussion

Our study provided risk behavior information for wide age-range CCS, which is currently lacking. Every one in four CCS was currently smoking. Interventions targeting risk behavior reduction should focus on CCS with multiple chronic health conditions.

Available only for authorised users

National Academies of Sciences, Engineering, and Medicine. Childhood cancer and functional impacts across the care continuum. The National Academies Press. Accessed 2023. https://doi.org/10.17226/25944.

Bhatia S, Meadows AT. Long-term follow-up of childhood cancer survivors: future directions for clinical care and research. Pediatr Blood Cancer. 2006;46(2):143–8. https://doi.org/10.1002/pbc.20613.CrossRefPubMed

Rebholz CE, Rueegg CS, Michel G, et al. Clustering of health behaviours in adult survivors of childhood cancer and the general population. Br J Cancer. 2012;107(2):234–42. https://doi.org/10.1038/bjc.2012.250.CrossRefPubMedPubMedCentral

White J, Flohr JA, Winter SS, Vener J, Feinauer LR, Ransdell LB. Potential benefits of physical activity for children with acute lymphoblastic leukaemia. Pediatr Rehabil Jan-Mar. 2005;8(1):53–8. https://doi.org/10.1080/13638490410001727428.CrossRef

Demark-Wahnefried W, Jones LW. Promoting a healthy lifestyle among cancer survivors. Hematol Oncol Clin North Am. 2008;22(2):319–42. https://doi.org/10.1016/j.hoc.2008.01.012. (viii).CrossRefPubMedPubMedCentral

Emmons K, Li FP, Whitton J, et al. Predictors of smoking initiation and cessation among childhood cancer survivors: a report from the childhood cancer survivor study. J Clin Oncol. 2002;20(6):1608–16. https://doi.org/10.1200/jco.2002.20.6.1608.CrossRefPubMed

Florin TA, Fryer GE, Miyoshi T, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1356–63. https://doi.org/10.1158/1055-9965.Epi-07-0048.CrossRefPubMed

Robison LL, Green DM, Hudson M, et al. Long-term outcomes of adult survivors of childhood cancer. Cancer. 2005;104(11 Suppl):2557–64. https://doi.org/10.1002/cncr.21249.CrossRefPubMed

Gibson TM, Liu W, Armstrong GT, et al. Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study. Cancer. 2015;121(22):4035–43. https://doi.org/10.1002/cncr.29609.CrossRefPubMed

10.

Salman A, Nguyen C, Lee YH, Cooksey-James T. A Review of Barriers to Minorities’ Participation in Cancer Clinical Trials: Implications for Future Cancer Research. J Immigr Minor Health. 2016;18(2):447–53. https://doi.org/10.1007/s10903-015-0198-9.CrossRefPubMed

11.

Joseph G, Dohan D. Recruiting minorities where they receive care: Institutional barriers to cancer clinical trials recruitment in a safety-net hospital. Contemp Clin Trials. 2009;30(6):552–9. https://doi.org/10.1016/j.cct.2009.06.009.CrossRefPubMed

12.

Ng DQ, Ritt-Olson A, Freyer DR, et al. Substance Use Among Young Adult Survivors of Childhood Cancer With Cognitive Impairment: An Analysis of the Project Forward Cohort. JCO Oncol Pract. 2023;19(3):e345–54. https://doi.org/10.1200/op.22.00458.CrossRefPubMed

13.

Cappelli C, Miller KA, Ritt-Olson A, Pentz MA, Salahpour S, Milam JE. Binge Drinking, Tobacco, and Marijuana Use Among Young Adult Childhood Cancer Survivors: A Longitudinal Study. J Pediatr Oncol Nurs Sep-Oct. 2021;38(5):285–94. https://doi.org/10.1177/10434542211011036.CrossRef

14.

Armstrong GT, Chen Y, Yasui Y, et al. Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer. N Engl J Med. 2016;374(9):833–42. https://doi.org/10.1056/NEJMoa1510795.CrossRefPubMedPubMedCentral

15.

Yeh JM, Ward ZJ, Chaudhry A, et al. Life Expectancy of Adult Survivors of Childhood Cancer Over 3 Decades. JAMA Oncol. 2020;6(3). https://doi.org/10.1001/jamaoncol.2019.5582.

16.

Centers for Disease Control and Prevention. CDC - BRFSS - 2022 BRFSS Modules used by category. Accessed, 2022. https://www.cdc.gov/brfss/questionnaires/modules/category2020.htm.

17.

Wan F, Colditz GA, Sutcliffe S. Matched Versus Unmatched Analysis of Matched Case-Control Studies. Am J Epidemiol. 2021;190(9):1859–66. https://doi.org/10.1093/aje/kwab056.CrossRefPubMedPubMedCentral

18.

Boston University. Case-control studies. Accessed April 15, 2023. https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_case-control/ep713_case-control_print.html.

19.

Li Y, Graubard BI, DiGaetano R. Weighting methods for population-based case–control studies with complex sampling. J R Stat Soc: Ser C: Appl Stat. 2011;60(2):165–85.MathSciNetCrossRef

20.

Clarke S-A, Eiser C. Health behaviours in childhood cancer survivors: a systematic review. Eur J Cancer. 2007;43(9):1373–84.CrossRefPubMed

21.

Cantrell MA, Posner MA. Engagement in High-Risk Behaviors Among Young Adult Survivors of Childhood Cancer Compared to Healthy Same-Age Peers Surveyed in the National Longitudinal Study of Adolescent Health. J Adolesc Young Adult Oncol. 2016;5(2):146–51. https://doi.org/10.1089/jayao.2015.0053.CrossRefPubMedPubMedCentral

22.

Brinkman TM, Recklitis CJ, Michel G, Grootenhuis MA, Klosky JL. Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature. J Clin Oncol. 2018;36(21):2190–7. https://doi.org/10.1200/jco.2017.76.5552.CrossRefPubMedPubMedCentral

23.

Carretier J, Boyle H, Duval S, et al. A Review of Health Behaviors in Childhood and Adolescent Cancer Survivors: Toward Prevention of Second Primary Cancer. J Adolesc Young Adult Oncol. 2016;5(2):78–90. https://doi.org/10.1089/jayao.2015.0035.CrossRefPubMed

24.

Rabin C. Review of health behaviors and their correlates among young adult cancer survivors. J Behav Med. 2011;34(1):41–52. https://doi.org/10.1007/s10865-010-9285-5.MathSciNetCrossRefPubMed

25.

Hudson MM, Findlay S. Health-risk behaviors and health promotion in adolescent and young adult cancer survivors. Cancer. 2006;107(7 Suppl):1695–701. https://doi.org/10.1002/cncr.22103.CrossRefPubMed

26.

Daniel CL, Kohler CL, Stratton KL, et al. Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study. Cancer. 2015;121(11):1856–63. https://doi.org/10.1002/cncr.29265.CrossRefPubMed

27.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010.CrossRef

28.

Sawyer SM, Drew S, Yeo MS, Britto MT. Adolescents with a chronic condition: challenges living, challenges treating. Lancet. 2007;369(9571):1481–9. https://doi.org/10.1016/s0140-6736(07)60370-5.CrossRefPubMed

29.

Klosky JL, Howell CR, Li Z, et al. Risky health behavior among adolescents in the childhood cancer survivor study cohort. J Pediatr Psychol. 2012;37(6):634–46. https://doi.org/10.1093/jpepsy/jss046.CrossRefPubMedPubMedCentral

30.

Marjerrison S, Hendershot E, Empringham B, Nathan PC. Smoking, Binge Drinking, and Drug Use Among Childhood Cancer Survivors: A Meta-Analysis. Pediatr Blood Cancer. 2016;63(7):1254–63. https://doi.org/10.1002/pbc.25943.CrossRefPubMed

31.

Asfar T, Dietz NA, Arheart KL, et al. Smoking behavior among adult childhood cancer survivors: what are we missing? J Cancer Surviv. 2016;10(1):131–41. https://doi.org/10.1007/s11764-015-0459-6.CrossRefPubMed

32.

Polosa R, Thomson NC. Smoking and asthma: dangerous liaisons. Eur Respir J. 2013;41(3):716–26. https://doi.org/10.1183/09031936.00073312.CrossRefPubMed

33.

Fagard RH, Nilsson PM. Smoking and diabetes–the double health hazard! Prim Care Diabetes. 2009;3(4):205–9. https://doi.org/10.1016/j.pcd.2009.09.003.CrossRefPubMed

34.

Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther. 2010;8(7):917–32. https://doi.org/10.1586/erc.10.56.CrossRefPubMedPubMedCentral

35.

Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987;317(21):1303–9. https://doi.org/10.1056/nejm198711193172102.CrossRefPubMed

36.

Sethi JM, Rochester CL. Smoking and chronic obstructive pulmonary disease. Clin Chest Med. 2000;21(1):67–86. https://doi.org/10.1016/s0272-5231(05)70008-3. (viii).CrossRefPubMed

37.

Gallaway MS, Glover-Kudon R, Momin B, et al. Smoking cessation attitudes and practices among cancer survivors - United States, 2015. J Cancer Surviv. 2019;13(1):66–74. https://doi.org/10.1007/s11764-018-0728-2.CrossRefPubMedPubMedCentral

38.

Lown EA, Goldsby R, Mertens AC, et al. Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction. 2008;103(7):1139–48. https://doi.org/10.1111/j.1360-0443.2008.02242.x.CrossRefPubMedPubMedCentral

39.

Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82. https://doi.org/10.1056/NEJMsa060185.CrossRefPubMed

40.

Tzu-Hsuan CD. The psychosocial impact of the COVID-19 pandemic on changes in smoking behavior: Evidence from a nationwide survey in the UK. Tob Prev Cessat. 2020;6:59. https://doi.org/10.18332/tpc/126976.CrossRef

41.

Gaffney A, Himmelstein DU, Woolhandler S. Smoking Prevalence during the COVID-19 Pandemic in the United States. Ann Am Thorac Soc. 2022;19(6):1065–8. https://doi.org/10.1513/AnnalsATS.202110-1184RL.CrossRefPubMedPubMedCentral

42.

Denlinger-Apte R, Suerken CK, Ross JC, et al. Decreases in smoking and vaping during COVID-19 stay-at-home orders among a cohort of young adults in the United States. Prev Med. 2022;156: 106992. https://doi.org/10.1016/j.ypmed.2022.106992.CrossRefPubMedPubMedCentral

43.

Stolley MR, Sharp LK, Tangney CC, et al. Health behaviors of minority childhood cancer survivors. Cancer. 2015;121(10):1671–80. https://doi.org/10.1002/cncr.29202.CrossRefPubMed

44.

Krull KR, Annett RD, Pan Z, et al. Neurocognitive functioning and health-related behaviours in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Eur J Cancer. 2011;47(9):1380–8. https://doi.org/10.1016/j.ejca.2011.03.001.CrossRefPubMedPubMedCentral

45.

Devine KA, Mertens AC, Whitton JA, et al. Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS). Psychooncology. 2018;27(2):613–9. https://doi.org/10.1002/pon.4528.CrossRefPubMed

46.

Suh E, Stratton KL, Leisenring WM, et al. Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study. Lancet Oncol. 2020;21(3):421–35. https://doi.org/10.1016/s1470-2045(19)30800-9.CrossRefPubMedPubMedCentral

47.

Centers for Disease Control and Prevention. Complex sampling weights and preparing 2020 BRFSS module data for analysis. 2021. Accessed, 2021. https://www.cdc.gov/brfss/annual_data/2020/pdf/Complex-Smple-Weights-Prep-Module-Data-Analysis-2020-508.pdf.

48.

Antwi GO, Jayawardene W, Lohrmann DK, Mueller EL. Physical activity and fitness among pediatric cancer survivors: a meta-analysis of observational studies. Support Care Cancer. 2019;27(9):3183–94. https://doi.org/10.1007/s00520-019-04788-z.CrossRefPubMed

49.

Ford JS, Barnett M, Werk R. Health behaviors of childhood cancer survivors. Children. 2014;1(3):355–73.CrossRefPubMedPubMedCentral

50.

Ford JS, Ostroff JS. Health behaviors of childhood cancer survivors: what we’ve learned. J Clin Psychol Med Settings. 2006;13(2):144–60.CrossRef

51.

Berdan CA, Tangney CC, Scala C, Stolley M. Childhood cancer survivors and adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity. J Cancer Surviv. 2014;8(4):671–9. https://doi.org/10.1007/s11764-014-0376-0.CrossRefPubMed

Title: Health-related risk behaviors among U.S. childhood cancer survivors: a nationwide estimate
Authors: Van T. Nghiem
Jing Jin
Stephen T. Mennemeyer
F. Lennie Wong
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-024-11894-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 1/2024

PTEN and P-4E-BP1 might be associated with postoperative recurrence of rectal cancer patients undergoing concurrent radiochemotherapy

Attitudes of oncology patients’ towards biospecimen donation for biobank research

Healthy lifestyles, systemic inflammation and breast cancer risk: a mediation analysis

Long-term survival after neoadjuvant therapy for triple-negative breast cancer under different treatment regimens: a systematic review and network meta-analysis

Does depressurization of the portal vein before liver transplantation affect the recurrence of HCC? A nested case-control study

Real-world patient characteristics and treatment patterns in US patients with advanced non-small cell lung cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer