With childhood cancer survival rates continually climbing, there is increasing focus on supportive care to reduce future risk of ill-health for childhood cancer survivors (CCS). As a result of chemotherapy, radiotherapy and prolonged hospitalisation, CCS are at more risk than their healthy peers of developing cardiovascular disease , obesity or secondary malignancies. Further, CCS also have lower fitness levels than their peers. Lifestyle modifications amongst CCS are warranted to help reduce these health risks.

One such modification is the concept termed ‘exercise-oncology’, in which patients are encouraged to increase their physical activity levels after cancer treatment. Participating in higher volumes of exercise is known to increase fitness levels and reduce the risk of many chronic health conditions.
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Exercise has been shown to improve fatigue levels, muscular strength, endurance, quality of life, psychological health & body composition (Huang & Ness, 2011). Exercise has also been shown to reduce the risk of cardiovascular co-morbidity development in CCS (Jones et al., 2014), and there is preliminary evidence to indicate that exercise can reduce the likelihood of cancer recurrence in adults (Meyerhardt, 2006). 

Type: The most common type of physical activity is “aerobic exercise”, which includes walking, running, cycling, rowing, swimming or playing sport. The aim is to increase the heart rate and breathing rate. “Resistance (or strength) exercise” such as using body weight for push ups, resistance bands or machine weights in the gym to aim to build up muscle and bone strength, and can make completing normal daily tasks easier.

Intensity: Exercise can be broken into low, moderate or high intensity. Generally speaking, more benefits are achieved with higher intensity exercise. Examples of activities for each exercise intensity are:

• Low (activities where you can maintain conversation easily):
  • slow walking, light house work (e.g. cooking)
• Moderate (activities where it is becoming difficult to catch your breath):
  • faster walking, hill walking, cycling, hard house work (e.g. vacuuming)
• High (activities where you can no longer sustain conversation):
  • jogging, cycling fast, tennis, gym classes

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The American College of Sports Medicine and American Cancer Society recommends the following guidelines for physical activity participation:

You do not just have to be a member of a gym or a sporting team to increase your physical activity levels. Here are some suggestions of other ways to increase your physical activity levels:

• Get on/off the bus 2 stops earlier and walk the rest of the way
• Home-programs with body weight or resistance bands
• Use a pedometer to track step counts (fun for the whole family to use)
• Take the stairs instead of lifts
• Try new activities such as bushwalking or hiking
• Download the Pokemon Go app and go on walking adventures (Gotta Catch Em All!!)
• If your endurance is low, break up your walks into smaller chunks and build it up. E.g:

You can do it, small steps at a time! Do not be hard on yourself if you cannot achieve the guidelines straight away. Remember that “more is better than less” and “some is better than none”.



Disclaimer: The above information is not a substitute for medical advice. It is important to speak with you/your child’s treating team or general practitioner prior to making major changes to your/your child’s exercise regime. This is particularly important if considering resistance training with a current cardiac issue. You may be eligible for an Enhanced Primary Care Plan from Medicare to receive subsidised sessions with an Accredited Exercise Physiologist (AEP). AEPs are university trained allied health practitioners who specialise in providing exercise programs for chronic health conditions. Search for an AEP in your location by typing your postcode into the website https://www.essa.org.au/find-aep/   

​References

1. Arroyave, W. D., Clipp, E. C., Miller, P. E., Jones, L. W., Ward, D. S., Bonner, M. J., Demark-Wahnefried, W. (2008). Childhood Cancer Survivors' Perceived Barriers to Improving Exercise and Dietary Behaviors. Oncology Nursing Forum, 35(1), 121-130
2. Children’s Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers, Version 4.0. Monrovia, CA: Children’s Oncology Group; October 2013; Available online: www.survivorshipguidelines.org.
3. Huang, T. T., & Ness, K. K. (2011). Exercise interventions in children with cancer: a review. Int J Pediatr, 2011, 461512. doi:10.1155/2011/461512
4. Jones, L. W., Liu, Q., Armstrong, G. T., Ness, K. K., Yasui, Y., Devine, K., . . . Oeffinger, K. C. (2014). Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol, 32(32), 3643-3650. doi:10.1200/jco.2014.56.7511
5. Meyerhardt, J., Heseltine, D., Hollis, D., Saltz, L., Nelson, H., Fuchs, C. Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803. Journal of Clinical Oncology, 24 (22), 3535-3541
6. Rock, C. L., Doyle, C., Demark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., .Gansler, T. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62(4), 242-274.
7. Speck, R. M., Courneya, K. S., Mâsse, L. C., Duval, S., & Schmitz, K. H. (2010). An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship, 4(2), 87-100.

​The Behavioural Sciences Unit is Proudly Supported by the Kids with Cancer Foundation.

From June 22nd – 25th ANZCHOG hosted their Annual Scientific Meeting in sunny Cairns, highlighting important research in the improvements of the cure, treatment and care of Australian and New Zealand children with cancer. The conference was well attended by healthcare professionals, with talks and posters from oncologists, nursing, psychosocial and allied health professionals, with a parents’ day held on Friday 24th June.
The Behavioural Sciences Unit was represented by seven team members, with talks and posters highlighting our current research in the fields of survivorship, e-mental health, education, response rates and the psychosocial aspects of treatment and follow-up care.​
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A/Prof Claire Wakefield: E-health interventions, genetic testing and response rates in psycho-oncology research.

​Dr Joanna Fardell delivered two presentations, winning ANZCHOG’s best presentation prize for her first talk on long-term childhood cancer survivors’ and parents’ information needs, highlighting unmet needs for medical information. Dr Fardell also presented on the impact of enrolling children in early phase clinical trials on the long term emotional-wellbeing and quality of life of bereaved parents.

​Dr Richard Mitchell: haematopoietic stem cell transplant and recruitment in early phase clinical trials

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The Behavioural Sciences Unit is Proudly Supported by the Kids with Cancer Foundation.

​A recent article from the US highlighted the effects of chronic conditions on quality of life among survivors of childhood cancers.[1] Yeh et al (2016) showed that having multiple and severe chronic health conditions reduced quality of life in childhood cancer survivors.[1] One of our recent students (Ramon Tillemans) has just completed a study which also showed that multiple health conditions, among other factors, affects quality of life in childhood cancer survivors in Australia.
 
Working with data collected as part of the Behavioural Sciences Unit’s Long-Term Follow-Up Study, Ramon sought to understand the factors influencing the quality of life of childhood cancer survivors and parents. Childhood cancer survivors aged over 16 years, and parents of those aged under 16 years, who had completed treatment more than five years ago provided information on socio-demographic and clinical characteristics, as well as quality of life.
 
Our data from 317 childhood cancer survivors and 153 parents of survivors from 10 Australian and New Zealand hospitals showed that survivors often experienced pain/discomfort, and anxiety/ depression. Both survivor and parent quality of life were heavily influenced by their current health status, but differed with respect to the influence of other factors. Survivors’ quality of life was also affected by prior therapies received, having other health conditions, and their use of financial support. In contrast, parents’ quality of life was affected by private health insurance status, and their child’s quality of life range.
 
Overall, this project has showed some important similarities and differences about the factors that influence quality of life in childhood cancer survivors and the parents in Australia and New Zealand. Data from this study will continue to accumulate allowing further opportunities to look at outcomes. In the meantime, look out for publications of the full results which are on the horizon.


​​References:

1. Yeh JM, Hanmer J, Ward ZJ, et al. Chronic Conditions and Utility-Based Health-related Quality of Life in Adult Childhood Cancer Survivors. J Natl Cancer Inst 2016; 108.

This blog is co-authored by Richard De Abreu Lourenco (Research Fellow at the Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney) and the Behavioural Sciences Unit (BSU). Ramon Tillemans (read more about Ramon here) was supervised by Mr De Abreu Lourenco along with A/Prof Claire Wakefield and Dr Joanna Fardell (BSU). This blog is based on an article originally published in the Cancer Research Economics Support Team (CREST) newsletter, available at: http://www.crest.uts.edu.au/pdfs/Newsletter_June_2016.pdf
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​The Behavioural Sciences Unit is Proudly Supported by the Kids with Cancer Foundation.