Our research suggests that health education programs such as SHARE may have an important impact on improving bone health behaviors among adolescent survivors of childhood cancer,” lead author Darren Mays, PhD, MPH, Lombardi Comprehensive Cancer Center, tells the Academy of Oncology Nurse Navigators. His research, a randomized controlled trial of adolescent survivors of childhood cancer, found that a single, half-day, group-based health education and health-behavior counseling intervention, the Survivor Health and Resilience Education (SHARE) program, produced a significant impact on self-reported bone health behaviors among this population.
The SHARE intervention included messages and skill-building exercises that addressed relevant risk-reducing and health-promoting behaviors, with the goal of increasing awareness of cancer’s late effects, reducing barriers to and increasing perceived benefits of health-promoting behaviors, and improving self-efficacy to lead a healthy lifestyle. Instruction placed a strong emphasis on nutrition and bone health behaviors and included didactic presentations of bone health, demonstrations of healthy and unhealthy bone, and a discussion of meeting US Department of Agriculture–recommended daily calcium consumption levels of 1300 mg. Also included was reading and understanding food labels, taste-tasting calciumrich foods, and role playing of making calcium-rich food choices.
For the trial, Mays and colleagues randomized adolescents aged 11 to 21 years who were treated for an oncologic malignancy and were ≥1 years posttreatment as well as ≥1 years cancerfree. In total, 38 patients attended the intervention. For the control group, 37 patients completed the same baseline assessment and follow-up telephone assessment interviews as the intervention group. The researchers analyzed 4 outcome measures: milk consumption frequency, any calcium supplementation, days of calcium supplementation in the past month, and dietary calcium intake.
At 1 month postintervention, average milk consumption frequency was higher among the intervention group (mean, 3.36; standard deviation [SD], 0.72) compared with the control group (mean, 2.93; SD, 0.88; t63 = 2.16; P = .03). Also at 1 month, a greater portion (82.9%) of patients reported taking any calcium supplementation compared with control patients (24.1%; P <.001). In addition, the mean number of days with calcium supplementation was higher among intervention patients (mean, 14.45; SD, 10.97) compared with control patients (mean, 3.03; SD, 7.86; t62 = 4.47; P <.001). Dietary calcium intake, in contrast, was similar among all participants (intervention, mean, 1263.7 mg; SD, 736.2 mg; control, mean, 1152.1 mg; SD, 891.6 mg; t64 = 0.56; P = .58).
“Such programs may help reduce young survivors’ risk for low bone density and other adverse bone health outcomes that stem from cancer treatment,” Mays says, noting that oncology nurses can help “identify young survivors who may be at risk for bone health issues, such as those who undergo certain cancer therapies, and ensure these patients have access to health education programs.” Nurse navigators also can help. Adolescent survivors can be put in contact with late-effects programs at cancer centers or referred to nutritionists with experience working with those who have survived childhood cancer, shares Mays.
“Further research is needed to examine the long-term impact of the SHARE program on clinically relevant outcomes (eg, bone density),” cautions Mays, “but our initial results are promising.”
The complete study is published in the August issue of the Annals of Behavioral Medicine.
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