Targeting Caregivers to Enhance Health Behaviors in Pediatric Cancer Survivors

Approximately 40% of off-treatment pediatric cancer survivors (PCS) are overweight or obese,
which increases their risk for negative long-term physical health complications. Consistent
with the Institute of Medicine's (IOM) emphasis on patients transitioning from treatment to
cancer survivorship and increasing long-term healthy behaviors in these survivors, we
conducted a pilot RCT to address the increasing overweight/obesity rates among PCS by
targeting their caregivers as agents for PCS behavior change. We focused on parents'
behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in
PCS and adapted an evidence-informed, manualized parent intervention - NOURISH - found to be
effective for parents of overweight and obese children and adolescents in reducing child and
adolescent BMI. We adapted NOURISH for caregivers of 5 - 13 year old PCS (6 months -4 years
off active cancer treatment). Our pilot feasibility RCT - NOURISH-T (Nourishing Our
Understanding of Role modeling to Improve Support for Healthy Transitions) evaluates: 1) the
preliminary feasibility efficacy of NOURISH-T for PCS, compared with an Enhanced Usual Care
(EUC) control condition, and 2) factors to consider to improve future adaptations of the
intervention. The project enrolled caregivers of PCS at two pediatric oncology clinics into
the 6-week intervention (or EUC) with assessments of both caregivers and PCS occurring pre-
and post-6 weeks of intervention, and at a 4-month follow-up. In comparison to EUC, we
hypothesized that caregivers and PCS assigned to the NOURISH-T condition would show greater
improvements in dietary intake, physical activity, and in anthropometric health indicators
over time.

Inclusion Criteria:

Caregivers

- Mothers and fathers (biologic/adoptive/step parents/legal guardians) of pediatric
cancer survivors

- 18 years or older

- Fluent in English

Pediatric Cancer Survivors

- Diagnosis of cancer

- between 5-13 years of age at study entry

- off active cancer treatment for 6 months to 4 years,

- reside with a participating caregiver

- able to engage in PA tailored to current medical status

- NOT taking medications that affect body weight, e.g., steroids within 6 months of
enrollment

- at or above the 85th BMI %ile.

Exclusion Criteria:

Caregivers

- are non-ambulatory

- do not reside with the PCS at least 50% of the time.

Pediatric cancer survivor

- relapse during the intervention

- taken a medication known to affect body weight such as oral steroids or antipsychotic
medications within 6 months of enrollment