title: Efficacy of the Survivor Health and Resilience Education (SHARE) Program to Improve Bone Health Behaviors Among Adolescent Survivors of Childhood Cancer Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL). Feasibility of implementing health promotion interventions to improve health‐related quality of life Implementing an intervention to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia: BONEII, a prospective placebo-controlled double-blind randomized interventional longitudinal study design. Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. Fitness of Children With Standard-risk Acute Lymphoblastic Leukemia During Maintenance Therapy: Response to a Home-based Exercise and Nutrition Program The randomization and stratification of patients to clinical trials. Validation of a milk consumption stage of change algorithm among adolescent survivors of childhood cancer.
abstract: Purpose The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention — a manualized , behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer . Methods Participants were 75 teens aged 11–21 years , one or more years post-treatment , and currently cancer-free . Teens were r and omized to a group-based intervention focusing on bone health or a wait-list control .  Bone health behaviors were assessed at baseline and 1-month post-intervention . Results Controlling for baseline outcome measures and theoretical predictors , milk consumption frequency ( p = 0.03 ) , past month calcium supplementation ( p < 0.001 ) , days in the past month with calcium supplementation ( p < 0.001 ) , and dietary calcium intake ( p = 0.04 ) were significantly greater at 1-month follow-up among intervention participants compared with control participants . Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer . Research examining long-term intervention effectiveness is warranted BACKGROUND We sought to improve lumbar spine bone mineral density ( LS-BMD ) in long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) using calcium and cholecalciferol supplementation . PROCEDURE This double-blind , placebo-controlled trial r and omized 275 participants ( median age , 17 [ 9 - 36.1 ] years ) with age- and gender-specific LS-BMD Z-scores < 0 to  receive nutritional counseling with supplementation of 1,000 mg/day calcium and 800 International Unit cholecalciferol or placebo for 2 years . The primary outcome was change in LS-BMD assessed by quantitative computerized tomography ( QCT ) at 24 months . Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes . RESULTS Pre-r and omization LS-BMD below the mean was associated with male gender ( P = 0.0024 ) , White race ( P = 0.0003 ) , lower body mass index ( P < 0.0001 ) , and cumulative glucocorticoid doses of ≥ 5,000 mg ( P = 0.0012 ) . One hundred eighty-eight ( 68 % ) participants completed the study ; 77 % adhered to the intervention . Mean LS-BMD change did not differ between survivors r and omized to supplements ( 0.33 ± 0.57 ) or placebo ( 0.28 ± 0.56 ) . Participants aged 9 - 13 years and those 22 - 35 years had the greatest mean increases in LS-BMD ( 0.50 ± 0.66 and 0.37 ± 0.23 , respectively ) . Vitamin D insufficiency ( serum 25[OH]D < 30 ng/ml ) found in 296 ( 75 % ) , was not associated with LS-BMD outcomes ( P = 0.78 ) . CONCLUSION Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL ( 93 % of whom had LS-BMD Z-scores above the mean at study entry ) Survivors of childhood cancer are a growing and vulnerable population . Cure rates for pediatric cancers now exceed 60 % and , by the year 2000 , an estimated 1 of every 1,000 young adults will be a cancer survivor . Because this population is at increased risk for late medical and neoplastic complications that impact adversely on health‐related quality of life , it is important to investigate methods to promote risk reduction by motivating survivors to practice health‐promoting behaviors . With this background , we initiated a prospect i ve , r and omized , controlled feasibility study in which survivors attending a long‐term follow‐up clinic were r and omized  to receive st and ard care or st and ard care plus an educational intervention . Our objectives were to determine if the intervention would improve the survivors ' knowledge about their cancer treatment and risks of late effects and increase their practice of health‐protective behaviors . Since July 1995 , 272 of 318 families ( 86 % ) approached about the study agreed to participate . Of these , 266 are evaluable for assessment of baseline knowledge and health behaviors . Demographic features , baseline knowledge , health perceptions and health behaviors did not differ among r and omized groups . Assessment of the intervention 's efficacy at changing health behaviors of survivors r and omized to the intervention group will be available when the 1‐year follow‐up evaluations are completed for the study cohort . Our preliminary experience with this pilot study supports the feasibility of educational intervention research in a specialty clinic dedicated to monitoring long‐term childhood cancer survivors . Int . J. Cancer Suppl . 12:138–142 , 1999 . © 1999 Wiley‐Liss , The BONEII study is a large two-phase study . The baseline study ( Study 1 ) aims to estimate the prevalence of diminished bone mineral density ( BMD ) in patients treated for childhood acute lymphoblastic leukemia ( ALL ) and identify risk factors for BMD deficits . The interventional phase ( Study 2 ) of BONEII has a placebo-controlled double-blind r and omized longitudinal design to evaluate the effects of nutritional counseling and calcium and vitamin D supplementation on changes in BMD and serum and urine markers of bone metabolism . The extensive information being collected through this large study will serve as a repository of relational data about BMD and bone turnover and will support further investigations to assess the association of calcium metabolism , bone turnover , nutritional intake , lifestyle factors ( such as exercise and the use of alcohol and tobacco ) , and the specific agents used in ALL therapy in this rapidly increasing population of childhood cancer survivors BACKGROUND Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy . Healthy behaviors can modify these risks . We initiated a controlled prospect i ve trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors ' health knowledge , health perceptions , and practice of health-protective behaviors . PROCEDURE Adolescent cancer survivors attending a long-term follow-up clinic were r and omized to receive st and ard follow-up care or st and ard care plus the educational intervention . Baseline measures were obtained at r and omization ( T(0 ) ) and repeated 1 year ( T(1 ) ) later during the survivors ' annual check-up . RESULTS Of 272 patients enrolled and r and omized , 251 are evaluable at both time points . Treatment and control groups were similar in regards to diagnosis , gender , race , and age . The change in outcome measures over the year ( T(1)-T(0 ) ) was not significantly different between the two groups as assessed by a two- sample pooled t test . However , additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores . In addition , patients who choose certain individual health goals , such as breast/testicular self-examination , showed improved practice of the health behavior . In addition , in a very exploratory analysis , a gender difference in response to the intervention was noted , with females exhibiting a greater improvement in knowledge scores than did males . CONCLUSIONS Although the multi-behavioral educational intervention did not induce change in health knowledge , perceptions , and behaviors of childhood cancer survivors for the treatment group as a whole , gender differences and specific health goal differences were found . These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment Background Altered nutrient intake and decreased exercise in response to cancer therapies and their side effects , particularly corticosteroids , may be key factors in the increased body weight and differences in physical fitness reported in survivors of childhood acute lymphoblastic leukemia ( ALL ) . Purpose To assess ( 1 ) the effect of a home-based nutrition and exercise intervention program on cardiovascular fitness , strength , and flexibility in children with ALL during maintenance therapy and ( 2 ) the feasibility of conducting and evaluating a home-based exercise and nutrition program in this patient population . Design Children ages 4 to 10 years with st and ard-risk ALL were r and omized when starting maintenance therapy to a 12-month home-based exercise and nutrition program ( n=6 , 3 males/3 females ) or control ( n=7 , 4 males/3 females ) group . Assessment of anthropometrics , dietary intake , physical activity , and fitness was performed at baseline and 6 and 12 months of study . Results Although age , body size , and nutrient intakes were similar between both subject groups at 0 , 6 , and 12 months , exercise and nutrition program children had greater improvement in physical activity and cardiovascular fitness between 6 and 12 months than control children . Conclusions These results suggest that a home-based exercise intervention during maintenance therapy encouraged greater physical activity and improved cardiovascular fitness in children with st and ard-risk ALL . Further investigation involving larger population s of children with ALL is warranted Solid bodies of polypeptides having repeating units of aspartic , glutamic , and aminoadipic esters are reacted with hydrazine or an amine having at least two NH2 groups until the ester moieties of the side chains are partly converted to the hydrazines or amides , and the side chains are partly crosslinked hydrazides other units by reaction with the hydrazine or diamine so as to make the polypeptide insoluble and infusible . The remaining ester moieties are saponified , and the result ing hydrophilic , but water-insoluble solid acts as an ampholyte in contact with water or other polar solvents . It may be used for capturing heavy metal ions from their aqueous solutions OBJECTIVE To assess the construct validity of a  milk consumption Stages of Change ( SOC ) algorithm among adolescent survivors of childhood cancer ages 11 to 21 years ( n = 75 ) . METHODS Baseline data from a r and omized controlled trial design ed to evaluate a health behavior intervention were analyzed . Assessment s included a  milk consumption SOC algorithm  and hypothesized theoretical and behavioral predictors of SOC . RESULTS Compared with survivors who expressed no readiness to change , those expressing readiness to change behavior for both 2 and 4 daily servings of milk reported more frequent milk consumption ( P < .001 ) , greater dietary calcium intake ( P = .006 ) , and were more likely to meet age-specific recommendations for daily calcium intake ( P = .01 ) . CONCLUSIONS AND IMPLICATION S Results provide support for the construct validity of the  milk consumption SOC algorithm relative to behavioral criteria . Research is needed to further examine algorithm validity with respect to theoretical predictors of SOC
target: Due to a paucity of studies , and the heterogeneity of the studies included in this review , we are unable to draw conclusions regarding the effectiveness of nutritional interventions for use with childhood cancer survivors .
  Although there is low quality evidence for the improvement in health behaviours using health behaviour change interventions , there remains no evidence as to whether this translates into an improvement in dietary intake .
  There was also no evidence that the studies reduced the risk of cardiovascular and metabolic disorders in childhood cancer survivors , although no evidence of effect is not the same as evidence of no effect .
background: BACKGROUND Childhood cancer survivors are at a higher risk of developing health conditions such as osteoporosis , and cardiovascular disease than their peers .
  Health-promoting behaviour , such as consuming a healthy diet , could lessen the impact of these chronic issues , yet the prevalence rate of health-protecting behaviour amongst survivors of childhood cancer is similar to that of the general population .
  Targeted nutritional interventions may prevent or reduce the incidence of these chronic diseases .
  OBJECTIVES The primary aim of this review was to assess the efficacy of a range of nutritional interventions design ed to improve the nutritional intake of childhood cancer survivors , as compared to a control group of childhood cancer survivors who did not receive the intervention .