Targeting Caregivers to Enhance Health Behaviors in Pediatric Cancer Survivors

描述（由申请人提供）：未接受治疗的儿童癌症幸存者（PCS）超重和肥胖的比率很高，从急性淋巴细胞白血病幸存者的约40%到一些肉瘤幸存者的50%不等。然而，与一般儿科人群相比，超重和肥胖的比例也很高（约为10%）。30%)，在PCS中伴随的负面健康后果的风险要大得多。根据最近文献的呼吁，并根据医学研究所（IOM）关于随访在促进幸存者健康行为中的重要性的报告，我们提出了一项可行性试验，通过将护理人员作为PCS行为改变的关键因素，来处理PCS中不断增加的超重和肥胖率。我们特别关注照顾者的行为、态度和在促进PCS中更健康的饮食和身体活动（PA）方面的作用，并采用一种基于证据的人工父母干预——滋养——发现对超重和肥胖儿童和青少年的照顾者有效。我们适应滋养护理5 - 11岁的PCS（6个月至4年的积极癌症治疗）。我们提出了一项试点可行性随机对照试验-营养- t（滋养我们对角色建模的理解，以改善对健康过渡的支持）来评估1)与增强常规护理（EUC）对照条件相比，营养- t对儿童癌症幸存者的初步有效性；2)考虑改善未来干预适应性的因素，包括根据护理人员参与率和反应变异性（PCS年龄、性别、种族和治疗结束后时间的函数）确定癌症后向护理人员提供干预的最佳时间。该项目将招募弗吉尼亚联邦大学（VCU）、匹兹堡大学和匹兹堡儿童医院（UP）共66名PCS的护理人员参加为期6个阶段的小组干预，并在干预前后和6个月的随访中进行评估。主要具体目标：1；目的：为超重和肥胖儿童癌症幸存者（PCS）的护理人员提供针对饮食和身体活动行为的健康行为改变干预（NOURISH-T）的最佳癌症后治疗时间的可行性。2. 初步探讨营养- t对改善儿童膳食摄入量、PA、生活质量和BMI的作用。次要目标：3；探讨与EUC照料者相比，nurish - t照料者是否表现出饮食摄入量、PA、生活质量、BMI的改善，以及儿童脆弱性感知和儿童过度保护的降低。

DESCRIPTION (provided by applicant): Rates of overweight and obesity for off-treatment pediatric cancer survivors (PCS) are high, ranging from about 40% in Acute Lymphoblastic Leukemia survivors to 50% among survivors of some sarcomas. However, in comparison to the general pediatric population where rates of overweight and obesity are also high (approx. 30%), the risk for concomitant negative health consequences is significantly greater in PCS. In line with recent calls in the literature and in accordance with the Institute of Medicine's (IOM) report on the importance of follow-up in promoting healthy behaviors in survivors, we propose a feasibility trial to deal with the increasing overweight and obesity rates among PCS by targeting their caregivers as key agents for PCS behavior change. We specifically focus on caregivers' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed manualized parent intervention -- NOURISH -- found to be effective for caregivers of overweight and obese children and adolescents. We adapt NOURISH for caregivers of five - 11 year old PCS (6 months to 4 years off active cancer treatment). We propose a pilot feasibility RCT- NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) to evaluate 1) the preliminary effectiveness of NOURISH-T for pediatric cancer survivors, compared to an Enhanced Usual Care (EUC) control condition; and 2) factors to consider to improve future adaptations of the intervention, including determining the best time post-cancer treatment to offer the intervention to caregivers based on caregiver participation rates and response variability as a function of the PCS age, gender, race, and time since end of treatment. The proposed project will enroll caregivers of a total of 66 PCS at Virginia Commonwealth University (VCU) and the University of Pittsburgh and Children's Hospital of Pittsburgh (UP) to participate in the 6-session group intervention with assessments occurring pre and post the intervention and at a 6-month follow-up. Primary Specific Aims: 1. to document the feasibility of an optimal time post-cancer treatment to offer a health behavior change intervention (NOURISH-T) targeting eating and physical activity behaviors to caregivers of overweight and obese pediatric cancer survivors (PCS). 2. To test the preliminary efficacy of NOURISH-T on improving child dietary intake, PA, QOL and BMI. Secondary Aim: 3. To explore whether caregivers in NOURISH-T show improved dietary intake, PA, QOL, BMI, and lowered child vulnerability perceptions and child over-protectiveness than caregivers in EUC.