Cox Cheryl L, McLaughlin Rosemary A, Rai Shesh N, Steen Brenda D, Hudson Melissa M
Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Pediatr Blood Cancer. 2005 Aug;45(2):144-54. doi: 10.1002/pbc.20389.
The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer.
The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors.
Knowledge (P = 0.038), breast self-examination (BSE) (P < or = 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P < or = 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated.
Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors.
放疗和化疗的远期效应增加了儿童癌症幸存者患慢性健康问题的风险。幸存者的行为对于改变这种风险至关重要，然而青少年及年轻成年幸存者未能践行重要的健康促进行为，且经常有高风险行为。这项二次分析重新评估了一项多成分行为改变干预措施，该措施先前在儿童癌症青少年幸存者中未显示出效果。
母试验在基线和1年时比较了干预组的132名青少年幸存者与标准治疗组的135名幸存者在疾病和治疗知识、远期效应风险认知以及健康风险和健康保护行为频率（合并为单一汇总指标）方面的情况。相比之下，二次分析分别检查了14种行为中的每一种。此外，进行了协方差分析（ANCOVA）以检查健康行为的变化，同时在统计上控制年龄、性别以及基线行为的广泛差异。
知识（P = 0.038）、乳房自我检查（BSE）（P≤0.0001）和睾丸自我检查（P = 0.004）有所增加，对改变行为必要性的认知（P = 0.004）和保持健康所需努力（P≤0.0001）也有所增加。在治疗组中，垃圾食品消费减少（P = 0.052），戒烟得以维持（P = 0.088）。显示出性别与治疗组之间存在显著交互作用。
健康风险和健康保护行为不能有效地合并在一个一维指标中。性别和年龄会影响针对幸存者健康行为的干预效果。未来的试验应包括观察患者与临床医生的接触、更复杂的抽样方法以及对研究行为分布的试验前了解。
