Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT, Hansine Hansens Veg 18, 9019, Tromsø, Norway.
BMC Public Health. 2023 Aug 8;23(1):1504. doi: 10.1186/s12889-023-16408-x.
The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors.
Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety.
Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy.
It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors.
18/02/2021, NCT04761042 (clinicaltrials.gov).
大多数儿童、青少年和青年癌症幸存者（AYA）在癌症治疗后会长期存在健康问题。因此，探索有效的健康促进策略来满足他们的需求至关重要。接触大自然是一种支持年轻癌症幸存者需求的有前途的方法。本研究旨在调查为儿童和 AYA 癌症幸存者开展荒野项目的随机对照试验（RCT）是否可行。
符合条件的参与者年龄在 16-39 岁之间，患有癌症且符合最低标准。有 71 人表示有兴趣，其中 59 人被随机分配到荒野或度假项目组。荒野项目包括为期 8 天的探险，包括背包旅行、皮划艇、峡谷攀岩、露营、野外生存技能和正念练习。3 个月后，进行为期 4 天的大本营。对照组为在水疗酒店进行为期 8 天的度假，3 个月后在同一家酒店进行为期 4 天的度假。主要结局是研究的可行性和安全性。
最终，19 名 AYA 参加了荒野项目，23 名参加了度假项目。所有参与者均在 1 年随访时完成了研究。参与者主要为女性（70%），代表多种癌症。临床特征在研究组之间相似，但荒野组的癌症诊断年龄较大（19.1 岁比 12.5 岁；p=0.024）。两组的方案依从性和数据完整性均较高（均大于 90%）。荒野组与度假组的不良事件（AE）相似（相对风险：1.0，95%置信区间 0.8-1.3）。最常见的 AE 是疲劳，均为轻度至中度，无严重不良事件报告。荒野组参与者的自然联系随着时间的推移显著增加，但度假组没有（p<0.001）。两组在生活质量、自尊或自我效能感方面没有差异。
开展 RCT 是可行的，对于儿童和 AYA 癌症幸存者来说，监督下的荒野冒险与度假项目一样安全。这项初步研究为一项更大的 RCT 奠定了基础，以调查荒野项目对年轻癌症幸存者健康的有效性。
2021 年 2 月 18 日，NCT04761042（clinicaltrials.gov）。
