Date of Award

8-14-2024

Author's School

Graduate School of Arts and Sciences

Author's Department

Psychology

Degree Name

Doctor of Philosophy (PhD)

Degree Type

Dissertation

Abstract

Children who survive acute lymphoblastic leukemia (ALL) and lymphoma are at considerable risk for chronic, treatment-related medical complications known as “late effects.” Not only are these late effects significant in and of themselves, but many are exacerbated by excess weight, a particularly concerning combination given the elevated rates of overweight and obesity within this population. Although the therapeutic regimens (e.g., steroid “pulses”) endured by children who survive ALL and lymphoma may contribute to excess weight, accumulating evidence also demonstrates the development of poor dietary habits and inadequate levels of physical activity during cancer treatment. Such weight-related health behaviors appear to contribute considerably to the high rates of overweight and obesity among these children, even long after cancer treatment has ended. The current study involved the adaptation and implementation of the first intensive (i.e. ≥ 26 contact hour), multicomponent, evidence-based, healthy lifestyle and weight management intervention for children who survive cancer and their families. Focus groups were conducted with 9 children who survived ALL and 11 of their parents to assess perceptions of weight, weight-related behaviors, and perceived barriers to family-based behavioral treatment (FBT) for overweight and obesity. The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), a theoretical framework to systematically guide the process of adapting of an evidence-based program, was then employed to inform adaptations to FBT. Finally, 12 children who survived ALL or lymphoma and their families completed a single-arm, non-randomized trial of the adapted intervention. Families completed height and weight measurements, 24-hour dietary recalls for the participating child, and additional measures of acceptability, feasibility, and weight-related health behaviors at baseline (BL), end of treatment (EoT), and follow up (FU; 6 months after baseline). Enrollment rates were only slightly lower (26%) than those demonstrated within previous trials of FBT and an analysis of possible predictors of intervention participation demonstrated that participants who were off cancer treatment for a shorter amount of time were more likely to enroll (Effect size: g = 0.706). Moreover, the most common reasons for non-participation were busy schedules (n = 11, 48%) and logistical considerations (n = 3, 13%), including the time commitment required by the study as well as its format (i.e., group format). High quantitative self-report ratings, qualitative feedback, and rates of attendance and retention indicated that the intervention was both acceptable and feasible for participating families. While the sample size was small, reductions in measures of relative weight for children across the intervention were particularly encouraging, with a significant linear reduction of PoM BMI across FBT (β = -1.03, 95% CI [-1.66, -0.40], t = 3.25; Effect size: g BL to EoT (0 - 4 months) = -0.617; g BL to FU (0 - 6 months) g = -0.630). Moreover, median change in child relative weight was 13.3 units, exceeding the previously established range of clinically meaningful reduction reliably achieved through past trials FBT. Reductions in guardian weight within the sample were also notable, demonstrating a reduction of 25 pounds, a level of change which exceeds the 10% and/or roughly 22-pound weight loss associated with maximal reduction of risk for most weight-related chronic illnesses. Curiously, changes in measures weight-related health behaviors, psychosocial dysfunction, and health-related quality of life across the intervention were otherwise non-significant and therefore warrant further investigation. The study highlights the potential of an intensive, multicomponent, evidence-based weight management intervention for children who survive cancer and their families as well as considerations for future intervention iterations involving a fully powered trial with a comparison group.

Language

English (en)

Chair and Committee

Denise Wilfley

Committee Members

Desiree White; Allison King; Michael Strube; Robert Hayashi

Download

Share

COinS