New Paper: Healthy Eating in Childhood Cancer Survivors

The team are very excited to share the findings of our Australian-first study on a parent-led dietary intervention to help re-establish healthy eating habits in young survivors of childhood cancer. In this blog post, we answer some of the most interesting and important questions about our project!

Why did we develop ‘Reboot’? 

Extraordinary improvements in how we treat children’s cancer means that over 80 per cent of children will successfully recover from their cancer diagnosis. The not-so-good news is that many young survivors of childhood cancer are at increased risk of serious diseases such as diabetes, obesity, and heart disease because of the long-term side effects of their cancer treatment. Although good eating habits after cancer treatment can help to protect young survivors from serious illness, cancer treatment typically turns children’s eating habits upside down. Common side effects of cancer treatment such as Nausea, vomiting often make eating difficult and children simply can’t ‘stomach’ most foods. After eating a very limited diet of simple carbohydrates and processed foods parents can find it very difficult to switch children’s food preferences back to healthier options like vegetables when their child’s cancer treatment finishes. This can make mealtimes very stressful for families and many parents can feel overwhelmed about how to manage fussy eating. To address this problem, we designed and evaluated ‘’, a four-week, four-session program delivered to parents by telephone soon after their child had completed cancer treatment. The key finding of our study was that parents reported feeling more confident in providing a healthier diet to their child after participating in our program. This means can benefit from
learning strategies on how to promote vegetables and fruit to children.

What does ‘Reboot’ add to what we already know? 

Our study adds important new knowledge about what we already know about the eating habits in young cancer survivors. World-wide, studies show that the diet quality of children who have finished cancer treatment is very poor. Most young survivors of childhood cancer consume excessive amounts of high kilojoule, low nutrient foods or ‘junk-foods’ and very little vegetables and fruit. Poor food choices after cancer treatment suggest that the negative impact of cancer treatment on children’s food preferences is difficult to reverse and can persist without early intervention. Currently, we don’t have any evidence-based dietary interventions for young cancer survivors in Australia.

What findings did we find surprising?

The good surprise was how well parents of young cancer survivors responded to . Nearly all parents who started the program completed all four intervention sessions. When we surveyed parents after the intervention, all parents perceived the program as useful, and reported feeling more confident about how to offer and provide vegetables to children again. The not-so-good surprise was that fewer parents responded to our invitation to participate in a healthy eating program than we anticipated. We believe that the telephone format may have deterred some families from taking part. We know that families are very busy and fitting in scheduled telephone sessions can be particularly tricky. To help encourage more families to participate, we have turned into an online program, ‘-KIDS’ that parents can now complete in their own time with the benefit of optional telephone support.

What excites us about ‘Reboot’?

We are excited that parents of young survivors found a distance delivered dietary program useful. Because cancer survivors live all over Australia, could potentially be delivered to all parents of young cancer survivors who are struggling with fussy eating.

How does ‘Reboot’ contribute to Australian research?

In Australia, trials of a brief parent fruit and vegetable program in children not previously treated for cancer (‘Healthy Habits’) have achieved significant increases in children’s vegetable and fruit intake. As a next step, we sought to investigate whether this type of healthy eating program could be modified to benefit young cancer survivors and their parents.

How important is this research project in Australia and overseas?

It is the first of its kind in Australia and the first intervention of its kind, world-wide, to specifically target strategies to promote vegetables and fruit intake in this at-risk population.

What are the limitations of our project?

Limited resources meant that we could only promote to parents of young survivors treated at one hospital. This meant that we couldn’t advertise our program to all parents of childhood cancer in Australia and didn’t get as many parents enrolled in our program as we had hoped. It is still unclear if parents of young cancer survivors are interested in a dietary parent program and are likely to use this program if it was available in the community. The small sample size limited the diversity of our participants and we tended to have parents living in areas associated with a higher socioeconomic ranking than parents who decided not to participate. As a first step, we focused on evaluating whether was acceptable to parents and could be delivered using the same methods and design features evaluated in children not previously treated for cancer (‘Healthy habits’ program). Although we know that parents found it useful, we also don’t yet know whether it increases survivor’s intake of vegetables and fruit.

What do we aim to do next?

The pilot of meant that we could explore what worked well and what didn’t work so well. We are using these exploratory findings to offer a modified version of to more parents of young cancer survivors. We are about to launch a randomised controlled trial to compare the impact of -Kids, an online and telephone delivered parent program, compared with no intervention, on young survivors’ intake of vegetables and fruit. This trial will use social media and community cancer organisations to advertise the study to potentially reach a greater number of parents. The use of a ‘wait-list’ control means that all parents will be offered the program. The only difference between parents who are randomised to the intervention group and parents who are randomised to the control group, is when they receive the intervention.

Who funded our project?

We are very grateful to all our funders who have made this project possible. This study was originally funded through the Kids Cancer Alliance, The Cancer Institute NSW Sydney, Australia (Grant Number; 11/TRC/1-03). This project is also funded by a Cancer Council NSW Program Grant PG16-02 with the support of the Estate of Late Harry McPaul.

If you would like to learn more about -Kids, visit our webpage at: https://www.behaviouralsciencesunit.org/reboot-kids.html or contact our team at reboot@unsw.edu.au. You can also read more about one parent’s experience in the Reboot program in an interview with the Kids Cancer Project at: https://www.thekidscancerproject.org.au/stories/march-2020/food-for-thought

For more information about Reboot, please see here newsroom.unsw.edu.au/news/health/rebooting-healthy-eating-habits-child-cancer-survivors

To read the paper in full click here