BACKGROUND: Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. METHODS: MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). RESULTS: Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. CONCLUSION: This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.

Center for Preventive Medicine and Digital Health Department for Prevention Medical Faculty Mannheim Heidelberg University Mannheim Germany

Childhood Cancer International Europe Vienna Austria

Childhood Cancer Research Group Danish Cancer Society Research Center Copenhagen Denmark

Department of Clinical Medicine and Faculty of Health Aarhus Universitet Aarhus Denmark

Department of Hematology Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen The Netherlands

Department of Oncology Paediatric Oncology KU Leuven Department of Paediatric Haematology and Oncology University Hospitals Leuven Leuven Belgium

Department of Paediatrics Emma Children's Hospital Amsterdam The Netherlands

Department of Pediatric and Adolescent Medicine Kepler University Clinic Linz Austria

Department of Pediatric Oncology and Hematology Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

DOPO clinic Department of Hematology Oncology IRCCS Istituto Giannina Gaslini Genoa Italy

Faculty of Health Sciences and Medicine University of Lucerne Lucerne Switzerland

Faculty of Medicine Utrecht University and Utrecht Medical Center Utrecht The Netherlands

Great North Children's Hospital Royal Victoria Infirmary Newcastle Upon Tyne UK

Institute of Social and Preventive Medicine University of Bern Bern Switzerland

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

PanCare Bussum The Netherlands

Population Health Sciences Institute Centre for Cancer Newcastle University Newcastle upon Tyne UK

Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands

St Anna Children's Hospital Vienna Austria

Translational and Clinical Research Institute Wolfson Childhood Cancer Research Centre Newcastle Upon Tyne UK

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