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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Gatta G, Zigon G, Capocaccia R, et al. Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer. 2009;45(6):992‐1005. doi:10.1016/j.ejca.2008.11.042 PubMed DOI

National Cancer Institute . Adolescents and Young Adults with Cancer. Accessed 9/6/2023. https://www.cancer.gov/types/aya

Leerink JM, De Baat EC, Feijen EAM, et al. Cardiac disease in childhood cancer survivors. JACC CardioOncol. 2020;2(3):363‐378. doi:10.1016/j.jaccao.2020.08.006 PubMed DOI PMC

den Hoed MAH, Klap BC, te Winkel ML, et al. Bone mineral density after childhood cancer in 346 long‐term adult survivors of childhood cancer. Osteoporos Int. 2015;26(2):521‐529. doi:10.1007/s00198-014-z PubMed DOI

Friedman DN, Tonorezos ES, Cohen P. Diabetes and metabolic syndrome in survivors of childhood cancer. Horm Res Paediatr. 2019;91(2):118‐127. doi:10.1159/000495698 PubMed DOI PMC

Turcotte LM, Liu Q, Yasui Y, et al. Chemotherapy and risk of subsequent malignant neoplasms in the childhood cancer survivor study cohort. J Clin Oncol. 2019;37(34):3310‐3319. doi:10.1200/JCO.19.00129 PubMed DOI PMC

Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK. Pulmonary outcomes in survivors of childhood cancer. Chest. 2011;140(4):881‐901. doi:10.1378/chest.10-2133 PubMed DOI PMC

Christen S, Roser K, Mulder RL, et al. Recommendations for the surveillance of cancer‐related fatigue in childhood, adolescent, and young adult cancer survivors: a report from the international late effects of childhood cancer guideline harmonization group. J Cancer Surviv. 2020;14(6):923‐938. doi:10.1007/s11764-020-00904-9 PubMed DOI PMC

Wu NL, Hingorani S, Cushing‐Haugen KL, Lee SJ, Chow EJ. Late kidney morbidity and mortality in hematopoietic cell transplant survivors. Transplant Cell Ther. 2021;27(5):434.e1‐434.e6. doi:10.1016/j.jtct.2021.02.013 PubMed DOI PMC

Meacham LR, Chow EJ, Ness KK, et al. Cardiovascular risk factors in adult survivors of pediatric cancer—a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2010;19(1):170‐181. doi:10.1158/1055-9965.EPI-09-0555 PubMed DOI PMC

Jones LW, Liu Q, Armstrong GT, et al. Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol. 2014;32(32):3643‐3650. doi:10.1200/JCO.2014.56.7511 PubMed DOI PMC

Travis LB. Lung cancer following chemotherapy and radiotherapy for hodgkin's disease. Cancer Spectr Knowl Environ. 2002;94(3):182‐192. doi:10.1093/jnci/94.3.182 PubMed DOI

Smith WA, Li C, Nottage KA, et al. Lifestyle and metabolic syndrome in adult survivors of childhood cancer: a report from the st. Jude lifetime cohort study: metabolic syndrome in childhood cancer. Cancer. 2014;120(17):2742‐2750. doi:10.1002/cncr.28670 PubMed DOI PMC

Schindera C, Zürcher SJ, Jung R, et al. Physical fitness and modifiable cardiovascular disease risk factors in survivors of childhood cancer: a report from the SURfit study. Cancer. 2021;127(10):1690‐1698. doi:10.1002/cncr.33351 PubMed DOI

Watson M, Holman DM, Maguire‐Eisen M. Ultraviolet radiation exposure and its impact on skin cancer risk. Semin Oncol Nurs. 2016;32(3):241‐254. doi:10.1016/j.soncn.2016.05.005 PubMed DOI PMC

Tonorezos ES, Robien K, Eshelman‐Kent D, et al. Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia. Cancer Causes Control. 2013;24(2):313‐321. PubMed PMC

Mays D, Black JD, Mosher RB, Heinly A, Shad AT, Tercyak KP. Efficacy of the survivor health and resilience education (share) program to improve bone health behaviors among adolescent survivors of childhood cancer. Ann Behav Med. 2011;42(1):91‐98. doi:10.1007/s12160-011-9261-5 PubMed DOI PMC

Mays D, Black JD, Mosher RB, Shad AT, Tercyak KP. Improving short‐term sun safety practices among adolescent survivors of childhood cancer: a randomized controlled efficacy trial. J Cancer Surviv. 2011;5(3):247‐254. doi:10.1007/s11764-011-0177-7 PubMed DOI PMC

Hudson MM, Tyc VL, Srivastava DK, et al. Multi‐component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. Med Pediatr Oncol. 2002;39(1):2‐11. doi:10.1002/mpo.10071 PubMed DOI

Emmons KM, Puleo E, Park E, et al. Peer‐delivered smoking counseling for childhood cancer survivors increases rate of cessation: the partnership for health study. J Clin Oncol. 2005;23(27):6516‐6523. doi:10.1200/JCO.2005.07.048 PubMed DOI

Emmons KM, Puleo E, Mertens A, Gritz ER, Diller L, Li FP. Long‐term smoking cessation outcomes among childhood cancer survivors in the partnership for health study. J Clin Oncol. 2009;27(1):52‐60. doi:10.1200/JCO.2007.13.0880 PubMed DOI PMC

Rueegg CS, Gianinazzi ME, Michel G, et al. Do childhood cancer survivors with physical performance limitations reach healthy activity levels?: performance limitations & physical activity. Pediatr Blood Cancer. 2013;60(10):1714‐1720. doi:10.1002/pbc.24595 PubMed DOI

Ness KK, Hudson MM, Ginsberg JP, et al. Physical performance limitations in the childhood cancer survivor study cohort. J Clin Oncol. 2009;27(14):2382‐2389. doi:10.1200/JCO.2008.21.1482 PubMed DOI PMC

Cox CL, Zhu L, Finnegan L, et al. Survivor profiles predict health behavior intent: the childhood cancer survivor study: profiling survivors for risk‐based care. Psychooncology. 2012;21(5):469‐478. doi:10.1002/pon.1935 PubMed DOI PMC

Le A, Mitchell HR, Zheng DJ, et al. A home‐based physical activity intervention using activity trackers in survivors of childhood cancer: a pilot study. Pediatr Blood Cancer. 2017;64(2):387‐394. doi:10.1002/pbc.26235 PubMed DOI

Keats MR, Culos‐Reed SN, Courneya KS, McBride M. Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior. Psychooncology. 2007;16(5):448‐457. doi:10.1002/pon.1075 PubMed DOI

Emmons KM, Butterfield RM, Puleo E, et al. Smoking among participants in the childhood cancer survivors cohort: the Partnership for Health Study. J Clin Oncol. 2003;21(2):189‐196. doi:10.1200/jco.2003.06.130 PubMed DOI

Mayes J, Brown MC, Davies N, Skinner R. Health promotion and information provision during long‐term follow‐up for childhood cancer survivors: a service evaluation. Pediatr Hematol Oncol. 2016;33(6):359‐370. doi:10.1080/08880018.2016.1225325 PubMed DOI

Pugh G, Hough R, Gravestock H, Haddrell JB, Beeken RJ, Fisher A. The lifestyle information and intervention preferences of teenage and young adult cancer survivors. Cancer Nurs. 2018;41(5):389‐398. doi:10.1097/ncc.0000000000000508 PubMed DOI PMC

Bouwman E, Pluijm SMF, Stollman I, et al. Perceived barriers and facilitators to health behaviors in European childhood cancer survivors: a qualitative PanCareFollowUp study. Cancer Med. 2023;12(11):12749‐12764. doi:10.1002/cam4.5911 PubMed DOI PMC

Dugan KF, Hidde MC, Chard CA, Graham DJ, Withycombe JS, Leach HJ. Exploring social ecological determinants of physical activity among adult survivors of childhood cancer. J Adolesc Young Adult Oncol. 2020;10:316‐325. doi:10.1089/jayao.2019.0169 PubMed DOI

Klosky JL, Howell CR, Li Z, et al. Risky health behavior among adolescents in the childhood cancer survivor study cohort. J Pediatr Psychol. 2012;37(6):634‐646. doi:10.1093/jpepsy/jss046 PubMed DOI PMC

Alexander GK, Bashore L, Brooks V. Improving food literacy and access among young adult cancer survivors. Cancer Nurs. 2021;45:161‐166. doi:10.1097/ncc.0000000000000992 PubMed DOI

Cheung Y, Yang L, Ma JC, et al. Health behavior practices and expectations for a local cancer survivorship programme: a cross‐sectional study of survivors of childhood cancer in Hong Kong. Hong Kong Med J. 2022;28(1):33‐44. doi:10.12809/hkmj209112 PubMed DOI

Cox CL, Montgomery M, Oeffinger KC, et al. Promoting physical activity in childhood cancer survivors. Cancer. 2009;115(3):642‐654. doi:10.1002/cncr.24043 PubMed DOI PMC

Fluehr M, Kwok G, Stapleton JL, Masterson M, Devine KA. Factors associated with sun protection behaviors among childhood cancer survivors. Pediatr Hematol Oncol. 2023;45(3):e323‐e327. doi:10.1097/mph.0000000000002618 PubMed DOI PMC

Arroyave WD, Clipp EC, Miller PE, et al. Childhood cancer survivors' perceived barriers to improving exercise and dietary behaviors. Oncol Nurs Forum. 2008;35(1):121‐130. PubMed

Ness KK, Leisenring WM, Huang S, et al. Predictors of inactive lifestyle among adult survivors of childhood cancer. Cancer. 2009;115(9):1984‐1994. doi:10.1002/cncr.24209 PubMed DOI PMC

Rueegg CS, Von der Weid NX, Rebholz CE, et al. Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population‐based questionnaire survey. PLoS One. 2012;7(4):e34930. doi:10.1371/journal.pone.0034930 PubMed DOI PMC

Bhandari R, Teh JB, Herrera C, et al. Prevalence and risk factors for vitamin D deficiency in long‐term childhood cancer survivors. Pediatr Blood Cancer. 2021;68(7):e29048. doi:10.1002/pbc.29048 PubMed DOI

Zhang FF, Ojha RP, Krull KR, et al. Adult survivors of childhood cancer have poor adherence to dietary guidelines. J Nutr. 2016;146(12):2497‐2505. doi:10.3945/jn.116.238261 PubMed DOI PMC

Bougas N, Fresneau B, Pinto S, et al. Smoking and cannabis use among childhood cancer survivors: results of the French childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2021;30(10):1965‐1973. doi:10.1158/1055-9965.epi-21-0193 PubMed DOI

Lown EA, Goldsby R, Mertens AC, et al. Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction. 2008;103(7):1139‐1148. doi:10.1111/j.1360-0443.2008.02242.x PubMed DOI PMC

Kahalley LS, Robinson LA, Tyc VL, et al. Risk factors for smoking among adolescent survivors of childhood cancer: a report from the childhood cancer survivor study. Pediatr Blood Cancer. 2011;58(3):428‐434. doi:10.1002/pbc.23139 PubMed DOI PMC

Slater ME, Kelly AS, Sadak KT, Ross JA. Active transportation in adult survivors of childhood cancer and neighborhood controls. J Cancer Surviv. 2015;10(1):11‐20. doi:10.1007/s11764-015-0447-x PubMed DOI PMC

Zwemer EK, Mahler HI, Werchniak AE, Recklitis CJ. Sun exposure in young adult cancer survivors on and off the beach: results from project REACH. J Cancer Surviv. 2011;6(1):63‐71. doi:10.1007/s11764-011-0201-y PubMed DOI

Florin TA, Fryer GE, Miyoshi T, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1356‐1363. doi:10.1158/1055-9965.epi-07-0048 PubMed DOI

Cappelli C, Miller KA, Ritt‐Olson A, Pentz MA, Salahpour S, Milam JE. Binge drinking, tobacco, and marijuana use among young adult childhood cancer survivors: a longitudinal study. J Pediatr Oncol Nurs. 2021;38:285‐294. doi:10.1177/10434542211011036 PubMed DOI

Darabos K, Barakat LP, Schapira M, Hill‐Kayser C, Schwartz LA. Association of Demographic and Cancer‐Specific Factors on health behavior recommendations specific to cancer prevention and control among adolescent and young adult survivors of childhood cancer. J Adolesc Young Adult Oncol. 2020;10:619‐628. doi:10.1089/jayao.2020.0130 PubMed DOI PMC

Rueegg CS, Michel G, Wengenroth L, von der Weid NX, Bergstraesser E, Kuehni CE. Physical performance limitations in adolescent and adult survivors of childhood cancer and their siblings. PLoS One. 2012;7(10):e47944. doi:10.1371/journal.pone.0047944 PubMed DOI PMC

Whitsett SF, Guðmundsdóttir M, Davies B, McCarthy P, Friedman DN. Chemotherapy‐related fatigue in childhood cancer: correlates, consequences, and coping strategies. J Pediatr Oncol. 2008;25(2):86‐96. doi:10.1177/1043454208315546 PubMed DOI

Marchak JG, Kegler MC, Meacham LR, Mertens AC, Effinger KE. Cancer‐related barriers to health behaviors among adolescent and young adult survivors of pediatric cancer and their families. J Adolesc Young Adult Oncol. 2022;12(1):118‐122. doi:10.1089/jayao.2021.0169 PubMed DOI

Lucıa A, Earnest CP, Pérez M. Cancer–related fatigue: can exercise physiology assist oncologists? Lancet Oncol. 2003;4(10):616‐625. doi:10.1016/s1470-2045(03)01221-x PubMed DOI

Brunton G, Harden A, Rees R, et al. Children and Physical Activity: a Systematic Review of Barriers and Facilitators. 2003. In: Database of Abstracts of Reviews of Effects (DARE): Quality‐Assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK); 1995. Available from: http://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20and%20summaries/Children_PA.pdf?ver=2006‐03‐02‐124608‐950

Burke SM, Brunet J, Wurz A, Butler C, Utley A. Cycling through cancer: exploring childhood cancer Survivors' experiences of well‐ and ill‐being. Adapt Phys Act Q. 2017;34(4):345‐361. doi:10.1123/apaq.2016-0011 PubMed DOI

Mbabazi J, Kanmodi KK, Kunonga E, Tolchard B, Nnyanzi LA. Barriers and facilitators of physical activity. J Health Allied Sci NU. 2022;13:019‐027. doi:10.1055/s-0042-1753561 DOI

Rosselli M, Ermini E, Tosi B, et al. Gender differences in barriers to physical activity among adolescents. Nutr Metab Cardiovasc Dis. 2020;30(9):1582‐1589. doi:10.1016/j.numecd.2020.05.005 PubMed DOI

Brown MC, Podmore M, Araújo‐Soares V, Skinner R, Sharp L. Childhood cancer survivors' perceptions of the barriers and facilitators to physical activity: a systematic review and thematic synthesis of qualitative evidence using the theoretical domains framework. Health. Psychol Rev. 2022;17:1‐24. doi:10.1080/17437199.2022.2032795 PubMed DOI

World Health Organization. Global status report on alcohol and health 2018 . Published September 27, 2018. https://www.who.int/publications/i/item/9789241565639

Taylor GMJ, Baker AL, Fox N, Kessler DS, Aveyard P, Munafò MR. Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals. BJPsych Advances. 2021;27(2):85‐95. doi:10.1192/bja.2020.52 PubMed DOI PMC

WHO global report on trends in prevalence of tobacco use 2000–2025, third edition. www.who.int.https://www.who.int/publications/i/item/who‐global‐report‐on‐trends‐in‐prevalence‐of‐tobacco‐use‐2000‐2025‐third‐edition

Holman DM, Berkowitz Z, Guy GP Jr, Hawkins NA, Saraiya M, Watson M. Patterns of sunscreen use on the face and other exposed skin among US adults. J Am Acad Dermatol. 2015;73(1):83.e1‐92.e1. doi:10.1016/j.jaad.2015.02.1112 PubMed DOI PMC

Sleddens EF, Kroeze W, Kohl LF, et al. Determinants of dietary behavior among youth: an umbrella review. Int J Behav Nutr Phys Act. 2015;12(1):7. doi:10.1186/s12966-015-0164-x PubMed DOI PMC

Sleddens EFC, Kroeze W, Kohl LFM, et al. Correlates of dietary behavior in adults: an umbrella review. Nutr Rev. 2015;73(8):477‐499. doi:10.1093/nutrit/nuv007 PubMed DOI PMC

Kang KA, Han SJ, Chun J, et al. Healthy lifestyle interventions for childhood and adolescent cancer survivors: a systematic review and meta‐analysis. Child health. Nurs Res. 2023;29(2):111‐127. doi:10.4094/chnr.2023.29.2.111 PubMed DOI PMC

Sainsbury K, Walburn J, Foster L, et al. Improving photoprotection in adults with xeroderma pigmentosum: personalisation and tailoring in the “XPAND” intervention. Health Psychol Behav Med. 2020;8(1):543‐572. doi:10.1080/21642850.2020.1840379 PubMed DOI PMC

Araújo‐Soares V, Hankonen N, Presseau J, Rodrigues A, Sniehotta FF. Developing behavior change interventions for self‐Management in Chronic Illness. Eur Psychol. 2019;24(1):7‐25. doi:10.1027/1016-9040/a000330 PubMed DOI PMC

Bouwman E, Pluijm SMF, Stollman I, et al. Healthcare professionals' perceived barriers and facilitators of health behavior support provision: a qualitative study. Cancer Med. 2022;12:7414‐7426. doi:10.1002/cam4.5445 PubMed DOI PMC

Lie HC, Juvet LK, Street RL, et al. Effects of Physicians' information giving on patient outcomes: a systematic review. J Gen Intern Med. 2021;37(3):651‐663. doi:10.1007/s11606-021-07044-5 PubMed DOI PMC

Efficacy of the PanCareFollowUp eHealth Lifestyle Intervention for Survivors of Childhood, Adolescent and Young Adult Cancer