Survivors of Childhood Cancer

The ASSIST Study is designed to explore whether a brief, evidence based substance use screening and counseling approach can be easily integrated into routine survivorship care at St. Jude Children's Research Hospital. During a regularly scheduled psychosocial visit, participants complete the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This short questionnaire helps identify patterns of use related to tobacco, alcohol, cannabis, prescription medications, and other substances. Survivors whose results show possible risk receive a brief, supportive counseling session during the same appointment. This session uses motivational interviewing techniques to help individuals reflect on their use and consider steps to reduce potential harm. Primary Objective: \- Assess the feasibility and acceptability of integrating a standardized substance use screening and brief intervention protocol into routine psychosocial workflows within a survivorship clinic. Secondary Objective: \- Evaluate the fidelity of delivering a brief substance use intervention to reduce substance use behaviors among survivors.

In France today, it is estimated that one in every 850 people aged between 20 and 45 is a childhood cancer survivor (CCS), equivalent to around 40,000 to 50,000 people. Some descriptive studies have established that the diagnosis and treatment of cancer can affect psychological health. A French study published by our team in 2015 and 2020 showed that in adulthood, 40% of CCS had anxiety symptoms, a rate significantly higher than that of the general French population (25%). However, although there are validated scales for screening children for psychological disorders (anxiety, depression, etc.), there is no rapid screening tool that can be used routinely by an oncologist during consultations. So, the study aims to develop and validate a short test, which could easily be carried out systematically during follow-up consultations after childhood cancer. It would make it possible to identify people with no psychological complications and, conversely, those in whom further investigation, based on the classic reference scales for assessing psychological disorders, would be relevant.

Survivors of childhood cancer have a substantially increased risk of long-term health problems in adulthood, including cardiovascular disease, metabolic disorders, psychological morbidity, and impaired health-related quality of life (HRQoL). These risks are partly related to cancer treatment exposures but are also strongly influenced by modifiable lifestyle factors such as physical activity, diet, body weight, and cardiometabolic risk factors. Although healthy lifestyle behaviors are known to reduce morbidity and mortality in this population, many adult childhood cancer survivors do not meet current lifestyle recommendations and rarely receive structured, tailored support to change health behaviors. The Behavioral Reinforcement Intervention for Greater Health Trajectories (BRIGHT) study aims to evaluate whether a person-centered, remotely delivered lifestyle intervention can improve health-related quality of life and key health markers in adult survivors of childhood cancer with an unhealthy lifestyle. The intervention focuses on increasing physical activity and improving dietary habits through structured video-based coaching delivered by trained health promoters over a 26-week period. BRIGHT is conducted within NOPHO-CARE Sweden, a national population-based cohort of childhood cancer survivors, and uses a register-based randomized controlled design with two randomization steps. First, eligible participants are randomized to be offered the intervention or not, enabling evaluation of the population-level effect of offering the intervention through long-term register-based follow-up. Second, participants who consent to active participation are randomized to immediate or delayed start of the intervention, allowing controlled assessment of short-term intervention effects. The primary research question is whether the BRIGHT lifestyle intervention leads to a clinically meaningful improvement in health-related quality of life, measured by the PROPr utility index derived from PROMIS-29, compared with a control period. Secondary questions address whether the intervention improves physical activity, cardiorespiratory fitness, muscle strength, diet quality, body weight, blood pressure, and cardiometabolic and biological markers, including epigenetic age acceleration. The study also examines feasibility, adherence, and scalability of delivering a person-centered lifestyle intervention within a national survivorship follow-up structure. In addition, BRIGHT investigates whether offering the intervention to the full eligible population leads to long-term reductions in cardiovascular disease, metabolic disease, psychiatric morbidity, and mortality, using national health registers. By combining individual-level efficacy and population-level effectiveness within a single study framework, BRIGHT aims to generate robust evidence to inform future preventive care and long-term follow-up strategies for adult survivors of childhood cancer.

The over-arching aim of this study is to evaluate the effects of two specific anti-cancer chemotherapies, vincristine and doxorubicin, on bladder function and urine composition.