The findings show an extensive but largely early-stage research base: 12 of 20 empirical studies were feasibility studies, while eight were efficacy trials. The researchers defined adolescent and young adult childhood cancer survivors as people aged 13 to 39 who had been diagnosed with childhood cancer, meaning a diagnosis before age 21 or a typical childhood cancer arising before age 30. The imbalance was pronounced: 13 of the 17 interventions included a physical-activity component, compared with four addressing tobacco use and two each targeting nutrition and alcohol.

Only three programs crossed behavioral domains, combining physical activity with alcohol and tobacco, tobacco with alcohol, or physical activity with nutrition. The review authors said this distribution is consequential because survivors of childhood cancer face elevated risks of chronic disease and premature death, while physical inactivity, poor diet, risky drinking and tobacco use can compound treatment-related toxicities. They also noted that adolescent and young adult survivors may engage in risk-taking behaviors at rates similar to those of their peers, despite their medical vulnerability.

However, the evidence was too heterogeneous and methodologically uneven to support conclusions about comparative effectiveness or clinical benefit. The physical-activity programs used varied delivery modes, including supervised exercise sessions, university facilities, telehealth consultations, web-based counseling, mobile applications, social-media groups and wearable activity trackers. StepByStep used Fitbits, individualized goals, an Instagram peer group and staff messages over 48 weeks.

Making Moves was designed as an eight-week, self-paced online program with exercise-physiologist consultations, while the SURFit trial offered physiotherapist coaching, pedometers and web-based activity diaries over 12 months. Some interventions delivered skills directly, such as resistance, aerobic and flexibility training, whereas others relied more heavily on self-monitoring, planning and digital feedback. Results from individual studies illustrate why feasibility and efficacy must be interpreted separately.

A 10-participant theory-based program reported initial improvements in physical activity, fitness and quality of life, but activity levels were not maintained at three- or 12-month follow-up. In the 151-participant SURFit trial, the intervention significantly affected a composite cardiovascular-risk score, yet accelerometer and pedometer data showed no effect on physical activity. A counseling trial in 89 survivors found no significant improvement in vigorous activity, although favorable trends emerged during follow-up.

The Fitbit-and-Facebook pilot was feasible and acceptable but produced no significant group differences in activity or sedentary time. By contrast, a six-month home tracker study found a modest, statistically nonsignificant rise in moderate-to-vigorous activity, while a wearable-only observational study recorded adherence falling below one-third within 12 weeks and nearly disappearing by one year. These findings suggest that trackers can support self-monitoring but are not consistently sufficient as stand-alone behavior-change tools.

Nutrition was represented by only two interventions. ENHANCE combined individual telehealth sessions of motivational interviewing, education, problem-solving, goal setting and skills training for nutrition and physical activity. In a pilot randomized trial involving 58 survivors, 96.7% completed all sessions, the intervention was highly feasible, and interventionists demonstrated expert-level proficiency in motivational interviewing on 97% of coded sessions; the publication focused largely on feasibility, acceptability and fidelity rather than establishing efficacy.

The INAYA pilot provided individualized counseling based on German Nutrition Society recommendations to 23 survivors. Twelve participants, or 52.2%, improved their Healthy Eating Index score by 20 points, but the uncontrolled design, small sample and 30% attrition limit causal interpretation. Both nutrition programs emphasized psychological capacity and reflective motivation, yet neither addressed physical capacity or physical and social opportunity.

Alcohol-focused research was equally sparse, and no intervention exclusively targeted alcohol. A six-week web program offered young adult survivors modules, check-ins and tailored information about exercise, drinking and smoking; the pilot was feasible and acceptable, with 85.7% satisfaction, but documented no significant pre-to-post improvements in physical activity, alcohol consumption or tobacco use. Decision KEYS used a 12-month cognitive-behavioral decision-aid program with CD-ROM modules, tailored counseling, booster contacts and videos portraying positive role models and refusal strategies.

The review interpreted this evidence as descriptive and preliminary, not as proof that either program could reduce drinking. Smoking cessation had the largest body of intervention research after physical activity, encompassing four distinct programs and seven publications. The Partnership for Health trials compared proactive telephone counseling by trained childhood cancer survivors with self-help materials.

In a trial of 796 participants, proactive counseling increased quit rates, with benefits sustained at 12 months; participants receiving more calls were more likely to quit, and high self-efficacy strongly predicted cessation, although the intervention cost more than self-help. Long-term follow-up found continued advantages for proactive counseling, with nicotine replacement therapy mediating part of the effect. By contrast, a quit-line trial of 519 survivors produced self-reported abstinence that proved misleading: biochemical testing found that 80% of those claiming abstinence were still using tobacco, and biochemically adjusted cessation rates were below 2%.

The contrast demonstrates why outcome measurement and intervention delivery must be considered alongside self-reported findings. Mapping the programs through the Behavior Change Wheel revealed that they typically used about four of nine intervention functions and addressed about four of six sources of behavior change. All physical-activity programs included enablement, usually through trackers or fitness platforms, and targeted physical opportunity and reflective motivation.

Common functions included education, training, environmental restructuring, incentives and peer modelling; none used coercion or restriction. Every tobacco program addressed psychological capacity and reflective motivation, while most also supported physical or social opportunity, often by providing nicotine replacement therapy or social support. Nutrition and alcohol programs were more dependent on education, knowledge and reflective planning.

Across domains, interventions favored supportive strategies consistent with the value that adolescent and young adults place on autonomy, but physical capacity and automatic motivation were underused, despite the role of conditioned cues in addiction and the importance of sustained habit formation. Major reporting gaps complicate replication and interpretation. Most studies described modes, schedules and procedures clearly enough to outline general delivery, but intervention materials, curricula, message scripts and contextual details were often incomplete.

Only one of the 17 programs publicly provided a provider training manual. Four reported explicit plans for monitoring fidelity, and only one subsequently reported an actual fidelity percentage; many others used attendance, retention or engagement as a proxy for whether the intervention was delivered as intended. Participant characteristics were also reported inconsistently, including age at diagnosis, age at intervention, cancer type and treatment history.

The evidence was geographically concentrated, with 14 of 23 publications coming from the United States, and much of the smoking-cessation research predated widespread vaping. The review therefore supports stronger manualization, standardized reporting, clearer links between theory and techniques, and larger trials with longer follow-up, while its own findings remain a descriptive map rather than a verdict on which programs work.

Subject of Research: Behavior-change interventions for physical activity, nutrition, alcohol use and tobacco cessation among adolescent and young adult childhood cancer survivors

Article Title: Behavior Change Interventions to Promote Healthy Lifestyles Among Adolescent and Young Adult Childhood Cancer Survivors: A Scoping Review

Article References: Gélinas‐Gagné, C., Bilodeau, K., Guarascio, N., Caru, M., Coltin, H., Curnier, D., Desjardins, L., Laverdière, C., Marcil, V., Santiago, R., Vairy, S., & Sultan, S. (2026). Behavior Change Interventions to Promote Healthy Lifestyles Among Adolescent and Young Adult Childhood Cancer Survivors: A Scoping Review. Cancer Reports, 9(10), Article e70721. https://doi.org/10.1002/cnr2.70721

Image Credits: AI Generated

DOI: 10.1002/cnr2.70721

Keywords: childhood cancer survivors, adolescent and young adults, scoping review, physical activity, nutrition, alcohol use, tobacco cessation, behavior change, digital health, survivorship care, Behavior, Change