Lifestyle Behaviors and Physical Health in Canadian Childhood, Adolescent, and Young Adult Cancer Survivors

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Abstract
Background: With this study, we aimed to investigate the longitudinal relationships between lifestyle behaviors and physical health in childhood, adolescent, or young adult (CAYA) cancer survivors attending the Long‐Term Survivor's Clinic (LTSC) in Calgary, Canada. Methods: Survivors attended the LTSC once or twice a year and completed a questionnaire at each visit. Among survivors of any cancer diagnosis who were aged ≥ 11 years at the time of assessment, physical health was captured using two outcomes: the number of self‐reported physical health problems and the number of physical health‐related medications used. Self‐reported lifestyle behaviors, including physical activity, alcohol, tobacco, and cannabis use, and sleep quality were scored as healthy (1) or unhealthy (0), and combined into a sum score ranging from 0 to 5. Multivariable, generalized linear mixed models (GLMM) were estimated to assess the association between lifestyle behaviors (sum score and individual behaviors) and physical health outcomes, irrespective of time. To address our second research question, cross‐lagged GLMMs, incorporating a time component, were estimated to assess directionality between lifestyle sum score and the number of physical health problems. Results: In total, 766 responses from 312 CAYA cancer survivors (median age at follow‐up 23.8 years; 49% male; 37% diagnosed with leukemia) were included. A healthier lifestyle sum score and sufficient physical activity were associated with fewer physical health problems (estimate −0.15, SE 0.06, p ‐value 0.02 and estimate −0.23, SE 0.11, p ‐value 0.04, respectively). No significant associations were found between lifestyle and the number of medications used. Lifestyle behaviors at an earlier time did not predict better physical health at a later time and vice versa. Conclusions: Findings confirm an association between a healthy lifestyle and fewer physical health problems. Additional studies are warranted to further elucidate directional pathways between a survivor's lifestyle and physical health.

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