Andrew Murnane

Objective: Poor sleep is a common issue among adolescents and young adults (AYA) with cancer. The present study describes the feasibility and impact of the Can‐Sleep stepped‐care intervention for AYA with cancer. Methods: A total of 51 AYA with cancer were screened. AYA who reported sleep disturbance (defined as insomnia severity index score [ISI] > 7) received self‐managed cognitive behavioural therapy for insomnia (SMCBT‐I) in the first instance (Step 1) followed by individual cognitive behavioural therapy for insomnia (ICBT‐I) if symptoms continued (Step 2). AYA screened as high risk for intrinsic sleep abnormalities (e.g., obstructive sleep apnoea) were referred to a specialised service. Results: Of the 51 AYA, 38 participants reported sleep disturbance. In total, 37 AYA commenced SMCBT‐I, four attending the specialised sleep service prior. Thirty‐one (84%) completed Step 1. Of these, 45% improved and required no further treatment, and 55% (17) were eligible for ICBT‐I (ISI > 7). Following intervention, the SMCBT‐I group showed a significant decline in insomnia symptoms ( p < 0.001, d = 0.84). Among the 17 AYA continuing to report sleep disturbance, 11 (65%) were referred to ICBT‐I, with 8 (73%) accepting and completing Step 2. Those who received the ICBT‐I showed a significant reduction in insomnia symptoms ( p = 0.007, d = 1.33). Conclusions: This study provides preliminary efficacy and acceptability of a stepped‐care intervention for sleep disturbances in AYA with cancer. A stepped‐care intervention may offer an effective and resource‐efficient method for managing sleep disturbance in AYA with cancer.

Advancements in cancer research, treatment protocols, and supportive care interventions have contributed to an increasing population of adolescent and young adult cancer survivors (AYA-CS). Impaired cardiorespiratory fitness is a key modifiable risk factor in AYA-CS, linked to several conditions, in particular cardiovascular disease. This scoping review describes and synthesizes previously published data that has documented the cardiorespiratory fitness in AYA-CS. Secondary objectives were to synthesize the assessment methodologies used to measure cardiorespiratory fitness and to explore whether exercise interventions improve AYA-CS fitness. CINAHL, EMBASE, MEDLINE, and SPORTDiscus were systematically searched from [28/02/2025]. Original articles that assessed cardiorespiratory fitness in AYA-CS (aged between 15 and 39 at the time of cancer diagnosis and had completed treatment) were eligible. A total of 3049 articles were identified from the database search. After screening, 10 studies were included, representing 494 participants (59.7% female). AYA-CS exhibit markedly reduced cardiorespiratory fitness with peak oxygen uptake values 20–47% below healthy controls when measured via cardiopulmonary exercise test. There was wide variability in both the measures used to assess cardiorespiratory fitness and the types and mode of prescribed exercise interventions. Exercise interventions were primarily individualized and aerobic, demonstrating good feasibility and high acceptability among AYA-CS. This scoping review highlights that AYA-CS experience persistent impairments in cardiorespiratory fitness post-treatment. Future research is required to standardize fitness assessment measures, establishing cardiorespiratory fitness norms to help guide clinical interventions and the development of targeted interventions aimed at improving fitness and health outcomes.

Purpose: The aim of this study is to understand how adolescent and young adult cancer survivors (AYA-CS) interact with exercise and nutrition information and programs after treatment, to explore their experiences in accessing these supports, and to identify where they perceive gaps to be in their care. This will include the perspectives of both AYA-CS and the health care professionals who deliver these services. Methods: A qualitative study using semistructured interviews, undertaken via Zoom. Group 1 consisted of AYA-CS, aged between 15 and 25 years of age at the time of diagnosis who had completed their primary treatment. Group 2 was made up of oncology health care professionals including medical, nursing, and allied health professionals who had a minimum of 2 years’ experience working with AYA cancer patients. Thematic analysis was conducted in an inductive manner to develop themes reflecting the needs and experiences of AYA-CS. Results: Eleven AYA-CS and seven health care professionals, from Australia, treated and working across adult and pediatric settings participated in the interviews. The analysis identified three primary themes “ The ongoing impacts of a cancer diagnosis ,” “ age as a critical construct ,” and “ delivering optimal care .” Conclusions: Findings highlight the number of challenges young people face in accessing necessary well-being supports post-treatment, emphasizing the need for individualized exercise and diet interventions. There is a need for health care services to better identify and tailor support for AYA-CS to ensure that their needs are met. Further research is needed to integrate these priorities into clinical practice.

Cancer treatment for adolescents and young adults (AYA) can be highly challenging and interferes with optimal nutrition, which is vital for healthy development, physical growth, and well-being. Cancer malnutrition and associated negative outcomes are well-studied in adult and paediatric populations, but the specific nutrition complications and requirements for AYA with cancer are poorly understood. This study aims to explore and describe the nutritional status, needs and outcomes of AYA after a diagnosis of cancer. The AYCANN-study (adolescent and young adult cancer nutrition project) adopts a mixed-methods study design, conducted over three inter-related studies; (1) Prospective observational study of AYA between 15 and 25 years, following diagnosis of any cancer type, to quantitatively assess changes in body weight, muscle mass/function, nutritional status, and health related quality of life (HRQoL). Study assessments will be undertaken at four time-points (recruitment, and 2- 4- and 6-months post-recruitment) and will include screening for nutrition risk (PNST or MST); assessment of nutritional status (PG-SGA, mid-upper arm circumference); assessment of muscle strength (hand-grip strength); frequency of dietitian referral, nutrition support and symptoms; and assessment of health-related quality of life (AQoL-6D); (2) Qualitative study using focus groups with AYA to assess access to nutrition related care and preference for nutrition services; (3) Qualitative study, utilising focus groups with oncology healthcare professionals (OHP) to explore and assess current access to nutrition-related care for AYA following a cancer diagnosis along with OHP nutrition education needs, service delivery and research priority areas. For study 1, statistical analysis will be primarily descriptive, and effect size estimates (Cohen’s d) will be used to characterise any differences between nutritional status groups at follow-up assessments. Thematic analysis will be undertaken for study 2 and 3 to understand patients and OHP access to and experience of nutrition-related care. This multi-site longitudinal study will explore and describe the nutritional status, needs and nutrition-related outcomes of AYA after a cancer diagnosis. Results will inform future clinical practice guidelines and interventional nutrition research targeting patients identified at greater risk of nutritional complications.

Purpose: To investigate cardiorespiratory fitness (CRF), body composition, health behaviors, and health-related quality of life (HRQoL) in adolescent and young adult cancer survivors (AYA-CS) compared with age-matched counterparts without a cancer diagnosis. Methods: This cross-sectional study recruited participants aged 15–25 years at the time of their cancer diagnosis and ≥ 5 years post-treatment. Participants completed cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, food diaries, physical activity (PA), fatigue, and HRQoL questionnaires. Results: We recruited 22 participants aged 27.9 (standard deviation [SD] 3.3) years (54.5% female) and 7.2 (SD 2.2) years post-treatment. AYA-CS had lower CRF compared with age-matched norms (female 27.1 vs. 39.1 mL/kg/min, p ≤ 0.0001; male: 39.7 vs. 45.6 mL/kg/min, p = 0.04). Bone mineral density Z -scores were all within normal ranges; however, male AYA-CS had higher body fat percentage (male: 27.1% vs. 21.2%, p = 0.01) and a trend toward higher body fat percentage in female AYA-CS (32.2% vs. 29.8%, p = 03). AYA-CS had lower HRQoL, with no difference observed with fatigue. A higher proportion of AYA-CS met recommendations for weekly PA (36.4% vs. 27.3%, p = 0.34) and daily servings of fruit and vegetables (13.6% vs. 3.9%, p = 0.02) compared with normative data, demonstrating better health behaviors. A higher proportion of AYA-CS reported one or more chronic diseases compared with Australian normative data (63.7% vs. 41.5%, p = 0.04). Conclusions: AYA-CS exhibit significantly lower CRF and unfavorable body composition to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase the risk of multimorbidity development. Interventions are needed to address these issues to improve health outcomes in AYA-CS.

Introduction: Current knowledge of the long‐term health behaviours and well‐being of adolescent and yong adult (AYA) cancer survivors is limited. The aim of this study was to evaluate the health behaviours of AYA cancer survivors compared to Australian normative data and describe their health‐related quality of life (HR‐QoL) and levels of fatigue.Method: A cross‐sectional online survey of participants aged 15–25 years at diagnosis and 2–7 years post treatment completion was conducted at a comprehensive cancer centre. Validated questionnaires assessed health behaviours and functioning including current physical activity (PA) levels, diet quality, fatigue (FACIT‐F) and HR‐QoL (AQoL‐6D, Short Form 36v2 [SF‐36v2]) were compared to Australian normative data.Results: Ninety individuals completed the survey (26% response rate) with a mean age of 25.4 years and median time post treatment of 61 months (24–85 months). Compared to normative data, a higher proportion of AYA cancer survivors was consuming the recommended daily serves of fruit and vegetables (16.7% vs. 3.9%, p < .0001), had a lower presence of overweight or obesity (46.7% vs. 57.7%, p = .04) and lower percentage of current smokers (2.2% vs. 16.7%, p < .0001). However, AYA cancer survivors reported increased fatigue (t[df = 596] = −4.1, p < .0001) and reduced HR‐QoL compared to normative data (t[df = 533] = 9.2, p < .0001) along with a higher proportion suffering from one or more chronic health conditions (65% vs. 40%, p < .0001).Conclusion: AYA cancer survivors from a single Australian institution, who were on average 5 years post treatment, exhibited better health behaviours compared to Australian normative data, but still below recommended guidelines. However, they continue to experience issues with fatigue and reduced HR‐QoL, especially in those not meeting the PA guidelines.

Background: Exercise physiologists and physiotherapists can provide exercise interventions for cancer survivors; however, many do not access this support. Our primary aim explored referral habits to exercise professionals and attitudes of oncology professionals. Secondary aims explored fitness levels of oncology professionals and the relationship between fitness and exercise referral habits.Methods: Oncology professionals (n = 67) attending a national cancer conference in Australia participated in this cross‐sectional study (23% doctors, 11% nurses, 25% allied health, and 41% other). A subgroup (n = 49) completed a fitness assessment measuring aerobic fitness (3‐minute step test), muscle strength (handgrip dynamometry), and body composition (waist‐to‐hip ratio). Oncology professionals in a position to refer patients to exercise professionals were assessed on their history of patient referrals.Results: Sixty‐seven of 750 eligible conference delegates participated (9% recruitment rate), of which 73% completed fitness assessments. Participants displayed above average physical activity and fitness levels with 60% meeting exercise guidelines. The majority (92%) agreed that exercise is important among cancer survivors to attenuate treatment‐associated symptoms. Most understand the role of exercise physiologists (61%) and physiotherapists (64%) in cancer care. Seventy‐three percent reported that referral to exercise professionals is optimal to increase exercise participation. Most (82%) oncology professionals who are able to refer patients to exercise professionals have self‐reported doing so, while 91% recommended exercise themselves. Sixty‐two percent were aware of evidence‐based exercise guidelines. Fitness levels (p = 0.25), strength (p = 0.88), and physical activity (p = 0.33) did not impact referrals made to exercise professionals.Conclusion: There was high awareness exercise‐oncology benefits and evidence‐based guidelines existed among sampled participants. Oncology professionals understand the role of exercise professionals, reflected by high self‐reported referral rates. Implementing referral pathways to exercise professionals in cancer care may facilitate improved patient outcomes.

Background: Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10‐week exercise intervention was associated with improved cardiorespiratory fitness (VO_2peak), fatigue, and QOL in AYA who have recently completed cancer treatment.Method: Forty‐three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n = 22) or a control group (n = 21). The exercise group received a structured 10‐week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO_2peak was measured at baseline, 10 weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively.Results: Mean VO_2peak at baseline was 26.5 ± 7.2 mL.kg⁻¹.min⁻¹, which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO_2peak at 10 weeks compared with controls (33.8 ± 8.1 vs 29.6 ± 7.6 mL.kg⁻¹.min⁻¹, P = 0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0 vs 30.9 ± 11.0 mL.kg⁻¹.min⁻¹, P = 0.21). There were no significant differences in fatigue or total QOL scores between groups.Conclusion: Cancer treatment is associated with reduced VO_2peak in AYA. Improvement in VO_2peak was accelerated by a 10‐week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO_2peak at six months suggests that a maintenance exercise program may be beneficial.

Introduction There is increasing evidence demonstrating the benefits of exercise in counteracting cancer treatment-related fatigue. Immunotherapy is an established treatment for advanced melanoma, and is associated with fatigue in a third of patients. The safety and efficacy of exercise in counteracting treatment-related fatigue in patients with advanced melanoma receiving immunotherapy are yet to be determined. This study aims to assess the safety, adherence to and acceptability of a mixed-methods parallel-group, pilot randomised controlled trial of a personalised, 12-week semi-supervised exercise programme prescribed by an exercise physiologist (iMove) in 30 patients with stage IV melanoma scheduled to commence immunotherapy: single agent ipilimumab, nivolumab or pembrolizumab, or combination ipilimumab and nivolumab. The trial will be used to provide preliminary evidence of the potential efficacy of exercise for managing fatigue. Methods and analysis Thirty participants will be recruited from a specialist cancer centre between May and September, 2019. Participants will be randomised 1:1 to receive iMove, or usual care (an information booklet about exercise for people with cancer). Feasibility data comprise: eligibility; recruitment and retention rates; adherence to and acceptability of exercise consultations, personalised exercise programme and study measures; and exercise-related adverse events. Patient-reported outcome measures assess potential impact of the exercise intervention on: fatigue, role functioning, symptoms and quality of life. Follow-up will comprise five time points over 24 weeks. Physical assessments measure physical fitness and functioning. Ethics and dissemination This study was reviewed and approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/48927/PMCC-2019). The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with clinicians, media, government and consumers. In particular, we will promote the outcomes of this work among the oncology community should this pilot indicate benefit for patients. Trial registration number ACTRN12619000952145; Pre-results.

Background: Exercise in the adult oncology setting has proven to be an effective intervention in improving patients' physical condition and mental health and reducing treatment side effects; however, its role in the adolescent and young adult (AYA) population is less well understood. This study aimed to explore the effects of an exercise physiology (EP) intervention on the functional capacity of AYA diagnosed with malignancy. Methods: A prospective, single-institution cohort study was conducted of all AYA patients who were referred to the EP service and participated in baseline and postintervention assessment. Patients were provided with an individualized exercise program aimed at improving functional capacity as measured by the Six-Minute Walk Test, maximum push-ups, arm curls, and Sit-to-Stand Test, and a hand-held dynamometer was used to measure limb strength. Results: Fifty-one patients were included in the analysis, with predominant histological subgroups being sarcoma (37%) and lymphoma (26%). Thirty-seven percent of patients completed the program while on treatment and 63% were posttreatment. For those on treatment, there were significant improvement between baseline and postintervention strength assessments in sit-to-stand, push-ups, and arm curls, with robust effect sizes (Cohen's d _R) ranging from small (d _R = −0.02, U ₃ = 49%) to large (d _R = 1.05, U ₃ = 85%). For posttreatment AYA, there were differences between all baseline and postintervention functional and strength assessments, with effect sizes ranging from small (d _R = 0.30, U ₃ = 61.8%) to large (d _R = 1.29, U ₃ = 90.1%). Conclusion: An individualized exercise intervention had a positive effect on AYA cancer patients' physical performance both while undergoing treatment and posttreatment. Future randomized controlled trials are required to validate these findings.