[Living Actively with Cancer - Recommendations for a Healthy Life Style: Needs Assessment and Design of Multimedia Patient Information]. / "Aktiv leben mit Krebs ­ Tipps für einen gesunden Lebensstil" ­ Bedarfserfassung und Entwicklung einer multimedialen Patienteninformation.

The positive effects of a healthy lifestyle on the holistic physical condition and quality of life of cancer survivors is scientifically proven. The National Comprehensive Cancer Network (NCCN) Guidelines for Survivorship specifically highlight the need for support in these areas. The lack of specialised offers for cancer patients in predominantly rural areas, however, represents a high level of assistance needed in terms of the development and implementation of a healthy lifestyle. Following a needs assessment, our aim was to conceptualise and design an easily accessible multi-media patient information system on the basis of a social-cognitive process model on health behaviour (Health Action Process Approach - HAPA). A higher level of health literacy represents, inter alia, the basis for informed choice and, as such, forms an important resource for the aftercare of cancer patients. Further studies are recommended on the acceptance, use and effects of patient information with regard to intended longer-term changes of health behaviour.

Fascia training in patients undergoing allogeneic hematopoietic cell transplantation-a pilot study.

PURPOSE: Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) spend many weeks of treatment in an isolated environment with little room for exercise. Feasibility of a daily-performed, unassisted fascia-training program and its effects on back and foot pain, back flexibility, and quality of life were investigated. METHODS: Eighteen patients receiving alloHCT were randomized to an intervention (IG: n = 9; 60.7 ± 9.2 years) or control group (CG: n = 9; 54.0 ± 15.5 years) and assessed from 1 week before to 3 weeks after transplantation (t0-t3). CG received standard care physical therapy, IG performed additionally fascia training for the back and feet twice daily. Back and foot pain, back flexibility, muscle tone, and quality of life were assessed for both IG and CG at baseline and three timepoints after alloHCT. RESULTS: Fascia-training program was well accepted. No increase in hematoma formation was observed. IG reported a trend towards reduction in back pain from pre- to post-intervention (p = .074), whereas CG showed a slight increase in back pain at t3 (p = .257). IG also improved back flexibility (- 1.79 ± 5.5 cm; p = .397) while CG declined (+ 2.71 ± 5.6 cm; p = .167). No differences between groups were found for muscle tone and no significant improvements in quality of life were reported at t3. CONCLUSION: Unassisted fascia training is feasible and safe for patients undergoing alloHCT. This pilot study suggests that fascia training has the potential to improve back flexibility and reduce back pain, and might be a valuable component for physical therapy in patients receiving alloHCT.

Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination.

Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the 'Clever in Sun and Shade for Preschools' program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES -0.56, CI -0.82 -0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.

UV protection for young athletes: using participatory program planning to develop a sports schools program.

BACKGROUND: The incidence of melanoma increased rapidly throughout the last decades, with overexposure to ultraviolet (UV) radiation being an established risk factor. Due to their intensive sun exposure, many student athletes (SAs) have an increased risk for skin cancer. The Clever in Sun and Shade Program (CSSP) aims at enforcing positive attitudes toward UV protection (UVP) and at supporting sports schools in establishing UVP strategies. METHODS: CSSP was developed in 2019 using participatory program planning (PPP) as well as following WHO recommendations for UVP at schools. After drafting first material, within a PPP groups were conducted at a partner school (convenience sample 1) with students (n = 20), teachers (n = 5), school administration (n = 2), and coaches (n = 5). Materials were then adapted. Program acceptance and feasibility were tested at two further schools (convenience sample 2) with PPP groups of students (n = 95) and school administration (n = 2). Content analyses and descriptive statistics were conducted. RESULTS: Less than 50% of SAs and coaches of sample 1 expressed positive attitudes toward UVP, less than 10% reported appropriate UVP behavior. By using PPP, program material was adapted to the target groups' needs, i.e., by including specific barriers and solutions. Only the most accepted video drafts were produced. The majority of SAs of sample 2 (80-86%) used predominantly positive adjectives such as "important" and "positive" to describe the completed videos and the behavior self-check poster. CONCLUSIONS: PPP process has greatly influenced concept and materials of CSSP for sports schools. Integration of future program participants has proven to be an important component in creating a fitting and feasible program. CSSP for sports schools is a program free of charge that enables sports schools to integrate UVP into their daily routine. It will be disseminated in cooperation with German Olympic Sports Confederation and German Cancer Aid in 2021.

Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated. METHODS: This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I2), and moderator effects in terms of regression coefficients. RESULTS: This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18-0.37) on PA, and I2=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES. CONCLUSION: Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.

Be smart against cancer! A school-based program covering cancer-related risk behavior.

BACKGROUND: Several studies suggest that most school-age children are poorly informed about cancer risk factors. This study examines the effectiveness of the 'Be smart against cancer' (BSAC) program in promoting cancer awareness and intentions to engage in health-promoting behavior. METHODS: 235 seventh-grade students were randomized to either the intervention (N = 152) or the wait-control group (N = 83). The intervention included the modules: "What is cancer?," "Sun protection," "Non smoking," and "Physical activity, Healthy nutrition, and Limited alcohol consumption." Outcomes measured at baseline and at the end of the one week BSAC program included knowledge of cancer and its behavioral risk factors, health-promoting intentions, and reported risk behavior. RESULTS: BSAC was effective in increasing knowledge about cancer and risk factors for cancer (p < .001), as well as in increasing intentions to engage in health-promoting behavior (p < .001), independent of a student's risk profile. Knowledge did not serve as a mediator for intention building. CONCLUSIONS: The BSAC is an effective school-based program for raising awareness of cancer, associated risk factors and intentions to engage in cancer-preventive behavior. The results indicate that the effectiveness of BSAC is independent of a student's risk profile. Therefore, it holds considerable promise as a broadly applicable program to raise cancer awareness and promote healthy behavior intentions.