Health-Related Behaviour Among Children of Childhood Cancer Survivors in Germany

Abstract

Purpose: Childhood cancer survivors fear that previous therapy could not only impair their own but also their children’s health. We examined whether health-related behaviour in children of childhood cancer survivors differs from the general population.

Methods: Our first nationwide survey wave (2013–2014) surveyed offspring health in 396 German childhood cancer survivors known to have a child of their own. Answers about health behaviour were analysed using descriptive statistics. Data were collected for 418 offspring and 394 could be integrated for matched-pair analyses with data from the German general population (KIGGS, n=17 641).

Results: Teeth-cleaning routine, body-mass-index or subjective body image evaluation by parents were no different from children in the general population. Parents who included a cancer survivor smoked less in the presence of their children (p=0.01). During pregnancy, mothers in cancer survivor parent pairs abstained from drinking alcohol more often (p=0.01) and smoked less (p=0.05). While the calculated effect sizes (Phi) were generally low (0.135–0.247), children from cancer survivors played less outdoors than peers did (p=0.01). Boys participated in sports outside a club more often (p=0.05) and watched less TV on weekdays (p=0.01) and girls spent more time on the computer during weekdays than peers did (p=0.01).

Conclusions: This study provides the first data for health-related behaviour in cancer survivors’ offspring and sheds light on differences to parenting in the general population. Multivariate analyses in a larger study population are needed to relate these differences to fear issues in cancer survivors.

Zusammenfassung

Hintergrund: Ehemalige kinderonkologische Patienten befürchten, dass die Krebstherapie nicht nur die eigene Gesundheit, sondern auch die der eigenen Nachkommen beeinträchtigen könnte. Wir untersuchten, inwieweit sich das gesundheitsbezogene Verhalten ehemaliger kinderonkologischer Patienten für ihre Kinder im Vergleich zur Allgemeinbevölkerung unterscheidet.

Methoden: Im Rahmen einer ersten Erhebungswelle (2013-2014) erhoben wir von 396 ehemaligen Patienten in Deutschland mit eigenen Kindern Fragebogendaten zur Gesundheit dieser Kinder. Fragen zum Gesundheitsverhalten wurden mittels deskriptiver statistischer Verfahren analysiert. 394 von 418 erhobenen Datensätzen von Kindern ehemaliger Patienten konnten in einer Matched-Pair Analyse mit bevölkerungsrepresentativen Daten (KIGGS, n= 17.641) ausgewertet werden.

Ergebnisse: In der Häufigkeit des Zähneputzens, dem Body-Mass-Index und der subjektiven Einschätzung des Körperbildes durch die Eltern zeigten sich keine Unterschiede zur Allgemeinbevölkerung. In der Anwesenheit von Kindern ehemaliger Patienten wurde seltener geraucht (p=0.01). Mütter von Kindern ehemaliger Patienten tranken seltener Alkohol (p=0.01) und rauchten seltener während der Schwangerschaft (p=0.05). Auch wenn die berechneten Effektstärken (Phi) hierbei gering (0.135 - 0.247) waren, zeigte sich, dass Kinder ehemaliger Patienten seltener im Freien (p=0.01) spielten. Jungen trieben häufiger Sport außerhalb eines Vereins (p=0.05) und sahen seltener innerhalb der Woche fern (p=0.01) als Jungen, deren Eltern keine Krebserkrankung im Kindesalter hatten. Mädchen spielten unter der Woche häufiger am Computer als Mädchen, deren Eltern im Kindesalter keine Krebserkrankung hatten (p=0.01).

Schlussfolgerung: Die Multizentrische Nachkommenstudie liefert erste Daten zum Gesundheitsverhalten der Nachkommen ehemaliger Patienten. Es zeigten sich Hinweise auf Unterschiede in der gesundheitsbezogenen Erziehung zur Allgemeinbevölkerung. Hier müssen multivariate Analysen in einer größeren Stichprobe mögliche Zusammenhänge zu weiteren potentiellen Einflussfaktoren aufzeigen.

• References

• 1 Innocenti Declaration – on the Protection, Promotion and Support of Breast-Feeding. Ecol Food Nutr 1991; 26: 271-273
• 2 Badr H, Paxton RJ, Ater JL. et al. Health behaviors and weight status of childhood cancer survivors and their parents: similarities and opportunities for joint interventions. Journal of the American Dietetic Association 2011; 111: 1917-1923
• 3 Balcerek M, Reinmuth S, Hohmann C. et al. Suspected infertility after treatment for leukemia and solid tumors in childhood and adolescence. Deutsches Arzteblatt international 2012; 109: 126-131
• 4 Balcerek M, Schilling R, Schlack R. et al. Nationwide Survey on the Health of Offspring from Former Childhood Cancer Patients in Germany. Klinische Padiatrie 2015; 227: 350-354
• 5 Emmons K, Li FP, Whitton J. et al. Predictors of smoking initiation and cessation among childhood cancer survivors: a report from the childhood cancer survivor study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2002; 20: 1608-1616
• 6 Emmons KM, Butterfield RM, Puleo E. et al. Smoking among participants in the childhood cancer survivors cohort: the Partnership for Health Study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2003; 21: 189-196
• 7 Giglia RC, Binns CW, Alfonso HS. Which women stop smoking during pregnancy and the effect on breastfeeding duration. BMC public health 2006; 6: 195
• 8 Green DM, Hyland A, Chung CS. et al. Cancer and cardiac mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1999; 17: 3207-3215
• 9 Haupt R, Byrne J, Connelly RR. et al. Smoking habits in survivors of childhood and adolescent cancer. Medical and pediatric oncology 1992; 20: 301-306
• 10 Hawkins MM, Stevens MC. The long-term survivors. British medical bulletin 1996; 52: 898-923
• 11 Hohmann C, Borgmann-Staudt A, Rendtorff R. et al. Patient counselling on the risk of infertility and its impact on childhood cancer survivors: results from a national survey. Journal of psychosocial oncology 2011; 29: 274-285
• 12 Hollen PJ, Hobbie WL. Risk taking and decision making of adolescent long-term survivors of cancer. Oncology nursing forum 1993; 20: 769-776
• 13 Hollen PJ, Hobbie WL. Decision making and risk behaviors of cancer-surviving adolescents and their peers. Journal of pediatric oncology nursing: official journal of the Association of Pediatric Oncology Nurses 1996; 13: 121-133 discussion 135–127
• 14 Holling H, Schlack R, Kamtsiuris P. et al. The KiGGS study. Nationwide representative longitudinal and cross-sectional study on the health of children and adolescents within the framework of health monitoring at the Robert Koch Institute. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2012; 55: 836-842
• 15 Hudson MM, Findlay S. Health-risk behaviors and health promotion in adolescent and young adult cancer survivors. Cancer 2006; 107: 1695-1701
• 16 Hudson MM, Jones D, Boyett J. et al. Late mortality of long-term survivors of childhood cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1997; 15: 2205-2213
• 17 Iannotti RJ, Janssen I, Haug E. et al. Interrelationships of adolescent physical activity, screen-based sedentary behaviour, and social and psychological health. International journal of public health 2009; 54 (Suppl. 02) 191-198
• 18 Kaatsch P, Spix C. German Childhood Cancer Registry – Annual Report 2015 (1980–2014). In: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz; 2015
• 19 Klosky JL, Howell CR, Li Z. et al. Risky health behavior among adolescents in the childhood cancer survivor study cohort. Journal of pediatric psychology 2012; 37: 634-646
• 20 Krug S, Jekauc D, Poethko-Müller C. et al. Zum Zusammenhang zwischen körperlicher Aktivität und Gesundheit bei Kindern und Jugendlichen. Bundesgesundheitsbl 2012; 2011 55: 111-120
• 21 Lange C, Schenk L, Bergmann R. Distribution, duration and temporal trend of breastfeeding in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2007; 50: 624-633
• 22 Larcombe I, Mott M, Hunt L. Lifestyle behaviours of young adult survivors of childhood cancer. British journal of cancer 2002; 87: 1204-1209
• 23 Manz K, Schlack R, Poethko-Muller C. et al. Physical activity and electronic media use in children and adolescents: results of the KiGGS study: first follow-up (KiGGS wave 1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2014; 57: 840-848
• 24 Mertens AC, Yasui Y, Liu Y. et al. Pulmonary complications in survivors of childhood and adolescent cancer. A report from the Childhood Cancer Survivor Study. Cancer 2002; 95: 2431-2441
• 25 Mertens AC, Yasui Y, Neglia JP. et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2001; 19: 3163-3172
• 26 Mulhern RK, Tyc VL, Phipps S. et al. Health-related behaviors of survivors of childhood cancer. Medical and pediatric oncology 1995; 25: 159-165
• 27 Nagarajan R, Robison LL. Pregnancy outcomes in survivors of childhood cancer. Journal of the National Cancer Institute Monographs 2005; 72-76
• 28 Natale RA, Messiah SE, Asfour L. et al. Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children’s healthy lifestyle habits. Journal of developmental and behavioral pediatrics: JDBP 2014; 35: 378-387
• 29 Neglia JP, Friedman DL, Yasui Y. et al. Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. Journal of the National Cancer Institute 2001; 93: 618-629
• 30 Nicholson HS, Fears TR, Byrne J. Death during adulthood in survivors of childhood and adolescent cancer. Cancer 1994; 73: 3094-3102
• 31 Oeffinger KC, Mertens AC, Hudson MM. et al. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Annals of family medicine 2004; 2: 61-70
• 32 Rees GS, Trikic MZ, Winther JF. et al. A pilot study examining germline minisatellite mutations in the offspring of Danish childhood and adolescent cancer survivors treated with radiotherapy. International journal of radiation biology 2006; 82: 153-160
• 33 Reinmuth S, Liebeskind AK, Wickmann L. et al. Having children after surviving cancer in childhood or adolescence – results of a Berlin survey. Klinische Padiatrie 2008; 220: 159-165
• 34 Signorello LB, Mulvihill JJ, Green DM. et al. Congenital anomalies in the children of cancer survivors: a report from the childhood cancer survivor study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2012; 30: 239-245
• 35 Stahl O, Boyd HA, Giwercman A. et al. Risk of birth abnormalities in the offspring of men with a history of cancer: a cohort study using Danish and Swedish national registries. Journal of the National Cancer Institute 2011; 103: 398-406
• 36 Tao ML, Guo MD, Weiss R. et al. Smoking in adult survivors of childhood acute lymphoblastic leukemia. Journal of the National Cancer Institute 1998; 90: 219-225
• 37 Tawn EJ, Whitehouse CA, Winther JF. et al. Chromosome analysis in childhood cancer survivors and their offspring – no evidence for radiotherapy-induced persistent genomic instability. Mutation research 2005; 583: 198-206
• 38 Troyer H, Holmes GE. Cigarette-Smoking among Childhood-Cancer Survivors. Am J Dis Child 1988; 142: 123-123
• 39 Tyc VL, Hadley W, Crockett G. Prediction of health behaviors in pediatric cancer survivors. Medical and pediatric oncology 2001; 37: 42-46
• 40 Winther JF, Boice Jr. JD, Christensen J. et al. Hospitalizations among children of survivors of childhood and adolescent cancer: a population-based cohort study. International journal of cancer Journal international du cancer 2010; 127: 2879-2887
• 41 Winther JF, Boice Jr. JD, Frederiksen K. et al. Radiotherapy for childhood cancer and risk for congenital malformations in offspring: a population-based cohort study. Clinical genetics 2009; 75: 50-56
• 42 Yeazel MW, Oeffinger KC, Gurney JG. et al. The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 2004; 100: 631-640