Good food habits after cancer treatment can create the difference between excellent health and serious illness. These researchers are making that difference.
The good news about the treatment of kids’ cancer today is that over 80 per cent of children with cancer will successfully complete their treatment. The not-so-good news is that those survivors will then go on to have an increased risk of heart disease, diabetes, obesity and osteoporosis, a group of diseases known collectively as ‘the metabolic syndrome’.
A powerful project is already hitting home runs with families affected by childhood cancer, with post-treatment wellbeing clearly in its sights. ‘Reboot-Kids’, developed by Dr Jennifer Cohen and Professor Claire Wakefield from the Kids Cancer Centre at the Sydney Children’s Hospital, is a behavioural medicine intervention driven from a nutrition and psychology standpoint. The program has also had support from oncologist, Richard Cohn, throughout. Reboot has as its goal the prevention of obesity and metabolic complications in young cancer survivors.
The work began with recognising the strong association between poor health outcomes and a diet high in saturated fat and sugar and low in fruit and vegetable intake. Cancer survivors who do not have what is considered a healthy diet, research says, are 2.2 times more likely to suffer the metabolic syndrome. Obesity can also create a higher risk of secondary cancers and other illnesses.
The work by Dr Cohen, a dietitian, and Professor Wakefield, a psychologist, has gone on to identify the fact that early intervention, during and immediately after treatment, is required to protect and/or restore healthy eating habits.
“The Reboot work began over a decade ago when I first came to the Sydney Children’s Hospital and met Jennifer,” Professor Wakefield says.
“She was a dietitian on the ward and she was aware that there wasn’t much support for families when they finished treatment. She was spending all of her time looking after patients during treatment, making sure they didn’t lose too much weight.”
“We joined forces and began interviewing families and health professionals about what was driving the problems after treatment. What were the difficulties and the specific mealtime behaviours? Then we did some quantitative studies documenting exactly where the gaps were, relative to how kids were eating before they had their cancer treatment and how and why they’d changed. We then developed Reboot as a program to help parents get back on top of their child’s fruit and vegetable intake.”
Diets change during cancer treatment, the pair confirmed, for reasons that were variously obvious and less so. Because of nausea and vomiting, sometimes the very thought of eating is difficult. But some drugs change the way particular foods taste, and the way the body perceives hunger and fullness. Also, behaviours by parents change as food is sometimes used as a bribe – ‘if you are brave during this injection you can have an ice-cream afterwards’.
“It’s hard for parents to take on this behaviour during treatment and then to switch back again, after treatment has finished,” Professor Wakefield says.
“It’s important to realise there are biological drivers of unhealthy eating and there are behavioural drivers. We address both in Reboot. One of our main goals is to help parents realise that they’re not crazy, and that this behaviour is not unique to their child. It is a common phenomenon and there are evidence-based ways to address it.”
Dr Cohen says the partnership between herself and Professor Wakefield, between a dietitian and a psychologist, is a natural and powerful one. The correct dietary intervention is important, but just as important is knowing exactly how to intervene.
The pair, and their teams, realised very quickly that they did not have the resources to consult every family of every cancer survivor. So they developed a program that is easily replicated and that can work effectively in an online environment.
“Claire has done a lot of work around telephone-based and online interventions, so some great expertise came from her experience with that,” Dr Cohen says. “I was able to bring knowledge of dietary habits amongst children who’d been through cancer treatment.”
Together they have developed, and are currently testing and fine-tuning, Reboot-Kids. It’s a four-week, four-session program that parents take part in soon after their child’s treatment is complete.
“It’s about giving parents some tools and strategies around how they can help their child to have a more healthy diet,” Dr Cohen says. “That way they dramatically reduce the risk of their child suffering a serious illness later in life.”
Every parent who has taken part in the pilot program, Professor Wakefield says, has said they are now more confident in providing a healthy diet for their child. In fact, as it is important for parents to role-play healthy eating habits, the entire family has typically benefited.
“That pilot gave us the confidence to start a much bigger trial,” she says. “So now, thanks to the funding from The Kids’ Cancer Project, we’re going to offer it to a lot more families across a lot more hospitals.”
“It doesn't matter where they live, they can access the program to improve nutrition and help to keep their kids healthier.”