Effectiveness of an adventure-based training programme in promoting physical activity, reducing cancer : related fatigue, enhancing quality of life among Hong Kong Chinese childhood cancer survivors : a randomized controlled trial

Abstract

Background. Recent medical technological advances in cancer screening and treatment have led to improvements in the survival rates for most childhood cancers. The improved prognosis is, however, accompanied by both an increasing number of survivors and in associated physical and psychological problems, which consequently affect their quality of life (QoL).

Cancer-related fatigue is a debilitating and long-lasting adverse effect, and symptoms may persist years after the completion of treatment. It is childhood cancer survivors’ most commonly raised concern. Although there is strong evidence that regular physical activity can attenuate cancer-related fatigue, many Hong Kong Chinese childhood cancer survivors are reluctant to engage in regular physical activity. Adventure-based training has been found to be effective in promoting physical activity among childhood cancer survivors, but large-scale or robust evidence of its’ effectiveness is scarce. It is unclear from the existing literature whether adventure-based training can help attenuate cancer-related fatigue. Rigorous empirical scrutiny of the effectiveness of adventure-based training is therefore a priority. Aim. To examine the effectiveness of an adventure-based training programme in promoting physical activity, reducing fatigue and enhancing QoL among Hong Kong Chinese childhood cancer survivors. Methods. Before the interventional study, the psychometric properties of the Chinese version of the fatigue scales for children and adolescents were examined. A Phase III randomised controlled trial was then conducted. A total of 222 Hong Kong Chinese childhood cancer survivors aged 9-16 were recruited in an outpatient clinic, through the Children’s Cancer Foundation and at the Sunshine Group. Of these 117 were randomly assigned to the experimental group, to participate in a 4-day adventure-based training programme, and 105 assigned to the control group to receive a placebo intervention. All subjects were assessed for physical activity levels, self-efficacy, cancer-related fatigue, hand grip strength and QoL at baseline, 3, 6, 9 and 12 months after starting the intervention. Results. Subjects in the experimental group reported statistically significantly lower levels of cancer-related fatigue, higher levels of physical activity and self-efficacy, greater right- and left-hand grip strength and better QoL than those in the control group. A statistically significant difference in stages of change from baseline to 12 months after starting the intervention was found for participants in the experimental group, but not for those in the control group. Conclusion. The present study is the largest RCT examining the effectiveness of adventure-based training for childhood cancer survivors. The overall results provide further evidence that such training is effective in promoting physical activity, reducing cancer-related fatigue and enhancing QoL among Hong Kong Chinese childhood cancer survivors. Implications for practice. Our evidence of the effectiveness of adventure-based training in promoting physical activity and reducing fatigue among childhood cancer survivors has major implications for practice. Healthcare professionals must advocate the importance of physical activity for childhood cancer survivors, and incorporate adventure-based training into their care, to encourage them to practice and maintain regular physical activity throughout their lives.