Utilizing Novel Information Technology to Promote Exercise and Well-Being in Adolescents and Young Adults With Cancer

Adolescents and young adults (AYAs) with cancer comprise a unique population within the larger cancer community. This is primarily due to distinct differences in disease biology compared to older and younger patients, as well as their unique psychosocial needs. AYAs with cancer historically have unmet needs relating to management of their mental health and treatment-related symptoms. One particular area of unmet need is distress management during cancer treatment, reported in nearly one third of AYAs with newly diagnosed cancer. Reasons for distress are multifactorial, including lack of medical information, worries about future life goals and fertility, and social isolation from peers and family. Proactively addressing and preventing this distress is critical for forestalling the high rates of depression, anxiety, and post-traumatic stress seen in AYAs. One promising but under explored intervention with the potential to mitigate distress is group-based physical activity. Multiple studies cite physical activity's benefits for patients with cancer, while oncology and sports medicine societies recommend including physical activity as part of comprehensive cancer care. Group physical activity intervention models have been successful in creating sustainable improvements in physical and psychosocial health in other populations with cancer, though can present transportation and scheduling barriers. Additionally, medical providers and participants undergoing treatment for cancer may be hesitant to engage in group-based physical activity interventions during times of neutropenia given infection risk.

Dr. Rao's mentors have extensive preliminary data that guided her project's development. The theoretical model for this study's intervention delivery is based on Dr. Rovniak's Social Networks for Activity Promotion (SNAP) model, and targets optimizing the physical environment where physical activity is received, as well as the importance of social network environments and interactions. Dr. Schmitz has been at the forefront of the movement to incorporate physical activity into the care of patients with cancer and cancer survivors. She has led multiple trials, including a large randomized controlled trial to assess the safety of upper body exercise among breast cancer survivors with and without lymphedema (Physical Activity and Lymphedema Trial [PAL]). Dr. Sciamanna's work has evaluated the implementation of a group strength training intervention in elderly patients, which has been found to be safe and effective, as well socially beneficial to its participants. Dr. Williams is the founder and president of Hip Hop for Public Health (HHPH) a non-profit organization which has successfully utilized hip-hop music to deliver sustainable health messages pertaining to nutrition and physical activity in youth.

The preliminary data as noted above set the foundation for this project, which builds on the importance of social network environments and interactions in encouraging physical activity. This is particularly true for adolescents as a whole, as social support has been found to be an especially important factor in the promotion of physical activity. Specifically for AYAs with cancer, physical activity has been cited as an area of preferred clinical program focus for AYAs with cancer and those who have completed treatment. Thus, a group-based physical activity intervention among AYAs with cancer could address an area of unmet need that potentially improves the psychosocial health of this patient population. Delivery using a virtual platform is culturally appropriate for AYAs with cancer, a unique patient population that is technologically savvy, and interested in using social media platforms to create a sense of belonging and community.

Inclusion criteria

• Participant age 15-21 years old at time of cancer diagnosis
• Participant diagnosis of cancer who is currently undergoing active treatment for cancer, or who is within 3 years of end of cancer treatment at the time of enrollment
• Participant receiving oncologic care at Penn State Health Children's Hospital or Penn State Cancer Institute
• Participant fluency in written and spoken English for participants >= 18 years old
• Parent and participant fluency in written and spoken English for participants < 18 years old
• Primary attending oncologist approval
• Participant must have access to a computer or smartphone
• Performance status of ECOG <= 2, and Lansky /Karnofsky scale >= 50

Exclusion criteria

• Cardiovascular or respiratory disease
• Class II, III or IV heart failure as defined by the New York Heart Association functional classification system
• History of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty or stenting within the past 6 months prior to the start of chemotherapy
• Uncontrolled arrhythmias
• Syncope
• Acute myocarditis, pericarditis or endocarditis
• Diagnosed with pulmonary embolism or pulmonary infarction within 3 months of enrollment
• Diagnosed with deep venous thrombosis within 3 months of enrollment
• Any history of intracardiac thrombosis
• Suspected dissecting aneurysm
• Pulmonary edema
• Respiratory failure
• Acute non-cardiopulmonary disorder that may affect exercise performance or be exacerbated by physical activity
• Altered mental status or dementia
• Mental impairment leading to inability to cooperate
• Active bleeding
• Absolute contraindication to exercise
• Hemodynamic instability
• Pregnant women
• Non-English speaking
• Recent initiation of physical activity program within last 3 months
• Patients with relapsed cancer
• Patients who have undergone allogeneic stem cell transplant