Lifestyle Medicine Adherence, Mental Wellbeing, and Quality of Life in Pediatric Oncology in Ecuador

Lifestyle Medicine Adherence, Mental Wellbeing, and Quality of Life in Pediatric Oncology in Ecuador: Protocol for a Multicenter Study

Background: Advances in pediatric oncology have significantly improved survival rates; however, many children and adolescents with cancer experience persistent physical and psychological challenges that negatively affect their health-related quality of life (HRQoL). Lifestyle medicine (comprising regular physical activity, restorative sleep, optimal nutrition, stress management, avoidance of risky substances, and positive social connections) is increasingly recognized as a determinant of well-being in chronic disease populations. However, evidence on its role in pediatric oncology survivorship remains limited, particularly in low- and middle-income countries like Ecuador.

Methods: A multicenter cohort study with a 6-month follow-up will evaluate the association between adherence to lifestyle medicine pillars and HRQoL among children and adolescents who have completed active cancer treatment in Ecuador. A total of 57-62 participants aged 3 to <18 years receiving care in major pediatric oncology centers will be recruited. The adherence to the 6 pillars of lifestyle medicine will be assessed using validated questionnaires. HRQoL will be measured using the Pediatric Quality of Life Inventory (PedsQL), while mental health outcomes will be evaluated through validated PROMIS measures. Sociodemographic and clinical variables will also be collected. Cross-sectional and longitudinal generalized linear mixed models will be used to explore associations between lifestyle behaviors, mental health, and HRQoL, adjusting for relevant confounders.

Conclusion: This study will provide one of the first comprehensive assessments of the prevalence, time trends, and associated factors of lifestyle medicine adherence and its relationship with quality of life and mental health among pediatric oncology patients in Ecuador. Results may help identify modifiable lifestyle factors associated with better wellbeing and inform future supportive care strategies and lifestyle-based interventions for children and adolescents with cancer.

Study Overview

• Status: Enrolling by invitation
• Conditions: Childhood Cancer Survivors

• Study Type: Observational
• Enrollment (Estimated): 62

Contacts and Locations

Study Locations

• Ecuador
  • Cuenca, Ecuador
    • SOLCA Cuenca
  • Guayaquil, Ecuador
    • SOLCA Guayaquil
  • Quito, Ecuador
    • Hospital SOLCA Quito
  • Quito, Ecuador
    • Hospital Baca Ortiz

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Children and adolescent aged 3 and ˂18 years diagnosed with cancer by imaging, cytology, or pathology who have currently finished active cancer treatment (chemotherapy, radiotherapy, surgery).

Description

Inclusion Criteria:

• Children and adolescent aged 3 and ˂18 years.
• Participants diagnosed with cancer by imaging, cytology, or pathology who have currently finished active cancer treatment (chemotherapy, radiotherapy, surgery).
• Individuals attending medical consultations follow-up at one of the oncology centers from the study.

Exclusion Criteria:

• Individuals who suffer critical conditions (i.e., disease relapse, severe neutropenia, treatment toxicities, psychological disturbances, etc.) at the time of the recruitment.
• Participants who are not authorized by the parents or legal guardians to participate in the research project.
• Participants who do not agree to take part in the research project.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Children and adolescent aged 3 and ˂18 years who have currently finished active cancer treatment; A multicenter cohort study with a 6-month follow-up will be performed to obtain information about the adherence to the six lifestyle medicine pillars (restorative sleep, stress management, adequate nutrition, optimal physical activity, avoidance of harmful substances, and healthy social relationship), HRQoL, and mental wellbeing (anxiety and depression symptoms) among children and adolescents who finished active cancer treatment in Ecuador. Data will be collected through phone call / video call interviews or by online surveys, depending on each parent/caregiver preference. Interviewers will read questions verbatim) to reduce bias. Follow-up will be established 6 months from the first evaluation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-Related Quality of Life (HRQoL)	Assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL 3.0 Cancer Module. A higher score indicates better HRQoL. Unit of Measure: Score on a scale from 0 to 100.	Baseline and 6 months
Mental Wellbeing - Depressive Symptoms	Assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Early Childhood Parent-Report Short Form v1.0, PROMIS Parent Proxy Bank v2.0, or PROMIS Pediatric Short Form GenPop v3.0, depending on participant age. A higher T-score indicates more severe symptoms. Unit of Measure: T-score (standardized score with a mean of 50 and standard deviation of 10)	Baseline and 6 months
Mental Wellbeing - Anxiety Symptoms	Assessed using the PROMIS Early Childhood Parent-Report Short Form v1.0, PROMIS Parent Proxy Short Form v2.0, or PROMIS Pediatric Short Form GenPop v3.0, depending on participant age. A higher T-score indicates more severe symptoms. Unit of Measure: T-score (standardized score with a mean of 50 and standard deviation of 10).	Baseline and 6 months
Lifestyle Medicine Adherence - Overall	For each of the six lifestyle medicine pillars (optimal nutrition, regular physical activity, restorative sleep, stress management, avoidance of harmful substances, and positive social connections), participants will be classified as meeting or not meeting the corresponding clinical or oncological guideline-based recommendations using data from the validated instruments described in the protocol. An overall binary classification (meets overall recommendations / does not meet overall recommendations) will be derived based on predefined criteria (e.g., meeting a minimum number of pillars or meeting all pillars) in accordance with supportive care guidelines for pediatric oncology survivorship. Unit of Measure: Binary classification (meets overall lifestyle medicine recommendations / does not meet overall recommendations).	Baseline and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence to Optimal Nutrition	Assessed using the KIDMED (Mediterranean Diet Quality Index) questionnaire. A higher score indicates better adherence to a Mediterranean diet.	Baseline and 6 months
Diet Quality	Assessed using the Diet Quality Questionnaire (DQQ) to calculate the Global Dietary Recommendations (GDR) score. A higher score indicates greater adherence to healthy dietary practices. Unit of Measure: Score on a scale from 0 to 18.	Baseline and 6 months
Body Mass Index (BMI)	Calculated from weight and height extracted from the medical record. Weight and height will be combined to report BMI in kg/m^2. Unit of Measure: kg/m^2	Baseline and 6 months.
Adherence to Physical Activity Guidelines	Assessed using the Youth Activity Profile (YAP), the Global School-Based Student Health Survey (GSHS) Physical Activity Module, and the Questionnaire for the Measurement of Physical Activity and Sedentary Behavior in Children (C-MAFYCS) depending on the age of the participant. Meeting the World Health Organization (WHO) guidelines is defined as an average of at least 60 minutes per day of moderate-to-vigorous physical activity. Unit of Measure: Binary classification (meets guidelines / does not meet guidelines).	Baseline and 6 months.
Adherence to Sleep Guidelines	Sleep duration is calculated from self- or parent-reported bedtimes and wake-up times. Meeting the National Sleep Foundation guidelines is defined as the following age-appropriate sleep duration ranges: 8-10 hours for adolescents, 9-11 hours for school-age children, 10-13 hours for preschoolers, and 11-14 hours for toddlers. Unit of Measure: Binary classification (meets guidelines / does not meet guidelines).	Baseline and 6 months.
Social Connections	Assessed using the Strengths and Difficulties Questionnaire (SDQ), the Multidimensional Scale of Perceived Social Support (MSPSS) for family and friends support, and the Health Behavior in School-aged Children (HBSC) social support subscales for classmates and teachers support. These measures assess peer relationship problems, prosocial behavior, and perceived support from family, friends, teachers, and classmates. Unit of Measure: Score (varies by instrument).	Baseline and 6 months.
Stress Management	Assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Psychological Stress Experiences (Pediatric Short Form v1.0 or Parent Proxy Short Form v1.0). A higher T-score indicates a more severe psychological stress experience. Unit of Measure: T-score (standardized score with a mean of 50 and standard deviation of 10).	Baseline and 6 months.
Avoidance of Harmful Substances	Assessed through questions about secondhand smoke exposure, personal substance use (cigarettes, alcohol, cannabis, e-cigarettes), and energy drink consumption. For participants aged 11 and older, this includes the lifetime prevalence and frequency of use. Unit of Measure: Binary (yes/no) for exposure and use; frequency counts for personal use.	Baseline and 6 months.

Collaborators and Investigators

• Sponsor: Universidad de Especialidades Espiritu Santo
• Investigators: Principal Investigator: José Francisco López-Gil, PhD, Universidad de Especialidades Espiritu Santo

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2025
• Primary Completion (Estimated): April 30, 2027
• Study Completion (Estimated): April 30, 2027

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 24, 2026

Study Record Updates

• Last Update Posted (Actual): April 1, 2026
• Last Update Submitted That Met QC Criteria: March 26, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: quality of life; mental health; health-related quality of life; lifestyle medicine
• Additional Relevant MeSH Terms: Behavior; Personal Satisfaction; Psychological Well-Being
• Other Study ID Numbers: C-UEES-25-27

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No