Protocol of a mixed-method randomised controlled pilot study evaluating a wilderness programme for adolescent and young adult cancer survivors: the WAYA study

Miek C Jong, Eric Mulder, Agnete E Kristoffersen, Trine Stub, Heléne Dahlqvist, Eija Viitasara, E Anne Lown, Winnie Schats, Mats Jong, Miek C Jong, Eric Mulder, Agnete E Kristoffersen, Trine Stub, Heléne Dahlqvist, Eija Viitasara, E Anne Lown, Winnie Schats, Mats Jong

Abstract

Introduction: The majority of childhood, adolescent and young adult (AYA) cancer survivors suffer from long-term and late effects such as fatigue, psychological distress or comorbid diseases. Effective health promotion strategies are needed to support the health of this vulnerable group. This protocol provides a methodological description of a study that aims to examine the feasibility and safety of performing a randomised clinical trial (RCT) on a wilderness programme that is developed to support the health of AYA cancer survivors.

Methods and analysis: The pilot RCT study has a mixed-method design, including quantitative and qualitative evaluations. Participants are AYAs, aged 16-39 years, that have been diagnosed with cancer during childhood, adolescence or young adulthood. A total of 40 participants will be randomly assigned to a wilderness programme (n=20) or a holiday programme (n=20). Both arms include participation in an 8-day summer programme, followed by a 4-day programme 3 months later. Primary outcomes are feasibility and safety parameters such as time to recruitment, willingness to be randomised, programme adherence and adverse effects. Secondary outcomes include self-reported health such as self-esteem, quality of life, self-efficacy and lived experiences. Descriptive statistics will be used to analyse outcomes and explore indications of differences between the programmes. Interviews are analysed by directed content analysis and hermeneutic phenomenology. A convergent parallel mixed-method analysis design will be applied to integrate quantitative and qualitative data. Results of this feasibility study will inform the preparation for a larger RCT with AYA cancer survivors.

Ethics and dissemination: The study protocol is approved by the Swedish Ethical Review Authority (reference: 2020-00239). This study will be performed between January 2021 and December 2023. Results will be published in international peer-reviewed journals, presented at conferences and disseminated to participants, cancer societies, healthcare professionals and outdoor instructors.

Trial registration number: NCT04761042.

Keywords: adult oncology; mental health; paediatric oncology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Bhakta N, Force LM, Allemani C, et al. . Childhood cancer burden: a review of global estimates. Lancet Oncol 2019;20:e42–53. 10.1016/S1470-2045(18)30761-7
    1. Hewitt M, Weiner SL, Simone JV, eds. Childhood cancer survivorship: improving care and quality of life. Washington, DC: National Academies Press, 2003.
    1. Berkman AM, Livingston JA, Merriman K, et al. . Long-term survival among 5-year survivors of adolescent and young adult cancer. Cancer 2020;126:3708–18. 10.1002/cncr.33003
    1. Miller KD, Fidler-Benaoudia M, Keegan TH, et al. . Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin 2020;70:443–59. 10.3322/caac.21637
    1. Hilgendorf I, Bergelt C, Bokemeyer C, et al. . Long-term follow-up of children, adolescents, and young adult cancer survivors. Oncol Res Treat 2021;44:184–9. 10.1159/000514381
    1. Oeffinger KC, Mertens AC, Sklar CA, et al. . Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006;355:1572–82. 10.1056/NEJMsa060185
    1. Lu Q, Krull KR, Leisenring W, et al. . Pain in long-term adult survivors of childhood cancers and their siblings: a report from the childhood cancer Survivor study. Pain 2011;152:2616–24. 10.1016/j.pain.2011.08.006
    1. Mulder RL, Font-Gonzalez A, Green DM, et al. . Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International late effects of childhood cancer guideline harmonization group. Lancet Oncol 2021;22:e57–67. 10.1016/S1470-2045(20)30582-9
    1. Tomlinson D, Zupanec S, Jones H, et al. . The lived experience of fatigue in children and adolescents with cancer: a systematic review. Support Care Cancer 2016;24:3623–31. 10.1007/s00520-016-3253-8
    1. Janssen SHM, van der Graaf WTA, van der Meer DJ, et al. . Adolescent and young adult (AYA) cancer survivorship practices: an overview. Cancers 2021;13:4847. 10.3390/cancers13194847
    1. Kaul S, Avila JC, Mutambudzi M, et al. . Mental distress and health care use among survivors of adolescent and young adult cancer: a cross-sectional analysis of the National health interview survey. Cancer 2017;123:869–78. 10.1002/cncr.30417
    1. Michel G, Vetsch J. Screening for psychological late effects in childhood, adolescent and young adult cancer survivors: a systematic review. Curr Opin Oncol 2015;27:297–305. 10.1097/CCO.0000000000000196
    1. Baker KS, Syrjala KL. Long-term complications in adolescent and young adult leukemia survivors. Hematology Am Soc Hematol Educ Program 2018;2018:146–53. 10.1182/asheducation-2018.1.146
    1. Barr RD, Ferrari A, Ries L, et al. . Cancer in adolescents and young adults: a narrative review of the current status and a view of the future. JAMA Pediatr 2016;170:495–501. 10.1001/jamapediatrics.2015.4689
    1. Schulte F, Forbes C, Wurz A, et al. . Childhood cancer survivorship: daily challenges. Pediatr Clin North Am 2020;67:1083–101. 10.1016/j.pcl.2020.07.004
    1. Mygind L, Kjeldsted E, Hartmeyer RD, et al. . Immersive Nature-Experiences as health promotion interventions for healthy, vulnerable, and sick populations? A systematic review and appraisal of controlled studies. Front Psychol 2019;10:943. 10.3389/fpsyg.2019.00943
    1. Victorson D, Luberto C, Koffler K. Nature as medicine: mind, body, and soil. J Altern Complement Med 2020;26:658–62. 10.1089/acm.2020.0221
    1. Blaschke S. The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis. BMC Cancer 2017;17:370. 10.1186/s12885-017-3366-6
    1. Ray H, Jakubec SL. Nature-based experiences and health of cancer survivors. Complement Ther Clin Pract 2014;20:188–92. 10.1016/j.ctcp.2014.07.005
    1. Jong M, Lown EA, Schats W, et al. . A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors. PLoS One 2021;16:e0243908. 10.1371/journal.pone.0243908
    1. Rosenberg RS, Lange W, Zebrack B, et al. . An outdoor adventure program for young adults with cancer: positive effects on body image and psychosocial functioning. J Psychosoc Oncol 2014;32:622–36. 10.1080/07347332.2014.936652
    1. Gill E, Goldenberg M, Starnes H, et al. . Outdoor adventure therapy to increase physical activity in young adult cancer survivors. J Psychosoc Oncol 2016;34:184–99. 10.1080/07347332.2016.1157718
    1. Zebrack B, Kwak M, Sundstrom L. First Descents, an adventure program for young adults with cancer: who benefits? Support Care Cancer 2017;25:3665–73. 10.1007/s00520-017-3792-7
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, et al. . SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013;346:e7586. 10.1136/bmj.e7586
    1. Schulz KF, Altman DG, Moher D, et al. . CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010;152:726–32. 10.7326/0003-4819-152-11-201006010-00232
    1. Naess A. The shallow and the deep ecology movement. Anker, Peder Deep Ecology in Bucharest The Trumpeter 2008;24:56–67.
    1. Visit Sweden . The high coast of Sweden – breathtaking nature away from the crowds. Available: [Accessed 24 Jan 2022].
    1. Medical dictionary for regulatory activities (MedDRA®) 2007.
    1. Bhatia S, Jenney MEM, Wu E, et al. . The Minneapolis-Manchester quality of life instrument: reliability and validity of the youth form. J Pediatr 2004;145:39–46. 10.1016/j.jpeds.2004.02.034
    1. Einberg E-L, Kadrija I, Brunt D, et al. . Psychometric evaluation of a Swedish version of Minneapolis-Manchester quality of life-youth form and adolescent form. Health Qual Life Outcomes 2013;11:79. 10.1186/1477-7525-11-79
    1. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press, 1965.
    1. Eklund M, Bäckström M, Hansson L. Psychometric evaluation of the Swedish version of Rosenberg’s self-esteem scale. Nord J Psychiatry 2018;72:318–24. 10.1080/08039488.2018.1457177
    1. Schwarzer R, Jerusalem M. Generalized self-efficacy scale. Windsor, UK: NFER-NELSON, 1995.
    1. Löve J, Moore CD, Hensing G. Validation of the Swedish translation of the general self-efficacy scale. Qual Life Res 2012;21:1249–53. 10.1007/s11136-011-0030-5
    1. Nisbet EK, Zelenski JM, Murphy SA. The nature relatedness scale: linking individuals’ connection with nature to environmental concern and behavior. Environ Behav 2009;41:715–40. 10.1177/0013916508318748
    1. Craig CL, Marshall AL, Sjöström M, et al. . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95. 10.1249/01.MSS.0000078924.61453.FB
    1. Ekelund U, Sepp H, Brage S, et al. . Criterion-related validity of the last 7-day, short form of the International physical activity questionnaire in Swedish adults. Public Health Nutr 2006;9:258–65. 10.1079/PHN2005840
    1. Enright PL. The six-minute walk test. Respir Care 2003;48:783–5.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories . Ats statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–7. 10.1164/ajrccm.166.1.at1102
    1. Tudor-Locke C, Sisson SB, Collova T, et al. . Pedometer-determined step count guidelines for classifying walking intensity in a young ostensibly healthy population. Can J Appl Physiol 2005;30:666–76. 10.1139/h05-147
    1. Hughes AD, Chaturvedi N. Estimation of maximal oxygen consumption and heart rate recovery using the Tecumseh sub-maximal step test and their relationship to cardiovascular risk factors. Artery Res 2017;18:29–35. 10.1016/j.artres.2017.02.005
    1. Hong SH, Yang HI, Kim D-I, et al. . Validation of submaximal step tests and the 6-Min walk test for predicting maximal oxygen consumption in young and healthy participants. Int J Environ Res Public Health 2019;16:4858. 10.3390/ijerph16234858
    1. Whitehead AL, Julious SA, Cooper CL, et al. . Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res 2016;25:1057–73. 10.1177/0962280215588241
    1. Aickin M. Separation tests for early-phase complementary and alternative medicine comparative trials. Evidence-Based Integ Med 2004;1:225–31. 10.2165/01197065-200401040-00001
    1. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88. 10.1177/1049732305276687
    1. Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci 2004;18:145–53. 10.1111/j.1471-6712.2004.00258.x
    1. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd edn. SAGE Publications, 2017.
    1. Svenska Fjällklubben . Riskanalys med riskmatris [In Swedish: Risk analysis with risk matrices]. Available: [Accessed 29 Apr 2021].
    1. Gabrielsen LE, Fernee CR, Aasen GO. Why randomized trials are challenging within adventure therapy research: lessons learned in Norway. J Exper Edu 2016;39:5–14. 10.1177/1053825915607535
    1. Jong MC, Lown A, Schats W, et al. . Mapping the concept, content and outcome of wilderness therapy for childhood cancer survivors: protocol for a scoping review. BMJ Open 2019;9:e030544. 10.1136/bmjopen-2019-030544

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