Health-risk behaviors and health promotion in adolescent and young adult cancer survivors

A diagnosis of cancer during adolescence, a period characterized by experimentation and risk-taking behaviors, has the potential to derail critical developmental tasks required for successful transition into adulthood. Health professionals caring for adolescents and young adults have an opportunity to influence behavioral practices by correcting knowledge deficits, addressing factors that enhance the survivor's sense of vulnerability to health problems, and providing personalized health counseling that encourages the practice of health promoting behaviors. The approach to health counseling in childhood cancer survivors should consider their unique educational needs related to their cancer experience. Previous investigations of adolescent and young adult survivor health behavior indicate that survivors perceive themselves as more vulnerable to health problems than their peers without cancer and recognize a need to protect their health. However, these perceptions of health vulnerability do not always correlate with health promoting behavioral practices, suggesting that factors other than health perceptions should be investigated to motivate behavioral change. Very few studies have been undertaken to prospectively evaluate the effectiveness of health promotion programs in adolescent and young adult survivors of cancer. The scarcity of knowledge in the issue of health promotion after childhood cancer underscores the need for more research to define 1) the optimal timing of health counseling; 2) the influence of developmental status and neurocognitive function; 3) the most effective methods and venues for health education; 4) the feasibility and cost-effectiveness of health promotion strategies; and 5) psychosocial and economic impediments to practice of healthy behaviors.