Predicting and modifying substance use in childhood cancer survivors: application of a conceptual model

Oncol Nurs Forum. 2006 Jan 1;33(1):51-60. doi: 10.1188/06.ONF.51-60.


Purpose/objectives: To identify factors that predict or modify substance use in childhood cancer survivors and to describe how a risk-counseling intervention reduced young survivors' substance use.

Design: Secondary analysis of clinical trial data and primary analysis of medical record data.

Setting: Outpatient clinic.

Sample: 149 females and 118 males 12-18 years of age whose cancer had been in remission for at least two years were randomly assigned to intervention (n = 132) and standard care (n = 135) groups.

Methods: Self-report questionnaires, abstracted medical record data, confirmatory factor analysis, and structural equation modeling.

Main research variables: Smoking, alcohol consumption, knowledge, risk perceptions, motivation, and worry about cancer and treatment effects.

Findings: Three factors directly predicted substance use at baseline: being in a higher grade in school (independent of age), feelings of being more susceptible to late effects of cancer therapy, and worrying more about cancer and its treatment. At follow-up a year later, grade in school and worry predicted increased substance use. In addition, a desire to change health behavior, influenced by the intervention and gender, predicted decreased substance use. The mechanism of influence of the intervention was evident: The intervention led to a need to change, which precipitated a desire to change and ultimately resulted in decreased substance use.

Conclusions: Young survivors' worries and concerns about their cancer and treatment-related late effects are a new intervention target. Motivation is sensitive to behavioral change interventions and positively affects risk reduction.

Implications for nursing: Two new intervention strategies to address the impact of survivors' concerns about their cancer and its treatment are implied: (a) Replace substance use with new coping methods to reduce fear and anxiety, and (b) tailor motivation-based interventions to age and gender to communicate graphically and realistically to survivors the personal importance of behavioral change in modifying the risks of late effects.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Alcohol Drinking / prevention & control*
  • Child
  • Female
  • Humans
  • Male
  • Models, Theoretical
  • Neoplasms* / therapy
  • Smoking Prevention*
  • Survivors*