Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer in the United States, with significant rates of overweight and obesity among affected youth. Excessive weight gain during early ALL treatment is linked to poorer health outcomes, including higher relapse rates and long-term morbidities, highlighting the need for interventions to prevent weight gain and improve prognosis.
Purpose: This study's purpose was to adapt family-based health promotion strategies to the early phases of pediatric ALL treatment. Adaptations aimed to create a new intervention (NOURISH-ALL) with the potential to prevent excessive weight gain during ALL treatment.
Methods: Guided by the Obesity-Related Behavioral Intervention Trials model phase 1a, this adaptation framework included integrating evidence-based recommendations for family stress, nutrition, and physical activity during pediatric cancer treatment into an existing intervention (NOURISH-T). Multimethod formative assessments were conducted with families, youth with ALL, and multidisciplinary experts to further adapt intervention content, format, and delivery to meet the specific needs of families of youth in the early phases of ALL treatment.
Results: Sixteen families (11 caregivers; 6 youth with ALL ages 8-12 years) and 11 multidisciplinary experts participated in formative assessments. Adaptations included integration of evidence-based methods to support caregiver distress, consistent messaging around nutrition and activity behaviors, and tailored intervention formats to improve engagement for families with logistical and time-related barriers.
Conclusions: This study adapted the NOURISH-T intervention to address the unique challenges faced by families during early pediatric ALL treatment (NOURISH-ALL). Further testing is required to evaluate NOURISH-ALL feasibility and efficacy.
Keywords: behavior therapy; family; health promotion; pediatrics; precursor cell lymphoblastic leukemia-lymphoma.
This study modified a health promotion program to better support families with a child undergoing treatment for acute lymphoblastic leukemia (ALL)—the most common type of childhood cancer. While survival rates for ALL are high, treatment is intensive and can last 2-3 years. During this time, many children experience excessive weight gain, which may make their treatment less effective. To address this, our goal was to develop a program that helps families maintain healthy habits—such as eating nutritious foods, staying physically active, and managing stress—even during the challenges of their child’s ALL treatment. We began by updating an existing program originally designed for cancer survivors (called NOURISH-T), incorporating current recommendations for nutrition, exercise, and stress management specific to children receiving treatment for ALL. Next, we interviewed children with ALL, their parents, and healthcare providers to understand what they would want in a health promotion program. Based on their feedback, we made further improvements to ensure the program was relevant, practical, and supportive.
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