This program is helping pediatric oncology patients (and their parents) use lifestyle habits to counter the impact of cancer treatments

A multidisciplinary approach to pediatric oncology care is gaining momentum. Undertaken in 2017 at the Sainte-Justine University Hospital Centre (CHU) in Montreal, the VIE project (valorization, involvement and education), is a research project that aims to implement a program promoting healthy lifestyle habits to lessen the side-effects of treatment in children and adolescents newly diagnosed with cancer. It is currently being rolled out in Quebec's other university hospitals with pediatric oncology departments: Quebec City's CHU de Québec-Université Laval (CHUL), CHU de Sherbrooke and the Montreal Children's Hospital of the McGill University Health Centre (MUHC) in Montreal. This expansion of the VIE project, co-funded by the Fonds de recherche du Québec en Santé (FRQS) and the Charles-Bruneau Foundation, has a dual objective: to confirm the safety of the program and to ensure that it can be applied elsewhere. “It's still a challenge, because this intervention program requires a lot of resources and a change in mentality and culture, both among parents and among clinical teams,” pointed out Dr. Caroline Laverdière, hemato-oncologist at CHU Sainte-Justine. The medical director of the long-term followup program for cancer survivors explains that parents and caregivers alike think that children are too tired from their treatments or in too much pain to be physically active. When it comes to food, “parents tend to give their children what they want, they feel they're spoiling them,” also observes the doctor, who describes the pediatric oncology department as “the kingdom of snacks and French fries.” But, she doesn't blame them: “A cancer diagnosis is an upheaval for families. Often, parents can't cook anymore. They're too tired, too stressed and they pick their battles."The idea for the VIE project arose from another corollary observation made by Dr. Laverdière and her colleagues. She mentions that her most frequent prescription had long been: Get out of your room four times a day and go around the floor three times. “Children hospitalized for oncology treatment are very passive in their rooms. They have their noses on their tablets,” she said. “This sedentary lifestyle combined with poor nutrition led us to want to change the lifestyle habits of children with cancer by providing support for their parents.”Convincing evidenceOn the scientific front, the relevance of the VIE program was confirmed by a study conducted at Sainte-Justine in 2017, which corroborated other studies on the subject that showed, among other things, that children who recover from cancer live an average of 10 years less due to the adverse effects associated with the aggressive treatments they received at an early age. Called PÉTALE, this research looked at the long-term side-effects of 350 survivors of acute lymphoblastic leukemia treated with radiotherapy or chemotherapy at the CHU since 1989.“PÉTALE revealed that survivors with healthy lifestyle habits had a much better quality of life,” said kinesiologist Daniel Curnier, a member of the VIE project team. These survivors, who averaged 20 to 22 minutes of physical activity a day, had lower rates of hypertension, heart failure, dyslipidemia, type 2 diabetes and obesity. “We're talking about significant reductions of the order of 40% for hypertension for example,” said Curnier. He adds that among the cohort, only 12% of survivors had no comorbidity requiring followup, while 19% had one, 23% had two, 26% had three, 13% had four and 7% had five or more.With this in mind, the VIE research team, bringing together several health professionals (oncologist, nutritionist, kinesiologist, occupational therapist, psychologist and social worker), developed an intervention program for children and their families, focusing on three areas: nutrition, physical activity and mental health. Unlike similar interventions elsewhere in the world, which are generally deployed towards the end of or after treatment, the VIE program offers care within two to three weeks of diagnosis, the aim being to ensure that bad habits don't have time to take root.Eating better“The earlier we intervene, the more we support them, and the more we give them tips, the more we reduce the long-term risk of complications,” stressed nutritionist Valérie Marcil. When it comes to diet, she points out that parents can be at a loss, as their children's tastes are altered by treatment. “Some can no longer tolerate peanut butter, which they used to love. Others may want to eat nothing but stew or bacon for two weeks, then no longer want it at all,” said Marcil. “What kids like,” she adds, ”is greasy and salty. Basically, McDonald's goes down pretty well.”To meet these dietary challenges, parents are offered regular meetings with the team's nutritionist for cooking workshops to vary menus to suit their child's changing tastes, and simple, economical meal planning. “We've adapted recipes. We've created video capsules to help them at home. We also give them tips, like ginger water, which goes down better than plain water and soothes nausea,” said Marcil. “It's so simple. We help them as much as they want.”Move moreDaniel Curnier, in charge of the physical activity component of the VIE project, speaks of a “phenomenon of overprotection on the part of parents” and “a great deal of resistance.”They need to be convinced of the safety of sport. "They often think their child is too tired to take part. And yet, when a child treated for cancer takes part in physical activity, his or her symptoms of fatigue diminish,” he pointed out, adding that sport also induces better tolerance of treatment. “We've trained over 100 children and we can clearly see the differences.” Usually, parental reluctance eventually falls, and their views change along the way. He particularly remembers one father who recognized that physical activity had completely transformed his child. “In his head, if he was doing sport, it meant he was getting better.”Each patient included in the VIE program benefits from individualized followup by a kinesiologist, in collaboration with CHU physiotherapists. “We aim to achieve the recommended 30 minutes of physical activity per day,” said Curnier. He also favours a play-based approach that entertains children to put a smile on their faces.The mental health component of the program is aimed specifically at parents. “Cancer is a trauma that has a long-term impact on families, and can profoundly upset family equilibrium. At the time of diagnosis, parents experience acute stress linked to the threats facing their child. Then, the oncological care they receive causes them a great deal of overload,” explained psychologist Serge Sultan, whose research focuses on the psychosocial factors associated with cancer and other serious illnesses.Regaining controlAs part of the VIE project, he has developed a program entitled “Reclaiming control together.” “We help parents to be less emotionally distressed and stressed, so that they can regain control over what happens to them,” said Sultan. The program consists of six meetings with a social worker (four individually and two as a couple), during which the latter helps parents to solve a particular problem: work/hospital reconciliation, having time for oneself, communicating with medical teams, etc. “We brainstorm with them to come up with solutions and give them a problem-solving method. Often, people already know how to do this, but they're too stressed to do it, so we take the time and sit down with them so that they regain a sense of being able to solve their issues.”A pediatric hemato-oncologist at CHUL, Dr. Raoul Santiago was doing his fellowship at Sainte-Justine when the VIE project began. “I jumped right on board. It's a very promising program. Before, we were focusing on patient survival. Now, we're focusing on the aftermath, from the moment the diagnosis is announced. It's very positive for the families,” said Dr. Santiago, who has found patients readily embrace the program. “It gives them a routine and occupies the waiting time between appointments with fun activities for the children. For their parents, it's a release valve that allows them to refocus on less medical things.” Today, Dr. Santiago is in charge of implementing the VIE project at CHUL and said it has been well-received. “We have defined the intervention program in each of the three axes with modalities that suit the specificities of the pediatric hemato-oncology department and, currently, we are in the process of training the various stakeholders," he said. “We organized an information meeting with three researchers from CHU Sainte-Justine. I was surprised, because the room was full. The clinical teams immediately saw the relevance (of the program).” He is convinced that the program is feasible throughout Quebec and that it is effective.All that remains now is to convince the management of the four university hospitals involved “to make it a recurring standard of care, with associated budgets,” said Dr. Laverdière. The challenge: The project requires resources and is currently financed by the FRQS and the Charles-Bruneau Foundation, which is dedicated to the fight against pediatric cancer. This funding is not necessarily available to university hospitals. To compensate for this, Dr. Laverdière envisages, “an agreement between the foundation and the hospitals” to institutionalize the VIE project.In the meantime, her innovative approach is attracting international interest. Daniel Curnier has been approached by Norwegian researchers who want to deploy the physical activity component of the VIE program in their country. The kinesiologist will also be spending six months in New Zealand and a further six in Australia to set up the project there. “It's recognition of the relevance of our approach,” he said.The “Taking Control Together” intervention manual developed by Sultan will also be translated into Spanish for Chile.This article was translated from its original French and was first published on our sister site Profession Santé.

This program is helping pediatric oncology patients (and their parents) use lifestyle habits to counter the impact of cancer treatments

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