Mid Sweden University

Background

The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors sufers from long-lasting health issues following cancer treatment. It is therefore critical to explore efective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors.

Methods

Eligible participants were aged 16–39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety.

Results

Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p=0.024). Program adherence and data completeness was high (>90%) in both arms. Adverse Efects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confdence Interval 0.8–1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness signifcantly increased over time in the wilderness program participants, but not in the holiday program (p<0.001). No diferences were found between the two study arms regarding quality of life, self-esteem, or self-efcacy.

Conclusion

It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the efectiveness of wilderness programs on the health of young cancer survivors.