<div>ABSTRACT</div><div>As the effects of cancer and its treatment have long-lasting negative
impacts on the health and quality of life of survivors, there is a need
to explore new avenues to optimize long-term patient outcomes in
pediatric oncology. Therefore, this scoping review aims to report on the
state of the evidence on the use and effects of behavioural
interventions targeting physical activity and diet behaviours in
pediatric oncology. Fourteen quantitative studies were included. Studies
evaluated a combination of two or three different modalities, including
education (n=11), physical activity (n=6), psychosocial support or
training (n=6), reward system (n=2) and adventure-based activities
(n=1).  Overall, behavioural interventions in pediatric oncology appear
beneficial; however, no conclusive evidence favouring specific
interventions were identified.</div><div>INTRODUCTION</div><div>Progress in childhood cancer treatment, diagnosis and management have
resulted in childhood cancer survival rates of over 80% in North
America in the past decades [1, 2]. However, concurrent with this
success comes an increased appreciation of the late effects resulting
from the disease and its treatment that have been extensively described
in the literature [3-5]. It is estimated that 62.3% of adult
survivors of childhood cancer suffer from at least one chronic health
condition, 27.5% have a severe or life-threatening condition [6]
and 95% will have a significant health-related issue by the time they
are 45 years of age [7].</div><div>For many cancer-related complications, behavioural modifications
represent the primary method of risk modification available to survivors
[8]. Although exercising, having a healthy diet, and adopting other
healthy behaviours are beneficial for everyone, the importance of a
healthy lifestyle is critical for pediatric cancer patients who are at
increased risk of adverse health problems that could be potentially
preventable. Lifestyle practices are well-recognized modifiable factors
that contribute to lower the risk of cardiometabolic complications
[9], one of the treatment-related long-term complication prevalent
in this population [10, 11], and might increase the quality of life
of survivors [12]. A review of social cognitive theory-based
interventions in adult cancer survivors demonstrated promise in
improving physical activity (PA) and diet behaviour [13]. Whereas
interventions targeting one specific behaviour change such as exercise
interventions have been the subject of reviews [14-17], there are
currently no evidence-based recommendations to guide the promotion of
more global behavioural intervention changes in the pediatric oncology
population and little is known about complex health promotion
interventions and their effectiveness.</div><div>Hence, the purpose of this scoping review is to report on the extent of
what is known on the use of complex interventions or multimodal programs
addressing PA and diet behaviour for children with cancer or childhood
cancer survivors (CCS) and their reported findings. More specifically,
the aims of this study are to examine the extent, range and nature of
(1) the study populations, (2) the interventions or programs, and (3)
the findings regarding the effects on health behaviours, patient
outcomes, and clinical recommendations.</div><div>METHODS</div><div>The scoping review was conducted following the methodological framework
by Arksey &amp; O’Malley [18], with improved recommendations by Levac
et al. [19] to examine and summarize the extent, range, and nature
of complex interventions or multimodal programs targeting PA and/or
nutrition as well as their findings in pediatric oncology. The adopted
strategy involved searching for research evidence via electronic
databases (Embase, CINAHL, Ovid MedLine, and PsychINFO), using
snowballing technique of the reference lists of selected studies and
hand searching of key journals. For the electronic databases search, no
limit in publication dates was set and a combination of key words and
MeSH terms were used based upon the identified core concepts of the
research question. The search strategy for electronic databases was
developed from the research question and definitions of key concepts
with the help of a librarian. Materials in English and French were
included.</div><div>Prior to study selection, inclusion and exclusion criteria were created.
Then, two reviewers (CD and AB) independently screened the title and
abstract of studies for inclusion. Disagreements were resolved by
consensus. Studies were included for full-text review if they (i)
included children with cancer or survivors of childhood cancer that were
diagnosed before the age of 21, (ii) consisted of complex interventions
or multimodal program, (iii) interventions targeted PA and/or nutrition.
Behavioural complex interventions or programs were defined as broad
interventions that are built from several interacting components that
aim to change health behaviours and improve patient outcomes. The second
level of screening involved reading the full text of each article, which
was done by CD. AB was consulted as needed for further clarification of
any ambiguities. Full-text review included all methodologies and
excluded syntheses or reviews of existing evidence, theoretical and
empirical articles, conference abstracts, and editorials. Multiple
articles that provided results from the same study were grouped together
for analyses. For intervention studies that had been preceded by
published pilot studies, only the more recent version was discussed. A
charting form was developed to retrieve the following data from the
selected studies: authors, year of publication, study design, study
population, sample size, intervention/program description, and findings
(see Table 1).</div><div>In accordance with Levac et al. [19] and Colquhoun et al. [20]
guidelines, we conducted a descriptive numerical and a thematic
analysis. The descriptive numerical analysis focused on the
characteristics of the studies (e.g. age of patients, program duration).
We conducted a thematic analysis from the extracted data to answer our
scoping review questions. Themes emerged around: (i) population
addressed, (ii) type of interventions, (iii) patient outcomes, and (iv)
clinical recommendations.</div><div>RESULTS</div>