Age and sex rather than treatment intensity predicted health behaviors among AYA childhood cancer survivors, who had higher rates of insufficient physical activity and e-cigarette use but lower rates of alcohol and medicinal cannabis use compared with population controls.
Key Findings
Results
A substantial proportion of AYA childhood cancer survivors did not meet physical activity recommendations.
31% of the 312 CCS participants did not meet physical activity recommendations.
CCS had higher rates of insufficient physical activity compared with Canadian Community Health Survey (CCHS) population controls.
The cohort had a median age of 22.1 years (interquartile range 8.78) and was 50.6% female.
The study was conducted at the Long-Term Survivor Clinic at the Alberta Children's Hospital between July 2021 and July 2025.
Results
Tobacco and cannabis use were reported by notable proportions of AYA childhood cancer survivors.
13% of CCS reported current tobacco use.
29% of CCS reported current cannabis use.
Male sex was associated with tobacco use.
CCS had lower rates of medicinal cannabis use compared with population controls.
Results
E-cigarette use was higher among CCS compared with population-based controls.
CCS had higher rates of e-cigarette use compared with CCHS controls.
The authors identified e-cigarette use as an 'emerging behavior' representing a gap in current survivorship care.
The comparison was made using Canadian Community Health Survey (CCHS) controls as the population reference.
Results
Alcohol use was lower among AYA childhood cancer survivors compared with population controls.
CCS had lower rates of alcohol use compared with CCHS population controls.
This finding was identified through comparisons with the Canadian Community Health Survey.
The study captured health behavior outcomes via self-reported questionnaires.
Results
Sun protection behaviors were suboptimal among a large proportion of AYA childhood cancer survivors.
47% of CCS reported only sometimes or rarely using sunscreen.
14% reported never using sunscreen.
Only 5.8% reported ever using artificial tanning devices.
Older age predicted artificial tanning device use.
Male sex was associated with lower sunscreen adherence.
Results
Sleep quality was reported as poor by very few childhood cancer survivors.
Only 0.1% of CCS reported poor sleep quality.
This outcome was captured via self-reported questionnaires.
The sample included 312 CCS with a median age of 22.1 years.
Results
Age and sex, rather than cancer treatment intensity, were the primary predictors of health behaviors in AYA childhood cancer survivors.
Treatment intensity was not associated with any of the health behaviors examined.
Older age predicted artificial tanning device use.
Male sex was associated with tobacco use and lower sunscreen adherence.
Risk factors were determined using Bayesian analyses.
The authors concluded that 'age and sex rather than treatment intensity predicted health behaviors.'
Conclusions
The authors identified gaps in survivorship care related to emerging health behaviors and called for standardized counseling frameworks.
E-cigarette and medicinal cannabis use were highlighted as 'emerging behaviors' that 'highlight gaps in current survivorship care.'
The authors called for 'standardized counseling frameworks' to address these behaviors.
The authors concluded that 'integration of routine health behavior assessments and targeted interventions addressing these behaviors and associated factors is warranted to optimize long-term AYA survivorship outcomes.'
What This Means
This research followed 312 young cancer survivors (median age about 22 years) who were treated as children and are now being monitored at a long-term survivorship clinic in Alberta, Canada. The study found that many of these survivors engage in health behaviors that could worsen their already elevated risk for long-term health problems: nearly one-third were not getting enough physical activity, about half were inconsistent with sunscreen use, roughly 13% smoked tobacco, and 29% used cannabis. Compared to the general Canadian population, these survivors were more likely to use e-cigarettes and less likely to drink alcohol. Notably, sleep problems were rarely reported.
One of the study's key findings was that demographic factors — specifically age and sex — were better predictors of unhealthy behaviors than the intensity of cancer treatment the survivors had received. For example, male survivors were more likely to use tobacco and less likely to use sunscreen, while older survivors were more likely to have used artificial tanning devices. This suggests that tailoring health counseling based on treatment history alone may be insufficient, and that age- and sex-specific approaches are needed.
This research suggests that clinics caring for childhood cancer survivors should routinely screen for a broad range of health behaviors and provide targeted guidance, particularly around newer behaviors like e-cigarette use and medicinal cannabis, which are not always addressed in standard survivorship care. Because childhood cancer survivors face lifelong health risks from both their disease and its treatment, adopting healthy behaviors is especially important for this group, and better-structured counseling could help them make informed choices.
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de Beijer I, van den Oever S, Lawal O, Adham H, Ashofor T, Button A, et al.. (2026). Health Behaviors in Adolescent and Young Adult (AYA) Childhood Cancer Survivors: Prevalence, Determinants, and Comparison With Population Controls.. Cancer medicine. https://doi.org/10.1002/cam4.72236