This study aimed to evaluate the cardiovascular medical management of young adults who had viewed the massive open online course (MOOC) “Childhood Cancer, Living Well, After” four years earlier during the feasibility study (START-MOOC1), compared with those who had not.
Methods:
A retrospective, descriptive, French multicenter study was conducted involving 322 childhood cancer survivors (CCS) (range, 20–36 years) eligible to view the cardiovascular health module of the MOOC. Participants were divided into two groups those who had viewed the MOOC (MOOC+) four years earlier and those who had not (MOOC−). We collected data on medical follow-up, cardiovascular care, and lifestyle habits using a short questionnaire. We analyzed it using descriptive statistics and comparative tests.
Results:
Of the 322 eligible CCS, 95 completed the questionnaire (34 MOOC+ and 61 MOOC−). The participation rate was significantly higher in the MOOC+ group (55.7% vs. 23.4%, p < 0.0001). We found no significant difference between the groups regarding general medical care and cardiologist follow-up. However, 20% of MOOC+ participants began cardiological follow-up after the MOOC, 15% increased their physical activity, and 6% improved their diet. In addition, 25% of MOOC+ participants began complementary therapies.
Conclusion:
The MOOC “Childhood Cancer, Living Well, After” did not result in any significant difference in cardiovascular follow-up behaviors compared with patients who did not view the MOOC. However, the MOOC+ group promoted positive lifestyle changes. Further research with a larger cohort is necessary to assess the full impact of the MOOC on the long-term medical follow-up.
Pritchard-JonesK, PietersR, ReamanGH, et al.Sustaining innovation and improvement in the treatment of childhood cancer: Lessons from high-income countries. Lancet Oncol2013;14(3):e95–e103; doi: 10.1016/S1470-2045(13)70010-X
2.
SchwartzCL. Survivors of Childhood and Adolescent Cancer: A Multidisciplinary Approach. 3d edition. Springer; 2015; doi: 10.1007/b137709
3.
ChaoC, BhatiaS, XuL, et al.Chronic comorbidities among survivors of adolescent and young adult cancer. J Clin Oncol2020;38(27):3161–3174; doi: 10.1200/JCO.20.00722
4.
AckermanA, LyD, HallM, et al.Long-Term care of childhood cancer survivors at risk for cardiac late effects. JACC CardioOncol2025;7(3):309–311; doi: 10.1016/j.jaccao.2025.01.008
5.
HammoudRA, MulrooneyDA, RheaIB, et al.Modifiable cardiometabolic risk factors in survivors of childhood cancer. JACC CardioOncol2024;6(1):16–32; doi: 10.1016/j.jaccao.2023.12.008
6.
LyonAR, López-FernándezT, CouchLS, et al.; ESC Scientific Document Group. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J2022;43(41):4229–4361; doi: 10.1093/eurheartj/ehac244
7.
EhrhardtMJ, LeerinkJM, MulderRL, et al.Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol2023;24(3):e108–e120; doi: 10.1016/S1470-2045(23)00012-8
8.
Van DalenEC, MulderRL, SuhE, et al.Coronary artery disease surveillance among childhood, adolescent and young adult cancer survivors: A systematic review and recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Eur J Cancer2021;156:127–137; doi: 10.1016/j.ejca.2021.06.021
MertensL, SinghG, ArmenianS, et al.Multimodality imaging for cardiac surveillance of cancer treatment in children: Recommendations from the American Society of echocardiography. J Am Soc Echocardiogr2023;36(12):1227–1253; doi: 10.1016/j.echo.2023.09.009
11.
BottinorWJ, DengX, BandyopadhyayD, et al.Myocardial strain during surveillance screening is associated with future cardiac dysfunction among survivors of childhood, adolescent and young adult-onset cancer. Cancers (Basel)2023;15(8):2349; doi: 10.3390/cancers15082349
12.
SyedIA, KlassenAF, BarrR, et al.Factors associated with childhood cancer survivors’ knowledge about their diagnosis, treatment, and risk for late effects. J Cancer Surviv2016;10(2):363–374; doi: 10.1007/s11764-015-0482-7
13.
BergerC, CasagrandaL, Faure-ConterC, et al.Long-Term follow-up consultation after childhood cancer in the Rhône-Alpes region of France: Feedback from adult survivors and their general practitioners. J Adolesc Young Adult Oncol2017;6(4):524–534; doi: 10.1089/jayao.2017.0019
14.
GreenzangKA, CroninAM, MackJW. Parental preparedness for late effects and long-term quality of life in survivors of childhood cancer: Preparation for Cancer Survivorship. Cancer2016;122(16):2587–2594; doi: 10.1002/cncr.30092
15.
JiX, HuX, LipscombJ, et al.Utilization of cardiac tests in anthracycline‐treated cancer survivors differs between young adults and children: A claims‐based analysis. Cancer Med2023;12(24):22056–22061; doi: 10.1002/cam4.6801
16.
BougasN, AllodjiRS, FayechC, et al.Surveillance after childhood cancer: Are survivors with an increased risk for cardiomyopathy regularly followed-up? Br J Cancer2023;129(8):1298–1305; doi: 10.1038/s41416-023-02400-0
MillerTA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Educ Couns2016;99(7):1079–1086; doi: 10.1016/j.pec.2016.01.020
19.
LynnC, QuastL, RogersH, et al.Systematic review of health literacy in childhood cancer patients, survivors, and their caregivers. J Pediatr Psychol2020;45(4):373–385; doi: 10.1093/jpepsy/jsaa009
20.
OeffingerKC, FordJ, MoskowitzCS, et al.The EMPOWER study: Promoting breast cancer screening—A randomized controlled trial (RCT) in the Childhood Cancer Survivor Study (CCSS). JCO2016;34(15_suppl):10506; doi: 10.1200/JCO.2016.34.15_suppl.10506
21.
HudsonMM, LeisenringW, StrattonKK, et al.Increasing cardiomyopathy screening in at-risk adult survivors of pediatric malignancies: A randomized controlled trial. J Clin Oncol2014;32(35):3974–3981; doi: 10.1200/JCO.2014.57.3493
22.
VasilopoulouM, AsimakopoulouZ, VelissariJ, et al.Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors: A Prisma systematic review. Support Care Cancer2024;32(6):342; doi: 10.1007/s00520-024-08516-0
23.
MurphyP, LevineA, LermaT, et al.A portable survivorship care plan: A tool that helps educate and improve knowledge in childhood cancer survivors. Support Care Cancer2021;29(1):169–177; doi: 10.1007/s00520-020-05422-z
24.
BergerC, CasagrandaL, Sudour-BonnangeH, et al.Personalized massive open online course for childhood cancer survivors: Behind the scenes. Appl Clin Inform2021;12(2):237–244; doi: 10.1055/s-0041-1725185
25.
PoulalhonC, VignonL, IdbrikL, et al.Data resource profile: The French Childhood Cancer Observation Platform (CCOP). Int J Epidemiol2020;49(5):1434–1435k; doi: 10.1093/ije/dyaa048
26.
LacourB, Guyot-GoubinA, GuissouS, et al.Incidence of childhood cancer in France: National Children Cancer Registries, 2000–2004. Eur J Cancer Prev2010;19(3):173–181; doi: 10.1097/CEJ.0b013e32833876c0
27.
BerryD, BlonquistT, NayakM, et al.Self-Care support for patients with gastrointestinal cancer: ICancerHealth. Appl Clin Inform2018;9(4):833–840; doi: 10.1055/s-0038-1675810
28.
LeeMK, YunYH, ParkHA, et al.A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial. Int J Nurs Stud2014;51(12):1557–1567; doi: 10.1016/j.ijnurstu.2014.04.012
29.
KaneraIM, BolmanCAW, WillemsRA, et al.Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: A randomized controlled trial. J Cancer Surviv2016;10(5):883–897; doi: 10.1007/s11764-016-0535-6
30.
FrenshamLJ, ParfittG, DollmanJ. Effect of a 12-Week online walking intervention on health and quality of life in cancer survivors: A quasi-randomized controlled trial. Int J Environ Res Public Health2018;15(10):2081; doi: 10.3390/ijerph15102081
31.
ChatterjeeA, PrinzA, GerdesM, MartinezS. Digital interventions on healthy lifestyle management: Systematic review. J Med Internet Res2021;23(11):e26931; doi: 10.2196/26931
32.
CasillasJN, SchwartzLF, CrespiCM, et al.The use of mobile technology and peer navigation to promote adolescent and young adult (AYA) cancer survivorship care: Results of a randomized controlled trial. J Cancer Surviv2019;13(4):580–592; doi: 10.1007/s11764-019-00777-7
33.
ZabihV, KahaneA, O’NeillNE, et al.Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: A systematic review. J Cancer Surviv2019;13(5):713–729; doi: 10.1007/s11764-019-00790-w
34.
RokitkaDA, CurtinC, HefflerJE, et al.Patterns of loss to follow-up care among childhood cancer survivors. J Adolesc Young Adult Oncol2017;6(1):67–73; doi: 10.1089/jayao.2016.0023
35.
DixonSB, LiuQ, ChowEJ, et al.Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: A report from the Childhood Cancer Survivor Study cohort. Lancet2023;401(10386):1447–1457; doi: 10.1016/S0140-6736(22)02471-0
36.
RickTJ, SagaramS, JewettPI, et al.A pilot randomized controlled trial of an online intervention for Hodgkin lymphoma survivors to increase knowledge about late effects and recommended screening. J Cancer Surviv2025;19(6):1781–1792; doi: 10.1007/s11764-024-01587-2
37.
VogelRI, NiendorfK, PetzelS, et al.A patient-centered mobile health application to motivate use of genetic counseling among women with ovarian cancer: A pilot randomized controlled trial. Gynecol Oncol2019;153(1):100–107; doi: 10.1016/j.ygyno.2019.01.019
38.
NathanPC, DaughertyCK, WroblewskiKE, et al.Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. J Cancer Surviv2013;7(3):275–282; doi: 10.1007/s11764-013-0271-0
39.
SuhE, DaughertyCK, WroblewskiK, et al.General internists’ preferences and knowledge about the care of adult survivors of childhood cancer: A cross-sectional survey. Ann Intern Med2014;160(1):11–17; doi: 10.7326/M13-1941
40.
StalJ, PiomboSE, KyshL, et al.The integration of primary care and childhood cancer survivorship care: A scoping review. J Cancer Surviv2024;18(3):635–650; doi: 10.1007/s11764-022-01296-8
41.
Van KalsbeekRJ, MulderRL, HauptR, et al.The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer. Eur J Cancer2022;162:34–44; doi: 10.1016/j.ejca.2021.10.035
42.
ChowEJ, BaldwinLM, HagenAM, et al.Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer. Contemp Clin Trials2020;89:105915; doi: 10.1016/j.cct.2019.105915
43.
MeachamLR, EdwardsPJ, ChervenBO, et al.Primary care providers as partners in long-term follow-up of pediatric cancer survivors. J Cancer Surviv2012;6(3):270–277; doi: 10.1007/s11764-012-0224-z
44.
ChangBPI, WebbTL, BennY. Why do people act like the proverbial Ostrich? Investigating the reasons that people provide for not monitoring their goal progress. Front Psychol2017;8:152; doi: 10.3389/fpsyg.2017.00152
45.
Demoor-GoldschmidtC, LamoreK, JakabZ, et al.Addressing Akrasia in childhood, adolescent and young adult cancer survivors: Implications for long-term follow-up and preventive health interventions. Cancers (Basel)2025;17(8):1310; doi: 10.3390/cancers17081310
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
