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Paeds Cancer – Improved psychological health

Evidence Summary
There is evidence to show that children who have experienced cancer have more worry and anxiety than their peers – especially in boys. Cancer also reduces self-esteem in children and young people who are affected (14-21).
The majority of studies in this area show improvement in psychological well-being (4,7,12,19,21), though others failed to demonstrate a significant improvement. Several studies simultaneously assessed “quality of life” measures with parallel significant improvements (10,13,14,21)
Additionally, there is some weak evidence to show that psychological theory-based intervention and yoga can improve psychological wellbeing at 12 months. Wu et al showed improvement in sleep when cancer patients undertook exercise. Finally, if physical activity is coached or supported by family members, patients’ self-efficacy is improved (8-11).

Quality of Evidence
Strength of Recommendation

Cancer negatively impacts psychological health for children and young people. There is some evidence to show that physical activity improves psychological outcomes such as self-efficacy, self-esteem, body image and self-confidence and self-worth. PA can also reduce cancer related worry, anxiety and distress, particularly when combined with psychoeducation.


  1. Antwi G., Jayawardene W., Lohrmann D.K., Mueller E.L., (2019). Physical activity and fitness among pediatric cancer survivors: a meta-analysis of observational studies. Support Care Cancer. (EPUB ahead of print)
  2. Baumann, F. T., Bloch, W., & Beulertz, J. (2013). Clinical exercise interventions in pediatric oncology: a systematic review. Pediatric research, 74(4), 366.
  3. Beulertz, J., Prokop, A., Rustler, V., Bloch, W., Felsch, M. and Baumann, F.T., 2016. Effects of a 6‐Month, Group‐Based, Therapeutic Exercise Program for Childhood Cancer Outpatients on Motor Performance, Level of Activity, and Quality of Life. Pediatric blood & cancer, 63(1), pp.127-132.
  4. Bogg, (2015) Feasibility of an inpatient exercise intervention for children undergoing hematopoietic stem cell transplant, Pediatr Transplant; 19(8):925-31
  5. Braam K. I., van der Torre P., Takken T., Veening M. A., van Dulmen-den Broeder E., Kaspers G. J. L.(20130 Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews. 2013(4).
  6. Cross, A., Howlett, N & Sheffield, D (under review) Social ecological aspects of physical activity interventions for children and young people living with and beyond cancer. DOI 10.17605/OSF.IO/2JKPN
  7. Fiuza-Luces, C., Padilla, J.R., Soares-Miranda, L., Santana-Sosa, E., Quiroga, J.V., Santos-Lozano, A., Pareja-Galeano, H., Sanchis-Gomar, F., Lorenzo-González, R., Verde, Z. and López-Mojares, L.M., 2017. Exercise Intervention in Pediatric Patients with Solid Tumors: The Physical Activity in Pediatric Cancer Trial. Medicine and science in sports and exercise, 49(2), pp.223-230.
  8. Gilliam, M. B., Madan‐Swain, A., Whelan, K., Tucker, D. C., Demark‐Wahnefried, W., & Schwebel, D. C. (2013). Cognitive influences as mediators of family and peer support for pediatric cancer survivors’ physical activity. Psycho‐Oncology, 22(6), 1361-1368.
  9. Ouyang N, Cai R, Zhou X, Huang H, Qiu X, Liu K (2019). Effects of a group-based physical activity program for pediatric patients with cancer on physical activity and symptom experience: A quasi-experimental study. Pediatr Blood Cancer. 2019 Aug 12:e27965. doi: 10.1002/pbc.27965. [Epub ahead of print]
  10. Keats, M.R, Culos-Reed S,N., (2008) A community-based physical activity programme for adolescents with cancer (project trek): Programme feasibility and preliminary findings. J Pediatr Hematol Oncol ;30:272–280
  11. Lam, K., (2018). An integrated experiential training programme with coaching to promote physical activity, and reduce fatigue among children with cancer: A randomised controlled trial, Patient education and counseling, 101 (11)
  12. Marchese, V.G., (2004.) Effects of physical therapy intervention for children with acute lymphoblastic leukemia, Pediatric Blood and Cancer. 42(2):127–33
  13. Müller, C., Krauth, K.A., Gerß, J. and Rosenbaum, D., 2016. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program. Supportive Care in Cancer, 201624(9), pp.3793-3802.
  14. Paxton R. J., Jones L. W., Rosoff P. M., Bonner M., Ater J. L., Demark-Wahnefried W. Associations between leisure-time physical activity and health-related quality of life among adolescent and adult survivors of childhood cancers. Psycho-oncology. 2010;19(9):997-1003.
  15. Platschek, A.M., (2017) Computer-Based Exercise Program: Effects of a 12-Week Intervention on Mood and Fatigue in Pediatric Patients With Cancer, Clin J Oncol Nurs. 1;21(6):E280-E286.
  16. Rosenhagen A., et al, (2011) Implementation of structured physical activity in the pediatric stem cell transplantation. Klin Padiatr. 223(3):147–51.
  17. Sharkey, A.M., (1993) Cardiac rehabilitation for cancer in children and young adults, American journal of cardiology, 17 (16): 1488–1490
  18. Speck, R.M., Courneya, K.S., Mässe, L.C., Duval, S., Schmitz, K.H. (2010). An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 4, 87–100
  19. Su, H. L., Wu, L. M., Chiou, S. S., Lin, P. C., & Liao, Y. M. (2018). Assessment of the effects of walking as an exercise intervention for children and adolescents with cancer: A feasibility study. European Journal of Oncology Nursing, 37, 29-34.
  20. Speyer E, Herbinet A, Vuillemin A, Briançon S, Chastagner P. (2010) Effect ofadapted physical activity sessions in the hospital on health-related quality of life for children with cancer: a cross-over randomized trial. Pediatric Blood Cancer ; 55:1160–6.
  21. Tanir M.K., Kuguoglu S., (2013) Impact of exercise on lower activity levels in children with acute lymphoblastic leukemia: a randomized controlled trial from Turkey. Rehabilitation Nursing ;38(1):48–59
  22. Wallek, S., Senn-Malashonak, A., (2018) Impact of the initial fitness level on the effects of a structured exercise therapy during pediatric stem cell transplantation, Pediatr Blood Cancer. 65(2)
  23. Wurz A., Brunet J. The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review. Jmir Cancer. 2016;2(1).
  24. Wurz,A., (2014) The feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients. Pediatr Blood Cancer. 61(10):1828-34.