| Sumario: | Translation/Implementation Science Background & Significance: Rising survival rates in childhood cancer is accompanied by concern for secondary comorbidities such as obesity and effects on long-term health outcomes. Unhealthy eating habits developed during treatment often persist beyond treatment and contribute to higher rates of obesity, but factors influencing development of these habits during treatment are not well understood. Purpose: To elucidate factors that influence pediatric oncology patients' eating habits during treatment from the perspective of the child diagnosed with cancer, caregiver, and dyad. Methods: For this convergent mixed methods design, twelve dyads of children (10-18 years) diagnosed with cancer and their caregivers participated in virtual or in-person semi-structured interviews. Each member of the dyad was interviewed separately, then together. Qualitative data were transcribed and coded. Descriptive content analysis was used to identify themes. Data related to the child's cancer and caregiver's sociodemographic information were collected. Quantitative data were used to provide context and enrich interpretation of emergent themes. Findings and Interpretations: The mean age at diagnosis among the children who participated was 11.7 (±3.1) years; 75% were diagnosed with malignant hematologic cancer. Several themes emerged regarding factors that impacted eating habits during treatment. The most common theme among children was loss of enticing food options due to treatment-related changes in taste, nausea, and food safety guidelines leading to overconsumption of unhealthier foods that still tasted good and met guidelines. Among caregivers there was a contrasting desire to encourage healthy eating while desperately offering any foods, often unhealthy, to increase intake. Caregivers also commonly noted children's "fixation" on a particular low-quality food that would be eaten in excess. Children and caregivers each identified that it was common for the child to have control over food choices even when unhealthy. In dyadic interviews, it was common for the child and caregiver to acknowledge contention regarding eating habits, outweighed by a positive bond formed during the cancer experience. Discussion: Eating habits developed during cancer treatment in pediatric oncology patients are influenced by a complex interplay of treatment-related side effects and psychosocial factors. This study suggests that, to improve pediatric oncology patients' long-term health outcomes, interventions that support establishment and maintenance of healthy eating habits should include the child and caregiver and address both treatment effects and psychosocial factors that influence eating habits. Future research is needed to examine effective multifactorial strategies.
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