Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Sample
2.2. Study Instrument
2.2.1. Baseline Questionnaire
2.2.2. The Chinese Version of the SF-36
2.2.3. Brief Symptom Inventory (BSI)
2.3. Data Collection Methods
2.4. Data Analysis
3. Results
3.1. Health Behaviors
3.2. Health-Related Quality of Life and Psychological Distress by Health Behavior Status
4. Discussion
4.1. Health Behaviors
4.2. Cancer Screening
4.3. Insurance Coverage
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Siblings (n = 208) | Survivors (n = 614) | p-Value |
---|---|---|---|
Socio-demographics | |||
Age (years) † | 24.0 (5.1) | 21.9 (5.6) | <0.001 |
Gender | |||
Male | 94 (45.2%) | 360 (58.6%) | 0.001 |
Female | 114 (54.8%) | 254 (41.4%) | |
Birth in Hong Kong | |||
Yes | 189 (91.3%) | 533 (87.1%) | 0.105 |
No | 18 (8.7%) | 79 (12.9%) | |
Marital status | |||
Single | 177 (86.3%) | 571 (93.1%) | 0.001 |
Married/cohabiting | 22 (10.7%) | 40 (6.5%) | |
Divorced/widowed/separated | 6 (2.9%) | 2 (0.3%) | |
Educational level | |||
Not completed secondary | 24 (11.5%) | 259 (42.5%) | <0.001 |
Completed secondary | 39 (18.8%) | 177 (29.1%) | |
Sub-degree | 42 (20.2%) | 78 (12.8%) | |
University or above | 103 (49.5%) | 95 (15.6%) | |
Employment status | |||
Unemployed | 60 (29.0%) | 301 (49.2%) | <0.001 |
Employed | 147 (71.0%) | 311 (50.8%) | |
Personal monthly income (HK$) | |||
No income | 68 (32.9%) | 312 (51.1%) | <0.001 |
1–9999 | 60 (29.0%) | 160 (26.2%) | |
10,000–19,999 | 53 (25.6%) | 102 (16.7%) | |
≥20,000 | 26 (12.6%) | 36 (5.9%) | |
Housing ownership | |||
No | 163 (78.4%) | 567 (92.3%) | <0.001 |
Yes | 45 (21.6%) | 47 (7.7%) | |
Disease characteristics | |||
Years since diagnosis † | 14.1 (6.8) | ||
Types of cancer | |||
Leukemia | 279 (45.4%) | ||
Lymphoma | 62 (10.1%) | ||
Bone and soft tissue cancers | 75 (12.2%) | ||
Brain and CNS malignancies | 52 (8.5%) | ||
Others | 146 (23.8%) | ||
Treatments received | |||
Chemotherapy/Surgery/Radiotherapy only | 241 (46.4%) | ||
Chemotherapy & surgery | 145 (27.9%) | ||
Chemotherapy & radiotherapy | 62 (11.9%) | ||
Chemotherapy & surgery & radiotherapy | 71 (13.7%) |
Health Behavior Outcomes | Unadjusted Comparison | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
Siblings (ref) | Survivors | ORU | p-Value | ORA (95% CI) | p-Value | |
Among all respondents | ||||||
Alcoholic consumption | ||||||
No | 69 (33.2%) | 343 (56.1%) | ||||
Yes | 139 (66.8%) | 268 (43.9%) | 0.39 | <0.001 | 0.65 (0.43–0.97) | 0.035 |
Smoking | ||||||
No | 189 (90.9%) | 557 (90.7%) | ||||
Yes | 19 (9.1%) | 57 (9.3%) | 1.02 | 0.949 | 0.85 (0.44–1.66) | 0.638 |
Health insurance coverage | ||||||
No | 86 (41.3%) | 464 (76.6%) | ||||
Yes | 122 (58.7%) | 142 (23.4%) | 0.22 | <0.001 | 0.27 (0.18–0.39) | <0.001 |
Life insurance coverage | ||||||
No | 103 (50.0%) | 476 (78.7%) | ||||
Yes | 103 (50.0%) | 129 (21.3%) | 0.27 | <0.001 | 0.38 (0.26–0.56) | <0.001 |
Among all male respondents | ||||||
Monthly testicular self-examination | ||||||
Rarely or never | 77 (89.5%) | 299 (87.9%) | ||||
Occasionally/regularly | 9 (10.5%) | 41 (12.1%) | 1.17 | 0.682 | 1.28 (0.54–3.02) | 0.573 |
Among all female respondents | ||||||
Monthly breast self-examination | ||||||
Rarely or never | 66 (59.5%) | 174 (69.3%) | ||||
Occasionally/regularly | 45 (40.5%) | 77 (30.7%) | 0.65 | 0.068 | 0.87 (0.50–1.51) | 0.620 |
Ever had pap smear test | ||||||
No | 76 (67.9%) | 225 (89.6%) | ||||
Yes | 36 (32.1%) | 26 (10.4%) | 0.24 | <0.001 | 0.38 (0.19–0.75) | 0.005 |
Ever had breast examination | ||||||
No | 68 (60.7%) | 189 (75.0%) | ||||
Yes | 44 (39.3%) | 63 (25.0%) | 0.52 | 0.006 | 0.54 (0.31–0.95) | 0.033 |
Mammogram | ||||||
No | 105 (94.6%) | 237 (94.0%) | ||||
Yes | 6 (5.4%) | 15 (6.0%) | 1.11 | 0.837 | 2.31 (0.68–7.84) | 0.181 |
Characteristics | Alcoholic Consumption | Health Insurance Coverage | Life Insurance Coverage | |||
---|---|---|---|---|---|---|
Odds Ratio (95% CI) | p-Value | Odds Ratio (95% CI) | p-Value | Odds Ratio (95% CI) | p-Value | |
Socio-demographics | ||||||
Age (years) | 1.03 (0.97–1.10) | 0.373 | 0.90 (0.84–0.97) | 0.006 | 0.96 (0.90–1.02) | 0.203 |
Gender | ||||||
Male (ref) | 1 | NE | NE | NE | NE | |
Female | 0.65 (0.43–0.98) | 0.038 | ||||
Birth in Hong Kong | ||||||
Yes (ref) | NE | NE | 1 | 1 | ||
No | 0.61 (0.28–1.34) | 0.221 | 0.39 (0.16–0.98) | 0.044 | ||
Marital status | ||||||
Single/divorced/widowed/separated (ref) | 1 | 1 | 1 | |||
Married/cohabiting | 0.67 (0.29–1.56) | 0.356 | 1.71 (0.70–4.19) | 0.240 | 0.87 (0.36–2.09) | 0.756 |
Educational level | ||||||
Not completed secondary (ref) | 1 | 1 | 1 | |||
Completed secondary | 2.73 (1.54–4.84) | 0.001 | 1.28 (0.63–2.60) | 0.491 | 0.83 (0.40–1.70) | 0.604 |
Sub-degree | 3.67 (1.80–7.48) | <0.001 | 1.43 (0.61–3.38) | 0.411 | 1.09 (0.46–2.56) | 0.844 |
University or above | 4.00 (1.92–8.32) | <0.001 | 3.07 (1.31–7.16) | 0.010 | 1.60 (0.71–3.61) | 0.259 |
Employment status | ||||||
Unemployed (ref) | 1 | 1 | 1 | |||
Employed | 4.47 (2.32–8.62) | <0.001 | 0.91 (0.41–2.03) | 0.820 | 0.91 (0.40–2.05) | 0.810 |
Personal monthly income (HK$) | ||||||
No income (ref) | 1 | 1 | 1 | |||
1–9999 | 1.03 (0.57–1.88) | 0.915 | 1.64 (0.83–3.21) | 0.153 | 1.62 (0.80–3.30) | 0.181 |
10,000–19,999 | 1.05 (0.50–2.21) | 0.896 | 1.82 (0.77–4.30) | 0.175 | 3.23 (1.39–7.53) | 0.006 |
≥20,000 | 4.34 (1.20–15.75) | 0.026 | 1.12 (0.37–3.37) | 0.839 | 3.63 (1.30–10.18) | 0.014 |
Housing ownership | ||||||
No (ref) | 1 | 1 | 1 | |||
Yes | 1.51 (0.68–3.37) | 0.315 | 1.54 (0.64–3.67) | 0.334 | 1.44 (0.67–3.09) | 0.351 |
Disease characteristics | ||||||
Years since diagnosis | 0.95 (0.91–0.99) | 0.020 | 1.06 (1.01–1.12) | 0.028 | 1.04 (0.99–1.10) | 0.094 |
Types of cancer | ||||||
Leukemia (ref) | 1 | 1 | 1 | |||
Lymphoma | 1.42 (0.70–2.87) | 0.334 | 2.14 (1.04–4.40) | 0.040 | 0.90 (0.43–1.87) | 0.777 |
Bone and soft tissue cancers | 1.52 (0.80–2.89) | 0.199 | 1.44 (0.61–3.40) | 0.409 | 0.50 (0.20–1.28) | 0.148 |
Brain and CNS malignancies | 0.28 (0.11–0.70) | 0.007 | 1.69 (0.68–4.22) | 0.259 | 0.78 (0.32–1.90) | 0.581 |
Others | 1.46 (0.86–2.46) | 0.162 | 1.48 (0.75–2.90) | 0.257 | 1.59 (0.94–2.71) | 0.085 |
Treatments received | ||||||
Chemotherapy/Surgery/Radiotherapy only (ref) | NE | NE | 1 | NE | NE | |
Chemotherapy & surgery | 0.46 (0.23–0.89) | 0.022 | ||||
Chemotherapy & radiotherapy | 0.40 (0.17–0.90) | 0.027 | ||||
Chemotherapy & surgery & radiotherapy | 1.05 (0.52–2.14) | 0.896 |
Characteristics | Ever Had Pap Smear | Ever Had Breast Examination | ||
---|---|---|---|---|
Odds Ratio (95% CI) | p-Value | Odds Ratio (95% CI) | p-Value | |
Socio-demographics | ||||
Age (years) | 1.04 (0.85–1.26) | 0.728 | 1.01 (0.91–1.12) | 0.930 |
Birth in Hong Kong | ||||
Yes (ref) | NE | NE | NE | NE |
No | ||||
Marital status | ||||
Single/divorced/widowed/separated (ref) | 1 | 1 | ||
Married/cohabiting | 3.88 (0.85–17.73) | 0.081 | 2.48 (0.72–8.51) | 0.150 |
Educational level | ||||
Not completed secondary (ref) | 1 | NE | NE | |
Completed secondary | 2.86 (0.22–36.56) | 0.419 | ||
Sub-degree | 2.69 (0.18–41.16) | 0.476 | ||
University or above | 1.04 (0.05–21.03) | 0.981 | ||
Employment status | ||||
Unemployed (ref) | 1 | 1 | ||
Employed | 7.13 (0.53–95.43) | 0.138 | 2.23 (0.80–6.27) | 0.127 |
Personal monthly income (HK$) | ||||
<10,000 (ref) | 1 | NE | NE | |
≥10,000 | 2.29 (0.67–7.81) | 0.184 | ||
Housing ownership | ||||
No (ref) | 1 | 1 | ||
Yes | 3.76 (0.33–42.42) | 0.284 | 2.82 (0.55–14.41) | 0.214 |
Disease characteristics | ||||
Years since diagnosis | 0.97 (0.86–1.09) | 0.583 | NE | NE |
Types of cancer | ||||
Leukemia (ref) | NE | NE | 1 | |
Lymphoma | 3.22 (0.85–12.27) | 0.087 | ||
Bone and soft tissue cancers | 3.61 (0.96–13.54) | 0.057 | ||
Brain and CNS malignancies | 1.99 (0.37–10.62) | 0.421 | ||
Others | 3.24 (1.09–9.65) | 0.035 | ||
Treatments received | ||||
Chemotherapy/Surgery/Radiotherapy only (ref) | 1 | 1 | ||
Chemotherapy & surgery | 1.89 (0.40–8.93) | 0.421 | 0.34 (0.12–1.01) | 0.052 |
Chemotherapy & radiotherapy | 7.79 (1.25–48.43) | 0.028 | 1.54 (0.40–5.90) | 0.528 |
Chemotherapy & surgery & radiotherapy | 5.40 (1.00–29.03) | 0.049 | 4.29 (1.02–17.96) | 0.046 |
Outcomes | Alcoholic Consumption | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
No (ref) | Yes | p-Value | B | SE | p-Value | |
Health-related quality of life (SF-36) | ||||||
Physical functioning subscale score | 92.1 (15.4) | 94.2 (10.4) | 0.047 | 1.500 | 1.373 | 0.275 |
Role physical subscale score | 86.7 (20.4) | 88.0 (18.1) | 0.418 | 1.522 | 2.078 | 0.464 |
Body pain subscale score | 86.3 (21.2) | 83.6 (20.1) | 0.111 | −3.831 | 2.309 | 0.098 |
General health subscale score | 62.6 (19.4) | 60.8 (19.8) | 0.256 | −3.334 | 2.042 | 0.103 |
Vitality subscale score | 65.0 (17.9) | 60.4 (17.1) | 0.001 | −3.474 | 1.893 | 0.067 |
Social functioning subscale score | 90.1 (17.7) | 88.2 (14.9) | 0.157 | −4.655 | 1.920 | 0.016 |
Role emotional subscale score | 89.8 (18.5) | 87.1 (18.1) | 0.068 | −0.464 | 2.212 | 0.834 |
Mental health subscale score | 74.1 (15.1) | 70.7 (15.7) | 0.007 | −5.079 | 1.728 | 0.003 |
Physical health summary component score | 51.0 (9.2) | 51.6 (7.6) | 0.428 | 0.072 | 0.870 | 0.934 |
Mental health summary component score | 52.6 (8.0) | 50.2 (8.2) | <0.001 | −2.721 | 0.937 | 0.004 |
Psychological distress (BSI-18) | ||||||
Somatization | 42.4 (6.2) | 44.1 (7.5) | 0.002 | 1.588 | 0.788 | 0.045 |
Depression | 45.3 (8.0) | 47.7 (8.4) | <0.001 | 1.894 | 0.909 | 0.038 |
Anxiety | 42.5 (7.9) | 44.2 (8.5) | 0.013 | 1.581 | 0.936 | 0.092 |
Global severity index | 40.3 (9.5) | 43.3 (10.5) | <0.001 | 2.998 | 1.138 | 0.009 |
Outcomes | Health Insurance Coverage | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
No (ref) | Yes | p-Value | B | SE | p-Value | |
Health-related quality of life (SF-36) | ||||||
Physical functioning subscale score | 92.7 (14.0) | 93.8 (11.7) | 0.406 | −1.084 | 1.325 | 0.414 |
Role physical subscale score | 86.3 (20.6) | 90.5 (14.2) | 0.006 | 3.962 | 1.997 | 0.048 |
Body pain subscale score | 84.8 (21.2) | 85.6 (19.4) | 0.710 | 1.004 | 2.228 | 0.652 |
General health subscale score | 61.6 (19.6) | 61.8 (19.5) | 0.922 | −1.349 | 1.974 | 0.495 |
Vitality subscale score | 63.0 (17.5) | 63.0 (18.4) | 0.996 | −1.060 | 1.818 | 0.560 |
Social functioning subscale score | 88.7 (17.4) | 90.7 (13.9) | 0.225 | 1.066 | 1.865 | 0.568 |
Role emotional subscale score | 87.9 (19.0) | 90.4 (16.4) | 0.137 | 3.007 | 2.128 | 0.158 |
Mental health subscale score | 73.0 (15.2) | 71.6 (16.4) | 0.365 | −1.763 | 1.680 | 0.295 |
Physical health summary component score | 51.0 (8.9) | 51.8 (7.7) | 0.330 | −0.182 | 0.840 | 0.829 |
Mental health summary component score | 51.5 (8.2) | 51.6 (8.1) | 0.868 | 0.182 | 0.912 | 0.842 |
Psychological distress (BSI-18) | ||||||
Somatization | 42.8 (6.9) | 44.4 (6.7) | 0.019 | 1.611 | 0.759 | 0.034 |
Depression | 46.4 (8.1) | 46.1 (8.6) | 0.725 | 0.205 | 0.875 | 0.815 |
Anxiety | 43.3 (8.3) | 43.0 (8.1) | 0.702 | 0.444 | 0.903 | 0.624 |
Global severity index | 41.6 (10.0) | 41.8 (10.2) | 0.875 | 0.688 | 1.102 | 0.533 |
Outcomes | Life Insurance Coverage | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
No (ref) | Yes | p-Value | B | SE | p-Value | |
Health-related quality of life (SF-36) | ||||||
Physical functioning subscale score | 92.3 (14.2) | 95.5 (9.8) | 0.004 | 2.595 | 1.413 | 0.067 |
Role physical subscale score | 86.4 (20.0) | 90.7 (16.3) | 0.013 | 5.732 | 2.129 | 0.007 |
Body pain subscale score | 84.8 (21.2) | 85.6 (19.0) | 0.717 | 2.196 | 2.382 | 0.357 |
General health subscale score | 61.4 (19.4) | 62.5 (20.2) | 0.581 | 0.374 | 2.113 | 0.859 |
Vitality subscale score | 63.4 (17.5) | 61.5 (18.3) | 0.296 | −2.185 | 1.943 | 0.261 |
Social functioning subscale score | 88.2 (17.4) | 92.7 (12.7) | 0.002 | 5.170 | 1.981 | 0.009 |
Role emotional subscale score | 87.5 (19.1) | 92.1 (15.3) | 0.006 | 6.146 | 2.263 | 0.007 |
Mental health subscale score | 72.6 (15.7) | 72.9 (14.9) | 0.845 | −0.115 | 1.799 | 0.949 |
Physical health summary component score | 50.9 (8.8) | 52.3 (7.5) | 0.088 | 1.267 | 0.897 | 0.158 |
Mental health summary component score | 51.4 (8.3) | 52.0 (7.6) | 0.439 | 0.889 | 0.975 | 0.362 |
Psychological distress (BSI-18) | ||||||
Somatization | 42.9 (6.9) | 44.2 (6.7) | 0.048 | 1.415 | 0.806 | 0.080 |
Depression | 46.6 (8.4) | 45.6 (7.7) | 0.245 | −0.567 | 0.927 | 0.541 |
Anxiety | 43.3 (8.3) | 43.1 (8.1) | 0.760 | 0.573 | 0.957 | 0.550 |
Global severity index | 41.6 (10.2) | 41.8 (9.6) | 0.862 | 0.836 | 1.169 | 0.475 |
Outcomes | Pap Test | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
No (ref) | Yes | p-Value | B | SE | p-Value | |
Health-related quality of life (SF-36) | ||||||
Physical functioning subscale score | 92.6 (13.4) | 92.5 (12.1) | 0.968 | 4.497 | 3.519 | 0.203 |
Role physical subscale score | 84.8 (20.9) | 83.7 (24.1) | 0.791 | 2.515 | 5.198 | 0.629 |
Body pain subscale score | 81.4 (22.3) | 84.0 (19.7) | 0.573 | 6.128 | 6.178 | 0.323 |
General health subscale score | 60.0 (19.9) | 58.2 (19.1) | 0.653 | 2.818 | 5.172 | 0.587 |
Vitality subscale score | 62.0 (17.4) | 57.2 (15.8) | 0.179 | 0.463 | 4.524 | 0.919 |
Social functioning subscale score | 86.9 (18.5) | 86.1 (17.4) | 0.817 | 3.317 | 5.298 | 0.532 |
Role emotional subscale score | 85.2 (20.2) | 91.3 (17.6) | 0.136 | 10.153 | 5.642 | 0.074 |
Mental health subscale score | 71.0 (15.3) | 73.7 (15.1) | 0.403 | 5.341 | 4.335 | 0.220 |
Physical health summary component score | 50.4 (8.7) | 49.8 (9.6) | 0.754 | 2.223 | 2.292 | 0.334 |
Mental health summary component score | 50.4 (8.3) | 50.9 (8.5) | 0.769 | 2.118 | 2.457 | 0.390 |
Psychological distress (BSI-18) | ||||||
Somatization | 44.3 (6.6) | 40.4 (13.8) | 0.170 | −7.649 | 2.238 | 0.001 |
Depression | 46.2 (7.2) | 46.7 (8.1) | 0.779 | 0.269 | 2.059 | 0.896 |
Anxiety | 44.5 (8.4) | 42.2 (7.4) | 0.177 | −1.754 | 2.397 | 0.465 |
Global severity index | 42.9 (9.4) | 38.7 (14.9) | 0.165 | −7.496 | 2.900 | 0.011 |
Outcomes | Breast Examination | Adjusted Comparison | ||||
---|---|---|---|---|---|---|
No (ref) | Yes | p-Value | B | SE | p-Value | |
Health-related quality of life (SF-36) | ||||||
Physical functioning subscale score | 92.7 (12.1) | 92.3 (16.3) | 0.820 | 1.924 | 2.570 | 0.455 |
Role physical subscale score | 84.9 (20.3) | 84.2 (23.7) | 0.834 | 3.300 | 3.766 | 0.382 |
Body pain subscale score | 82.6 (21.5) | 78.8 (23.4) | 0.232 | 1.006 | 4.498 | 0.823 |
General health subscale score | 60.1 (19.6) | 59.3 (20.3) | 0.796 | 1.281 | 3.752 | 0.733 |
Vitality subscale score | 60.9 (18.2) | 63.8 (14.1) | 0.247 | 3.262 | 3.303 | 0.325 |
Social functioning subscale score | 86.6 (18.6) | 87.9 (17.8) | 0.620 | 4.731 | 3.832 | 0.219 |
Role emotional subscale score | 84.7 (20.2) | 89.3 (19.2) | 0.116 | 8.097 | 4.086 | 0.049 |
Mental health subscale score | 70.6 (15.8) | 73.4 (13.1) | 0.207 | 5.420 | 3.133 | 0.085 |
Physical health summary component score | 50.7 (8.3) | 49.3 (10.2) | 0.273 | 0.375 | 1.672 | 0.823 |
Mental health summary component score | 49.9 (8.7) | 52.1 (6.9) | 0.075 | 3.275 | 1.770 | 0.066 |
Psychological distress (BSI-18) | ||||||
Somatization | 44.6 (6.6) | 42.1 (10.2) | 0.028 | −3.764 | 1.666 | 0.025 |
Depression | 46.0 (7.1) | 47.0 (7.7) | 0.364 | 0.582 | 1.492 | 0.697 |
Anxiety | 44.7 (8.5) | 42.8 (7.9) | 0.118 | −2.008 | 1.736 | 0.249 |
Global severity index | 43.1 (9.4) | 40.7 (11.9) | 0.100 | −4.018 | 2.129 | 0.061 |
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Chan, C.W.H.; Choi, K.C.; Chien, W.T.; Sit, J.W.H.; Wong, R.; Cheng, K.K.F.; Li, C.K.; Yuen, H.L.; Li, C.K. Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings. Int. J. Environ. Res. Public Health 2020, 17, 6136. https://doi.org/10.3390/ijerph17176136
Chan CWH, Choi KC, Chien WT, Sit JWH, Wong R, Cheng KKF, Li CK, Yuen HL, Li CK. Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings. International Journal of Environmental Research and Public Health. 2020; 17(17):6136. https://doi.org/10.3390/ijerph17176136
Chicago/Turabian StyleChan, Carmen W. H., Kai Chow Choi, Wai Tong Chien, Janet W. H. Sit, Rosa Wong, Karis K. F. Cheng, Chi Kong Li, Hui Leung Yuen, and Chi Keung Li. 2020. "Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings" International Journal of Environmental Research and Public Health 17, no. 17: 6136. https://doi.org/10.3390/ijerph17176136
APA StyleChan, C. W. H., Choi, K. C., Chien, W. T., Sit, J. W. H., Wong, R., Cheng, K. K. F., Li, C. K., Yuen, H. L., & Li, C. K. (2020). Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings. International Journal of Environmental Research and Public Health, 17(17), 6136. https://doi.org/10.3390/ijerph17176136