Publications

2026

• This multicentre survey across ten European clinical sites examined the ethical experiences of healthcare professionals involved in implementing the FORTEe randomised controlled trial. While most respondents considered the overall burden–benefit balance appropriate and the trial’s ethical climate positive, they reported challenges related to questionnaire burden, logistical demands, and emotional discomfort surrounding control group allocation. The findings underscore the need for clearer guidance on paediatric autonomy, stronger institutional support for ethical reflection, and child-centred research designs that address real-world emotional and logistical pressures beyond procedural compliance.

• Digital interventions, such as mobile apps, can effectively promote physical activity in children, adolescents, and young adults with cancer. This article introduces the “FORTEe Get Strong” app (Nurogames GmbH) and reports a formative evaluation of its acceptability in this population. Developed within the multicenter FORTEe trial, the app is grounded in behavior change theories and uses gamification to provide a child-friendly platform for physical activity and health education. This study offers novel insights into user experience with a gamified exercise and education app. Unlike prior research focused on survivorship, it provides a comprehensive view of how digital tools can support physical activity during intensive cancer treatment.

• This study explored the experiences of children and young people, along with exercise and healthcare professionals, using an augmented reality (AR) app to support an individualised exercise programme in the FORTEe randomised controlled trial. Overall, participants reported positive experiences, finding the app engaging and valuing features such as personalised exercise programmes and AR demonstrations, although some technical and usability challenges were identified. The findings highlight the potential of AR to enhance participation in paediatric oncology exercise programmes and suggest that future tools should focus on improving reliability of AR features, increasing customisation and gamification, and ensuring the app complements rather than replaces face-to-face support. These insights will guide the development of more effective, child-centred digital interventions in healthcare.

• This pilot study tested an augmented reality (AR) smartphone app designed to support individualised exercise for children and young people with cancer, using age-matched school children and university students as part of an initial phase of app development. Most participants found the app fun, engaging, and easy to use, particularly valuing the interactive avatar and personalised exercises, although some technical issues and usability challenges were reported. Suggested improvements focused on features that could further support motivation and engagement, including clearer guidance, improved reliability of AR features, and more interactive elements such as challenges, rewards, and social features. Overall, the findings highlight the promise of such tools for supporting physical activity in young people, and provide key suggestions for future development of this app and similar digital interventions.

• This consensus statement provides practical, expert-based recommendations for implementing exercise therapy in pediatric oncology across Europe. Developed within the EU-funded FORTEe project, it offers guidance on staffing, training, medical clearance, safety monitoring, program delivery, and regulatory requirements to help multidisciplinary teams safely integrate exercise into routine childhood cancer care, regardless of local resources.

• The Mainz Resilience Assessment in Childhood Cancer (MRAcc) is a newly developed patient-reported outcome measure designed to assess resilience in children, adolescents, and young adults undergoing cancer treatment. It defines resilience as how well young patients maintain or regain their mental health in relation to the stress they experience during cancer and its treatment. The MRAcc includes age-specific versions for patients aged 5 to 21 years and is designed for longitudinal use throughout active treatment and follow-up.

• This FORTEe-funded study evaluated the use of a motion tracking device to support exercise therapy in children, adolescents, and young adults with cancer. Both patients and healthcare professionals viewed the technology positively, highlighting its real-time feedback, exercise variety, and motivational value. While some technical and practical challenges were identified, the findings suggest that motion tracking technology can effectively complement supervised exercise programs and inform future improvements to enhance engagement and usability in pediatric oncology care.

• This study investigated whether the 6-minute cycling test can be used to assess endurance capacity in children and adolescents with cancer, addressing the need for a simple and feasible assessment in clinical practice. The test showed high feasibility with 93% of 71 patients successfully completing it and was further validated in 46 patients using cardiopulmonary exercise testing. The results demonstrated moderate to strong correlations with established measures of exercise capacity, supporting the test as a valid and practical tool for assessing endurance capacity and for evaluating the effectiveness of training interventions

2025

• The FORTEe trial investigates how personalized exercise programs can improve the health and well-being of children, adolescents, and young adults undergoing cancer treatment. Across ten centers in Europe, 450 participants will take part in a tailored 8–10 week training program focusing on strength, endurance, flexibility, and balance, either in person or remotely via digital tools. By testing this approach in one of the largest studies of its kind, FORTEe aims to deliver solid scientific evidence that exercise can reduce treatment side effects and enhance quality of life. Ultimately, the project seeks to make exercise a standard part of cancer care for young patients worldwide.

• Qualitative methodologies are well suited and have increasingly been used for exploring pediatric cancer patients’ perspectives, but so far, ethical reflections on qualitative research in this specific setting have largely been missing. Vulnerabilities and ethical challenges are best understood as relational, i. e., as emerging within the situated interactions between patients, researchers and research settings. Patients’ disease- and therapy-related burdens, specifics of qualitative methodology, and patients’ status as ‘minors’ (both in terms of development and of generational power relations) can be identified as sources of vulnerability. Patients’ agreement to participate in research in an unsettled life situation, potential psychological burdens arising from communication in the context of a life-threatening illness, and challenges for relationship building and data generation in this setting are discussed as ethical complexities. Recognizing these vulnerabilities and ethical challenges should not lead to an exclusion of pediatric cancer patients from qualitative studies – as this may in turn expose these patients to epistemic injustice.

• Pediatric exercise oncology is an emerging research area with limited qualitative studies to date. This study highlights that both childhood cancer patients and their parents reported overwhelmingly positive experiences with an exercise program, noting benefits for physical and mental well-being. The program served as valuable supportive care and a helpful distraction during hospitalization. Patients particularly appreciated the individualized and flexible approach, offering key insights for effective implementation of exercise therapy in pediatric oncology.

2024

• Regular physical activity is associated with lower adult cancer incidence and mortality, as well as with a lower rate of tumour recurrence. The mechanisms underlying the antitumorigenic effects of exercise are reviewed, including an improvement in cancer immunosurveillance is involved, with different immune cell subtypes stimulated by exercise to infiltrate tumours. There is also evidence that immune cells from blood collected after an exercise bout could be used as adoptive cell therapy for cancer, which is of potential interest in the context of childhood blood malignancies.

• Smartphone applications and other digital health tools are emerging as promising supports for prescribing exercise in healthcare. This study developed a specific augmented reality (AR) app for children and young people aged 9-21 undergoing cancer treatment and established a pilot study protocol. Gathering user experiences, preferences, and suggested improvements is crucial in creating innovative apps like this one, which use algorithms and AR for exercise. Findings from this study will guide the app’s development and inform its application in a long-term paediatric oncology trial.

2023

• Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in paediatric oncology, and therapeutic interventions to reduce this symptom are needed. A systematic review of the literature has shown that physical activity may have the potential to reduce CRF in childhood cancer patients undergoing cancer treatment.

• Regular physical activity (PA) and exercise play an important role in primary and secondary cardiovascular prevention. This is an important consideration in the context of pediatric and adolescent cancer, because survivors of these malignancies are at higher long-term risk of cardiovascular conditions than their age and gender matched controls with no history of cancer in early life. This review discusses some of the main cardiovascular effects of PA/exercise and the mechanisms involved at the multisystem level.

Scientific Background Reading

Neu M et al. (2021). Mental health and health-related quality of life in preschool-aged childhood cancer survivors. Results of the prospective cohort study ikidS-OEVA. Pediatr Blood Cancer. 68(8): e29039.

• Already at preschool age, young childhood cancer survivors (YCCS) may be at increased risk of mental health (MH) problems and impaired health-related quality of life (HrQoL). This could have impacts on subsequent school performance and educational attainment. Follow-up health care for YCCS may include early screening for MH problems and reasons for HrQoL deficits.

Stössel S et al. (2020). Benefits of Exercise Training for Children and Adolescents Undergoing Cancer Treatment: Results From the Randomized Controlled MUCKI Trial. Front Pediatr. 8: Article 243.

• Within one of the first randomized controlled trials, this study provides evidence for a positive effect of combined training in childhood cancer patients (CCPs) during intensive cancer treatment.

Faber J et al. (2018). Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: Data from the German CVSS study. Eur Heart J. 39: 1555-1562.

• This large childhood cancer survivors (CCS) screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature cardiovascular disease (CVD). The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term.